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Experts debate whether kissing is to blame for gonorrhoea spread

The long-held position of sexual health experts is that gonorrhoea is transmitted by the penis, but an Australian researcher is studying the possibility the infection can be spread by kissing.

The debate comes as Australia’s gonorrhoea rates have more than tripled in the past nine years.

At the STI and HIV World Conference in Vancouver on Thursday, Professor Kit Fairley from Monash University will be arguing his case in a debate with Professor Emeritus H. Hunter Handsfield from the University of Washington.

Professor Fairley, who is also the director of the Melbourne Sexual Health Centre, said his five years of research was important given the global prevalence of the infection.

In Australia, gonorrhoea rates have more than tripled between 2008 and 2017 from 36 to 118 notifications per 100,000 people, according to the Australian Institute of Health and Welfare.

“Understanding how it is transmitted is the key to understanding how to control it – if transmission by kissing is a key route of transmission then it is important to investigate new methods of control,” Professor Fairleysaid.

Gonorrhoea is a bacterial infection that can affect the urinary tract in the penis, as well as the throat, cervix, and anus. There are usually only symptoms for gonorrhoea in the penis, which include a pus-like discharge and irritation when urinating. Professor Fairley said this is an important aspect of his argument as those symptoms prompt swift treatment.

“The significance of that is that when transmission occurs people find out about it quite quickly, and so they get treated so there’s not much opportunity to pass it on,” he said.

“The reason the rate of gonorrhoea is so high in men who have sex with men is because the transmission doesn’t always involve the penis, and so you don’t always get symptoms.”

Professor Handsfield, who is an expert on sexually transmitted infections, said the accepted research showed gonorrhoea was transmitted by the penis, and transmission by kissing or saliva during oral sex was “vanishingly rare”.

“All of the available research or basic understanding has been that yes that occurs, but the transmission is less efficient,” he said.

However, Professor Fairley said an example of a gonorrhoea outbreak at a music festival between seven people who all had some form of sexual contact, including kissing, boosted his argument.

“There were six cases of throat gonorrhoea transmitted between them, with the same gonorrhoea type. Not one of those seven people had genital gonorrhoea,” he said.

“I don’t know how it got to six throats if it didn’t get there by kissing.”

Professor Handsfield said Professor Fairley’s research about the importance of oral transmission would probably be proven correct in the future, but not to the degree the Melbourne team says.

“I think they are on to something, I think they are raising questions that deserve careful research that the world needs to take seriously, but I don’t believe their research currently shows oral infection accounts for over half of men having sex with men,” Professor Handsfield said.

Professor Fairley’s argument is being published in The Lancet Infectious Diseases journal on Thursday.

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