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 being on receptive anal sex. Mostly this was because of HIV infection but also the growing rates of more time-honoured sexually transmitted diseases like syphilis, chlamydia and gonorrhoea. 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 gonorrhoea. We discuss this concern in our piece on this STD HERE. But, this new research has increased the level of information that 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 infection 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 longer 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. Without proper medical testing, these symptoms may be mistaken or misdiagnosed as a cold, allergies or a basic sore throat. But this also means 90% of dudes infected with an oral clap infection are essentially asymptomatic. So proper and consistent testing is key!

We have noted many times on this site that condoms are not the perfect protection many gay males think they are. Bacterias like gonorrhoea and chlamydia are not transmitted like viruses. Both of these STDs are able to be transferred through bare skin contact and also 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 completely. They will offer no protection for oral sex, if not used, and zero if some sort of dental damn isn’t used for rimming.

Saliva as a mode of transmission:

The report is very clear. “The throat is a major source of gonorrhoea 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 gonorrhoea infection in the throat and/or anus in the absence of urethral infection. The investigators suggest that transmission is occurring due to kissing, oral sex, rimming, or the use of saliva as lubricant for anal sex”.

They add: “Our data are not consistent with the conventional paradigm of gonorrhoea transmission between men, in which most gonorrhoea transmission is from the urethra to the throat and anus, and vice versa. Instead, our data are consistent with a new paradigm of gonorrhoea 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 gonorrhoea, 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 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 gonorrhoea in the throat, but sex-only was not. The adjusted odds for gonorrhoea 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 compete series of contacts and actions. Rather our sex is researched around one singular activity at a time. This creates difficulties in finding out which activity causes some infections verses 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 with kissing and progress to touching and exploring each others naked bodies. At some point, Joe begins to rim Dale, who, in turn, performs oral sex on Joe. Joe returns the favour before inserting his condom covered penis inside of 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 gonorrhoea is spread.

  1. Saliva is a major mode of gonorrhoea 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 are occurring.
  2. Condoms will not stop the spread of gonorrhoea if kissing, rimming and oral sex are involved.
  3. Condoms should decrease the risk of infection if the only contact is anal sex, and the condom(s) are used each time and correctly.
  4. Kissing is not a new risk factor for gonorrhoea infection…IT ALWAYS HAS BEEN A RISK FACTOR, we just didn’t know it.
  5. Regular testing, and treatment for gonorrhoea and all STDs is paramount.
  6. It is time we change the conversation around safer sex to include risk factors associated with saliva.
  7. PrEP should not be blamed for increases in gonorrhoea 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 make sure that we are being tested for gonorrhoea 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. No one should stop kissing based off of this study, and 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 for reducing the risk due to rimming, oral sex or even kissing.

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

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

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