Download This Paper
Preprints with The Lancet is a collaboration between The Lancet Group of journals and SSRN to facilitate the open sharing of preprints for early engagement, community comment, and collaboration. Preprints available here are not Lancet publications or necessarily under review with a Lancet journal. These preprints are early-stage research papers that have not been peer-reviewed. The usual SSRN checks and a Lancet-specific check for appropriateness and transparency have been applied. The findings should not be used for clinical or public health decision-making or presented without highlighting these facts. For more information, please see the FAQs.
Modelling the Contribution that Different Sexual Practices Involving the Oropharynx and Saliva Have on Neisseria gonorrhoeae Infections at Multiple Anatomical Sites in Men Who Have Sex with Men
24 Pages Posted: 16 Jul 2020
More...Abstract
Background: There is controversy about what sexual practices transmit Neisseria gonorrhoeae in men who have sex with men (MSM). To date, no studies have modelled potential transmission when one sexual practice follows another in the same sexual encounter in transmission. We tested if these sequential practices were necessary to replicate the high proportion of MSM who have more than one anatomical site infected with gonorrhoea (‘multi-site infection’).
Methods: We developed eight compartmental models to test our hypothesis. We examined three possible transmission routes: (1) oral sex followed by anal sex (or vice versa); (2) using saliva as a lubricant for penile-anal sex, and (3) oral sex followed by oral-anal sex (rimming) or vice versa. For comparison, we used a baseline model that did not include any of these three transmission routes. The seven other models added one of the possible transmission routes or combinations of the three of them to the baseline model.
Findings: The baseline model could replicate infection at the single anatomical site but underestimated the multi-site infection. When we added the three transmission routes to the baseline model, oral sex followed by anal sex or vice versa could replicate the prevalence of multi-site infection. The other two transmission routes alone or together could not replicate multi-site infection without the inclusion of oral sex followed by anal sex or vice versa.
Interpretation: Our model suggests sexual practices that involve oral followed by anal sex (or vice versa) may be important for explaining the high proportion of multi-site infection.
Funding Statement: LZ is supported by the National Natural Science Foundation of China (8191101420), Thousand Talents Plan Professorship for Young Scholars (3111500001, and Xi'an Jiaotong University Young Talent Support Program; Xi’an Jiaotong University Basic Research and Profession Grant (xtr022019003). CKF is supported by an Australian National Health and Medical Research Council (NHMRC) Leadership Investigator Grant (GNT1172900). EPFC and DAW are supported by an Australian NHMRC Emerging Leadership Investigator Grant (GNT1172873 and GNT1174555, respectively). JJO is supported by an Australian NHMRC early career fellowship (APP1104781). MWS was supported by the National Natural Science Foundation of China (grant number:11801435 (MS)), China Postdoctoral Science Foundation (grant number 2018M631134), the Fundamental Research Funds for the Central Universities (grant number xjh012019055, xzy032020026), and Natural Science Basic Research Program of Shaanxi Province (Grant number: 2019JQ-187).
Declaration of Interests: The authors declare no conflict of interest.
Keywords: Neisseria gonorrhoeae, transmission, sexual practices, multi-site, saliva, MSM
Suggested Citation: Suggested Citation