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.
Sex Transm Dis. 2017 Oct;44(10):586-592. doi: 10.1097/OLQ.0000000000000661.
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.
男男性行为者（MSM）中的淋病报告病例迅速增加。我们开发了一种模型，以评估漱口液作为淋病控制的新干预措施。
我们建立了淋病奈瑟菌（NG）传播模型，以解释 MSM 中特定解剖部位淋病的流行率。该模型根据现有流行病学和行为数据进行了校准。我们估计了各种性行为对淋病发病率的贡献，并评估了筛查规模扩大和使用漱口液对淋病流行的潜在影响。
我们将模型校准到 MSM 中口咽、肛门和尿道淋病的流行率分别为 8.6%（7.7-9.5%）、8.3%（7.4-9.1%）和 0.20%（0.04-0.35%）。通过接吻进行口对口传播估计占 MSM 中所有淋病新发病例的近四分之三（71.6%[64.4-80.5%]）。将口咽淋病的年度筛查率从目前的 40%大幅提高到 100%，可能仅使 MSM 中的淋病流行率减半。相比之下，使用具有中等疗效的漱口液（每天使用增加 1%清除率）将进一步将相应的流行率降低至 3.1%（2.2-4.4%）、3.8%（2.3-4.9%）和 0.10%（0.06-0.11%），而高疗效的漱口液（每天使用增加 1.5%清除率）可能进一步将淋病流行率减半。如果没有口对口传播，我们就无法复制当前的流行数据。
尽管缺乏经验数据，但我们的模型表明，接吻可能在 MSM 中淋病传播中发挥重要作用。仅通过性传播感染筛查进行控制不太可能对 MSM 中的淋病流行产生重大影响。
