![]() ![]() In contrast, in heterosexuals, penile-vaginal sex occurs in 95% of most recent sexual acts therefore, most sexual acts between heterosexuals in which gonorrhea transmission occurs will lead to symptomatic infections that prompt them to seek treatment ( 9, 10). Studies assessing the most recent sexual acts among MSM show that most have kissed (75%), practiced mutual masturbation (64%), or had oral sex (77%) ( 9) oro-anal sex (25%) and penile-anal sex (35%) are less common ( 9). ![]() Determining the key drivers of the reproductive rate for gonorrhea in MSM involves characterizing transmission between anatomic sites, which requires quantifying the site-specific sexual practices of MSM. This longer duration of infectiousness translates into a higher reproductive rate for gonorrhea in MSM compared with heterosexuals, independent of the number of sexual partners. This behavior creates a scenario in which men with pharyngeal or rectal gonorrhea often go untreated, even if they transmit an infection to the urethra of a sex partner. Most pharyngeal or rectal infections (58%) were not associated with urethral infection ( 7).Īn additional factor favoring the persistence of gonorrhea-infected sites in MSM is their lower rate of partner notification compared with heterosexuals ( 8). Almost all urethral infections were symptomatic (96%), but most pharyngeal and rectal infections were asymptomatic. In a Seattle clinic, the proportion of MSM with pharyngeal gonorrhea was 6.5%, rectal gonorrhea 9.7%, and urethral gonorrhea 5.5% ( 7). In MSM, 3 sites are commonly infected: pharynx, rectum, and urethra ( 7). About half of women are asymptomatic, and thus they take longer to seek healthcare than men ( 5, 6). Most heterosexual men with urethral infection become symptomatic and quickly seek healthcare (after a few days) ( 5). In heterosexuals, the primary sites of gonorrheal infection are the urethra in men and cervix in women ( 4). We suggest that specific sexual practices of MSM result in them having a high prevalence of asymptomatic infection in particular anatomic sites and that these infections are the primary drivers of transmission ( 3). However, reducing prevalence requires understanding why gonorrhea is so common in MSM. In response, the Centers for Disease Control and Prevention has recommended reducing the prevalence of gonorrhea as a key strategy to mitigate against antimicriobial resistance ( 2). Gonorrhea is of particular concern because rising rates will increase the probability of antimicrobial drug resistance ( 2). The rates of sexually transmitted infections are rising rapidly in men who have sex with men (MSM) ( 1). ![]()
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