An estimate of the proportion of symptomatic gonococcal, chlamydial and non-gonococcal non-chlamydial urethritis attributable to oral sex among men who have sex with men: a case-control study.
Open accessAbstract
BACKGROUND: Sexually transmitted infections (STIs) of the pharynx are common among men who have sex with men (MSM); the degree to which these infections are transmitted through oral sex is unknown. METHODS: We conducted a case-control study of MSM attending Public Health-Seattle & King County STD Clinic between 2001 and 2013 to estimate the proportion of symptomatic urethritis cases attributable to oral sex using two methods. First, we categorised men into the following mutually exclusive behavioural categories based on their self-reported sexual history in the previous 60 days: (1) only received oral sex (IOS); (2) 100% condom usage with insertive anal sex plus oral sex (PIAI); (3) inconsistent condom usage with anal sex (UIAI); and (4) no sex. We then determined the proportion of cases in which men reported the oropharynx as their only urethral exposure (IOS and PIAI). Second, we calculated the population attributable risk per cent (PAR%) associated with oral sex using Mantel-Haenszel OR estimates. RESULTS: Based on our behavioural categorisation method, men reported the oropharynx as their only urethral exposure in the past 60 days in 27.5% of gonococcal urethritis, 31.4% of chlamydial urethritis and 35.9% non-gonococcal, non-chlamydial urethritis (NGNCU) cases. The PAR%s for symptomatic gonococcal urethritis, chlamydial urethritis and NGNCU attributed to oropharyngeal exposure were 33.8%, 2.7% and 27.1%, respectively. CONCLUSIONS: The pharynx is an important source of gonococcal transmission, and may be important in the transmission of chlamydia and other, unidentified pathogens that cause urethritis. Efforts to increase pharyngeal gonorrhoea screening among MSM could diminish STI transmission.
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Pharyngeal infections with gonorrhea or chlamydia might be a principal source of urethral infections.
“Pharyngeal infections with gonorrhea or chlamydia might be a principal source of urethral infections (209–211).”
From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [209]
The Conclusions call the pharynx an important source of gonococcal transmission and say it may be important for chlamydia transmission. But the Discussion estimates that oral sex accounted for 33.8% of symptomatic gonococcal urethritis versus only 2.7% of symptomatic chlamydial urethritis among MSM. The paper therefore does not support describing pharyngeal chlamydia as a principal source of urethral infection. (LLM, conf=0.86)
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Self-citationAssociation ofMycoplasma genitaliumwith Nongonococcal Urethritis in Heterosexual Men
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- Authors
- Barbee, L. A., Khosropour, C. M., Dombrowski, J. C., Manhart, L. E., & Golden, M. R.
- Affiliations
- Public Health – Seattle & King County (US)
- University of Washington (US)
- Corresponding author
- Barbee, Lindley A
- Venue
- Sexually Transmitted Infections
- Publisher
- BMJ
- Published
- 2015-08-21
- Volume
- 92
- Issue
- 2
- Pages
- 155-160
- ISSN
- 0007-134X (ISSN-L)
- 1368-4973
- 1472-3263
- PMC
- PMC4861816
- OpenAlex
- W1899257082
- Cited by
- 72
- References
- 15
- Citations by year
- 2025: 3 · 2024: 4 · 2023: 3 · 2022: 6 · 2021: 9 · 2020: 13 · 2019: 9 · 2018: 10 · 2017: 10 · 2016: 4 · 2015: 1
- FWCI
- 7.02
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Sexually Transmitted Infections (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- University of Washington (P30 AI027757, AI027757)
- National Institutes of Health (AI-027757)
- Center for AIDS Research, University of Washington (P30 AI027757, AI 027757)
- National Heart, Lung, and Blood Institute (AI027757)
- National Institute of Mental Health (K23MH090923)
- National Institute of Allergy and Infectious Diseases (AI 027757, T32 AI 07140, K23 AI11523791, K23AI113185, T32AI007140, P30AI027757)
- National Institute of Child Health and Human Development (AI027757)
- Topics
- Life Sciences › Immunology and Microbiology › Microbiology › Reproductive tract infections research
- Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
- Social Sciences › General Social Sciences › HIV, TB, and STIs Epidemiology
- Keywords
- oral sex, men who have sex with men, gonococcal urethritis, chlamydial urethritis, pharyngeal gonorrhea, condom use, anal sex, population attributable risk
- MeSH terms
- Adult, Chlamydia Infections, Gonorrhea, Humans, Male, Pharyngeal Diseases, Pharynx, Sexual Behavior, Sexual Partners, United States, Urethra, Urethritis, Sexually Transmitted Diseases, Bacterial, Prevalence, Case-Control Studies, Homosexuality, Male
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