According to an Australian study, pharynx plays a central role in the transmission of gonorrhea among gay men, bisexuals and other men who have sex with men (MSM). The study, recently published in the journal Sexually Transmitted Infections, found a high prevalence of pharyngeal gonorrhea and / or year in the absence of urethral infection.

Gonorrhea is a sexually transmitted infection caused by the bacterium Neisseria gonorrhoeae. This infection mainly affects mucous membranes of the genital tract and urinary tract causing pain and secretions in the urethra in men and vaginal and pelvic pain in women (although a high percentage of people may not show symptoms). It can also cause an infection in the anorectal tract, with proctitis being the most characteristic syndrome.

The current paradigm of transmission of gonorrhea among gay men, bisexuals and other MSM states that most transmissions occur from and into the urethra (for example, from urethra to urine, from year to urethra, from urethra to pharynx or from pharynx to urethra), while transmission without involvement of the urethra (from pharynx to pharynx or pharynx to a year) is considered unusual. Therefore, prevention strategies have focused on the use of condoms during anal sex. However, in recent years gonorrhea rates among gay men, bisexual men and other MSM have been increasing.

Previous studies also conducted in Australia found that men who practice receptive anal sex whose couples with gonococcal pharyngitis use saliva as a lubricant have a probability more than twice as large as having rectal gonorrhea. However, given the size of the sample and the design, more studies were evaluated in greater depth if the current medical paradigm regarding the transmission of gonorrhea remains in force. For this, a team of researchers from the University of Monash (Melbourne, Australia) designed a study for which they had the data of 60 couples (120 men) where at least one partner had gonorrhea.

Participants were attended between March 2015 and June 2017 at a Melbourne sexual health clinic and had a median age of 30 years. Nucleic acid amplification (NAAT) tests performed a screening of gonorrhea in pharynx, anus and urethra.

In total, 85 men had gonorrhea infection. The most common location was in the pharynx, followed by the anorectal location and, lastly, in the urethra. A large number of participants presented gonorrhea in different locations and 10 of them in the 3 locations. A total of 25 men had urethral gonorrhea, of which 72% had a partner with gonorrhea in the pharynx and 76% had a partner with anal gonorrhea

Consistent use of the condom for insertive and receptive anal sex was reported by 8% and 10% of participants, respectively. Another 10% of men reported that they had not practiced insertive anal sex recently and another 11% stated they did not have receptive anal sex.

Anorectal gonorrhea was diagnosed in 48 participants. Of those less than half (52%) had a partner with pharyngeal gonorrhea. When the researchers excluded men with anorectal and urethral gonorrhea, 34% of men with anorectal gonorrhea had a companion with gonorrhea in the pharynx. When men with anal gonorrhea were excluded whose partner had urethral gonorrhea, 48% had a partner with gonorrhea in the pharynx.

Of the 31 couples where any of the men had anorectal gonorrhea (but none had urethral infection), there were 15 couples (45%) where both men had anorectal infection. Couples in which the man had an infection in the pharynx were excluded, leaving eight couples, including one in which both men had anorectal infection.

The authors of the present study claim that the moderately high prevalence of pharyngeal gonorrhea among couples with anal infection, even after excluding men with urethral infection, is not compatible with the current paradigm that states that the urethra is the main source of Gonorrhea infections in the pharynx and the anal canal.

The researchers also stressed that when a man presented pharyngeal gonorrhea, there was a high probability that both members of the couple had the infection at this location. Therefore, they suggest that in this case the transmission was produced directly from pharynx to pharynx through kisses.

According to these results, the researchers conclude that pharynx is an important source of transmission between gay men, bisexuals and other MSM producing transmission through kisses, oral sex, rimming (buco-anal sex) or use of saliva like lubricant.

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