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Pictured above: Not all types of kissing feature the exchange of saliva. From https://twitter.com/CDCSTD/status/728408953818775552

Some pretty depressing news hit a couple of months ago, when headlines proclaimed kissing could allow gonorrhea to jump from one person to another.

We already knew gonorrhea could be transmitted during oral sex — a terrible fact, given that most people don’t use condoms or dental dams during oral sex. And we knew that oral gonorrhea is more likely to develop drug resistance, which could be helping to drive the possibly untreatable gonorrhea of the near future.

Mouth-to-mouth kissing could be transmitting gonorrhea right under our noses — literally.

Gonorrhea is most famous as an infection of the cervix or the urethra. But the bacteria that cause gonorrhea can thrive in other warm, moist areas of your body — not just the reproductive tract, but also in the mouth, throat, eyes, and anus. Unprotected oral sex can allow those bacteria to travel in either direction between one person’s genitals and another person’s throat.

But what about mouth-to-mouth kissing, like French kissing? Is that enough to allow these bacteria to hitch a ride from one mouth to another? Previous research, using a mathematical model, estimated that mouth-to-mouth contact might be a significant — and underappreciated — mode of gonorrhea transmission. But that was a mathematical model, a sophisticated equation using what we know about a population’s gonorrhea prevalence and sexual behavior to estimate how frequently the infection is transmitted from one mouth to another.

Kissing and Gonorrhea

In May, Australian researchers published a study that put this mathematical model to a real-world test, making them the first to investigate mouth-to-mouth gonorrhea transmission in a population of actual humans. They surveyed 3,677 Australian gay and bisexual men about how many male partners they had in the previous three months. (Three months wasn’t an arbitrary chunk of time — it’s the likely maximum duration of untreated oral gonorrhea.)

They asked respondents to give them numbers for “kissing-only” partners, “sex-only” partners, and “kissing-with-sex” partners. After unraveling all the combinations and pairing them with each subject’s oral-gonorrhea test results, they found that kissing was, indeed, associated with oral gonorrhea — while sex without kissing was not.

The men surveyed were 46% more likely to have oral gonorrhea if they had four or more kissing-only partners in the past three months, and 81% more likely to have oral gonorrhea if they had at least four kissing-with-sex partners (compared to men who had zero or one partner in those categories). Men with sex-only partners, and who had not kissed anyone during those three months, were half as likely to test positive for oral gonorrhea compared with other study participants.

Kissing Abstinence? Safe Kissing?

Gonorrhea is on the rise, and the fact that gonorrhea is becoming almost completely drug-resistant makes this epidemic especially alarming. It’s time to focus on oral gonorrhea, which has generally been ignored as unimportant. When it comes to gonorrhea prevention, most people recognize the importance of condom use for vaginal or anal intercourse, but barriers are often dismissed for oral sex — and kissing really hasn’t been on anyone’s radar until recently.

Pictured right: Hands. From Plannedparenthood.org

So what’s the take-home message? Do we need to practice “safe kissing,” making out through dental dams or plastic wrap? Or should we take it even further, and abstain from kissing until marriage? These solutions seem ridiculous, but if gonorrhea is transmitted by kissing, and if its increasing resistance to antibiotics is a problem, what should we recommend?

The first step for any sexually active person is to know their STD status, and to know their partner’s STD status. Testing for oral infections isn’t standard when providing STD tests, so you can ask your health-care provider if an oral swab can be included in your screening. Second, barrier methods like condoms and dental dams can protect people during most types of sexual activity. Condoms are very effective in preventing the transmission of gonorrhea, whether they’re used for oral, vaginal, or anal sex, or on shared sex toys. Dental dams can also help prevent gonorrhea transmission during oral sex and anal-oral sex (aka anilingus or “rimming”).

But beyond regular STD testing and barrier methods, what else can you do to prevent gonorrhea? One study is investigating mouthwash as a preventative, and results should be available soonAn earlier study of men with oral gonorrhea found that 84% of them still tested positive for infection after gargling with saline for a full minute, while only 52% were still positive after gargling for a minute with an antiseptic mouthwash. However, those results only held true for the surface of the throat — the bacteria that cause gonorrhea were more likely to persist deeper into the throat. Whether that’s good enough to prevent transmission via kissing is a question for future research to answer.

Ultimately, the hope is that a gonorrhea vaccine hits the market. If people could be immune to gonorrhea, a lot of problems would be solved — the most significant of those being the problem of antibiotic resistance. Just two years ago, the World Health Organization used the word “impossible” when describing treatment of antibiotic-resistant gonorrhea, referring to documented cases of gonorrhea that were “untreatable by all known antibiotics.” If these drug-resistant strains become more prevalent, we could see a return to the pre-antibiotic era of gonorrhea, when the disease was a major cause of infertility.

You can pick up condoms or be tested for gonorrhea at any Planned Parenthood health center.

Tags: gay, gonorrhea, bisexual, kissing, condom, oral sex, vaccines, STD Awareness, STD, sexual health, dental dams

About Anna C.

Anna first volunteered for Planned Parenthood as a high school student in the 1990s. Since then, she has received a bachelor’s degree from UC Berkeley and a master's degree in epidemiology from the University of Arizona. As an ode to her fascination with microbes, she writes the monthly STD Awareness series, as well as other pieces focusing on health and medicine.


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