Kissing and rimming and gonorrhoea

The 21st of May, 2019, brought a new twist to the concept of “safer sex” for many gay males. Beginning in the late 1980s – early 1990s and progressing to today, our community has evolved from discussing safe sex (rimming, oral and anal sex with condoms EVERY TIME) to safer sex (anal sex with condoms EVERY TIME). The focus had always been on receptive anal sex. This was primarily because of HIV infection and the growing rates of more time-honored sexually transmitted diseases like syphilis, chlamydia, and gonorrhea. The traditional thinking at the time was that condoms would and could prevent infection from all of these STDs. We now know that this is not true. Further, life is more complex with the introduction of PrEP.

A new study, released and reported on by AIDSMAP, brings to light the issue of saliva (spit) as a mode of transmission for gonorrhea. We discuss this concern in our piece on this STD HERE. But, this new research has increased the level of information we have and new ways our community needs to think about sex and “safer sex” as a whole.

What is Gonorrhoea?

Also spelled GONORRHEA is a bacterial infection transmitted via some form of unprotected sexual intercourse or contact. The effects vary: the disease may take hold in your mouth, throat, urethra, or anus, with symptoms appearing between 2-10 days after infection, with some studies suggesting a possible more extended incubation period lasting up to 30 days.

Oral sex is known to produce more minor symptoms in the . . . let’s say, “dick suckers” throat, associated more with soreness for the estimated 10% of the population that will produce symptoms at all. These symptoms may be mistaken or misdiagnosed without proper medical testing, such as a cold, allergies, or a raw sore throat. But this also means 90% of dudes infected with an oral clap infection are asymptomatic. So, proper and consistent testing is critical!

On this site, we have noted many times that condoms are not the perfect protection many gay males think they are. Bacterias like gonorrhea and chlamydia are not transmitted like viruses, and both STDs can be transferred through bare skin contact and SALIVA. The HIV virus is not transmitted like this. This means that it is much easier to contract this pair, and condoms may reduce the risk of infection but not eliminate it. They offer no protection for oral sex if not used and zero if some dental damn isn’t used for rimming.

Saliva as a mode of transmission:

The report is unequivocal. “The throat is a major source of gonorrhea transmission among men who have sex with men (MSM), according to Australian research published in Sexually Transmitted Infections. The study involved 60 male couples and showed a high prevalence of gonorrhea infection in the throat and/or anus in the absence of urethral infection. The investigators suggest that transmission occurs due to kissing, oral sex, rimming, or using saliva as a lubricant for anal sex”.

They add: “Our data are not consistent with the conventional paradigm of gonorrhea transmission between men, in which most gonorrhea transmission is from the urethra to the throat and anus, and vice versa. Instead, our data are consistent with a new paradigm of gonorrhea transmission in which the throat plays a central role in transmission to the partner’s throat, anus, and urethra, presumably through infected saliva”.

The investigators also highlight that when one man in a couple had throat gonorrhea, there was a high chance that both men in the couple would have the infection at this site. They, therefore, suggest that transmission was occurring directly from throat to throat via kissing.

A second study from the same research group provides further evidence to support the hypothesis. A total of 3677 MSM attending the Melbourne clinic completed surveys, reporting on the numbers of sexual partners in the past three months:

mean 4.3 partners who they had kissed but not had oral or anal sex with
mean 5.0 partners they had kissed and had sex with
mean 1.4 partners they had had oral or anal sex with but not kissed.

Kissing-only and kissing-with-sex were associated with gonorrhea in the throat, but sex-only was not. The adjusted odds for gonorrhea in the throat were 1.46-fold for men with more than four kissing-only partners and 1.81-fold for men with more than four kissing-with-sex partners.

What does this mean?

Gay male sex is complex, but unfortunately, it is not studied as a complete series of contacts and actions. Instead, our sex is researched around one singular activity at a time, which creates difficulties in finding out which activity causes some infections versus others.

For the grown folks, here is an example regarding saliva.

Joe and Dale meet to have sex. Joe is a total top, and Dale is a vers/bottom. Joe and Dale begin kissing and progress to touching and exploring each other’s naked bodies. At some point, Joe starts to rim Dale, who, in turn, performs oral sex on Joe. Joe returns the favor before inserting his condom-covered penis inside Dale’s rectum.

Traditionally, the above activities would be considered very safe. But now, think of the large amounts of saliva and bare physical contact Joe and Dale had. This is how oral, penile, and rectal gonorrhea is spread.

Saliva is a significant mode of gonorrhea infection. Spit, when used during rimming, as lubrication for anal sex, exchanged during kissing, and even during oral sex, is the most likely way oral, anal, and penile infections occur.
Condoms will not stop the spread of gonorrhea if kissing, rimming, and oral sex are involved.
Condoms should decrease the risk of infection if the only contact is anal sex and the condom(s) are used each time correctly.
Kissing is not a new risk factor for gonorrhea infection…IT ALWAYS HAS BEEN A RISK FACTOR; we didn’t know it.
Regular testing and treatment for gonorrhea and all STDs is paramount.
It is time we change the conversation around safer sex to include risk factors associated with saliva.
PrEP should not be blamed for increases in gonorrhea infections.

What should you do?

The first thing is not to freak out. This is new information, but the facts and risks are not new. The best thing we can all do is ensure that we are being tested for gonorrhea infection and, if positive, take the treatment as prescribed.

Touching, kissing, and sex have always been easy ways to transmit everything from viruses to the common cold. Based on this study, no one should stop kissing; we doubt most of you will. But you should stop using spit as lubrication for anal sex. SPIT IS NOT LUBE. This should decrease the risk of rectal infection from saliva. But this will do nothing to reduce the risk due to rimming, oral sex, or even kissing.

The study authors conclude, “Public health messaging may need to discuss the risk of gonorrhea transmission during sexual activity that involves saliva. Also, a novel gonorrhea prevention strategy currently under investigation is using antiseptic mouthwash to reduce the prevalence of throat gonorrhea.”

The usage of antiseptic mouthwash to stop the spread of gonorrhea was first discussed back in 2017, with mixed reviews. There has not been enough research to conclude that its usage will definitely prevent the spread of gonorrhea, but there is enough to suggest that using it won’t hurt. And you will have fresher breath.