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Sex Transm Dis. 2017 Oct;44(10):586-592. doi: 10.1097/OLQ.0000000000000661.

Neisseria gonorrhoeae Transmission Among Men Who Have Sex With Men: An Anatomical Site-Specific Mathematical Model Evaluating the Potential Preventive Impact of Mouthwash.

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From the *Melbourne Sexual Health Centre; †Central Clinical School; ‡School of Public Health and Preventive Medicine, Faculty of Medicine, Monash University, Melbourne, Australia; §Research Centre for Public Health, Tsinghua University, Beijing, China; ¶Kirby Institute, UNSW Australia; ∥Marie Bashir Institute for Infectious Diseases & Biosecurity and Sydney Medical School-Westmead, University of Sydney, Sydney; **Western Sydney Sexual Health Centre, Western Sydney Local Health District, Parramatta; and ††Melbourne School of Population and Global Health, Melbourne University, Melbourne, Australia.



Gonorrhoea notifications are rapidly rising in men who have sex with men (MSM). We developed a model to assess mouthwash as a novel intervention for gonorrhoea control.


We developed a model of Neisseria gonorrhoeae (NG) transmission to explain anatomic site-specific prevalence of gonorrhoea among MSM. The model was calibrated to available epidemiological and behavioral data. We estimated the contribution of various sexual acts to gonorrhoea incidence and evaluate the potential impacts of screening scale-up and utilization of mouthwash on the gonorrhoea epidemic.


We calibrated the model to prevalence of oropharyngeal, anal, and urethral gonorrhoea of 8.6% (7.7-9.5%), 8.3% (7.4-9.1%), and 0.20% (0.04-0.35%), respectively, among MSM. Oropharynx to oropharynx transmission through kissing is estimated to account for nearly three quarters of all incident cases (71.6% [64.4-80.5%]) of gonorrhoea in MSM. Substantially increasing annual oropharynx screening for gonorrhoea from the current 40% to 100% may only halve the prevalence of gonorrhoea in MSM. In contrast, the use of mouthwash with moderate efficacy (additional 1% clearance per daily use) would further reduce the corresponding prevalence rates to 3.1% (2.2-4.4%), 3.8% (2.3-4.9%), and 0.10% (0.06-0.11%), and a high-efficacy mouthwash (additional 1.5% clearance per daily use) may further halve the gonorrhoea prevalence. Without oropharynx to oropharynx transmission, we could not replicate current prevalence data.


Despite a dearth of empirical data, our model suggests that kissing could potentially play an important role in NG transmission among MSM. Control through sexually transmitted infection screening alone is unlikely to have a substantial impact on the gonorrhoea epidemic in MSM.

[Indexed for MEDLINE]

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