On day 16, P3 tested positive for oropharyngeal gonorrhea and negative for urogenital gonorrhea. On day 0, P1 had tongue kissed P3 (female) and had tongue kissed and had reciprocal orogenital sex (without condoms) and penovaginal sex (without condoms) with P2. These 4 other male sexual partners subsequently tested negative for gonorrhea however, we were not able to confirm what anatomic sites were tested. Between the previous negative test and day 0, P1 had sex with 4 men besides their primary male sexual partner (P2) ( Figure). P1’s most recent negative test for gonorrhea was 5 months prior. Though asymptomatic, P1 tested positive for oropharyngeal gonorrhea and negative for urogenital gonorrhea.
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On day 10, the index patient (participant 1, nonbinary gender, assigned female sex at birth) sought screening for sexually transmitted infections at Melbourne Sexual Health Centre. FPU, first-pass urine HVS, high vaginal swab NG-MAST, N. Neisseria gonorrhoeae diagnoses among participants of a sexual network, Australia, 2018. No participant reported symptoms of gonorrhea, and none used antimicrobial drugs during the relevant period.įigure. Recalled accounts of sexual activity were consistent between participants. We performed whole-genome sequencing and bioinformatic analyses on available samples ( Appendix). We tested for Neisseria gonorrhoeae infection by nucleic acid amplification with the Aptima Combo 2 assay and confirmed by the Aptima GC assay (Gen-Probe, ). We describe the timing of events with respect to day 0, the day of a music festival during which most sexual activity occurred. Participants independently provided accounts of their sexual activity to permit interparticipant verification. After patients consented to take part in our study, they contacted their sexual partners, who then each consented and were interviewed. The index case was identified during routine patient care at Melbourne Sexual Health Centre (Carlton, Victoria, Australia). We describe a sexual network of 1 nonbinary, 2 male, and 4 female participants who were tested for gonorrhea at genital and oropharyngeal sites in early 2018 to explore gonorrhea transmission dynamics.Įthics approval was obtained from the Alfred Hospital Ethics Committee, Melbourne, Australia (project no. However, investigating whether kissing can lead to gonorrhea transmission has been difficult because kissing often occurs concurrently with other sexual acts ( 11). To address this epidemiologic conundrum, we previously described a paradigm of gonorrhea transmission in which oropharyngeal gonorrhea can be acquired from a partner’s oropharynx during tongue kissing ( 8), as originally proposed in the 1970s and 1980s ( 9, 10). Thus, infected penises are unlikely to be the source to explain the observed high prevalence of oropharyngeal gonorrhea ( 6, 7). However, male urethral gonorrhea is usually symptomatic ( 2– 4), prompting men to seek treatment soon after symptoms appear ( 5), resulting in short duration of infectivity and low point prevalence.
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Oropharyngeal gonorrhea is considered to be acquired primarily from an infected penis during oral sex ( 1).