Associations between oral sex practices and frequent mouthwash use in heterosexuals: a cross-sectional survey in Melbourne, Australia

Objective This study aimed to determine the frequency of mouthwash use and its association to oral sex practice in heterosexuals. Design A cross-sectional study. Setting Data obtained from a sexual health clinic in Victoria, Australia, between March 2019 and April 2019. Participants Heterosexual men and women attending the sexual health clinic answered a survey using computer-assisted self-interview. Primary and secondary outcome measures Univariable and multivariable logistic regression were performed to examine the association between frequent mouthwash use (ie, daily or weekly mouthwash use) and oral sex practices (including tongue kissing, fellatio, cunnilingus and insertive rimming). Results There were 681 heterosexuals included in the analysis: 315 (46.3%) men and 366 (53.7%) women. Of participants, 302 (44.3%) used mouthwash frequently, 173 (25.4%) used mouthwash infrequently and 206 (30.2%) never used mouthwash. There was no significant difference in the proportion of frequent mouthwash users between men and women (46.4% of men vs 42.6% of women; p=0.329). The proportion of frequent mouthwash users increased with increasing age groups (39.3% in ≤24 years, 45.2% in 25–34 years and 52.8% in ≥35 years or older; ptrend=0.039) with those aged ≥35 years having a 1.80 times (95% CI: 1.12 to 2.89) higher odds of being a frequent mouthwash user than those aged ≤24 years. There were no significant associations between frequent mouthwash users had sexually transmitted infection (STI) risk after adjusting for age and country of birth. Conclusion Older heterosexuals are more likely to use mouthwash. Given the high proportion and associations of mouthwash use in heterosexuals, future investigations related to oral STIs in this group should include mouthwash use.

[1]  J. Hocking,et al.  Incidence and duration of incident oropharyngeal gonorrhoea and chlamydia infections among men who have sex with men: prospective cohort study , 2020, Sexually Transmitted Infections.

[2]  J. Hocking,et al.  An open-label, parallel-group, randomised controlled trial of antiseptic mouthwash versus antibiotics for oropharyngeal gonorrhoea treatment (OMEGA2) , 2020, Scientific Reports.

[3]  J. Hocking,et al.  Duration of gargling and rinsing among frequent mouthwash users: a cross-sectional study , 2020, BMJ Open.

[4]  G. Farnham,et al.  Effects of Chlorhexidine mouthwash on the oral microbiome , 2020, Scientific Reports.

[5]  R. Guy,et al.  Sexual practices of female sex workers in Melbourne, Australia: an anonymous cross-sectional questionnaire study in 2017-18. , 2020, Sexual health.

[6]  Hongyu Miao,et al.  HIV Pre-Exposure Prophylaxis and Increased Incidence of Sexually Transmitted Infections in the United States. , 2020, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[7]  L. van der Hoek,et al.  Diverging trends in incidence of HIV versus other sexually transmitted infections in HIV-negative men who have sex with men (MSM) in Amsterdam. , 2019, AIDS.

[8]  L. Vodstrcil,et al.  Oropharyngeal and genital gonorrhoea infections among women and heterosexual men reporting sexual contact with partners with gonorrhoea: implication for oropharyngeal testing of heterosexual gonorrhoea contacts. , 2019, Sexually transmitted diseases.

[9]  J. Hocking,et al.  Models of gonorrhoea transmission from the mouth and saliva. , 2019, The Lancet. Infectious diseases.

[10]  C. Fairley,et al.  The role of saliva in gonorrhoea and chlamydia transmission to extragenital sites among men who have sex with men: new insights into transmission , 2019, Journal of the International AIDS Society.

[11]  C. Fairley,et al.  Risk factors for urethral gonorrhoea infection among heterosexual males in Melbourne, Australia: 2007-17. , 2019, Sexual health.

[12]  C. Fairley,et al.  Epidemiology and prevention of sexually transmitted infections in men who have sex with men at risk of HIV. , 2019, The lancet. HIV.

[13]  C. Fairley,et al.  Prevalence of genital and oropharyngeal chlamydia and gonorrhoea among female sex workers in Melbourne, Australia, 2015–2017: need for oropharyngeal testing , 2019, Sexually Transmitted Infections.

[14]  C. Fairley,et al.  Translating mouthwash use for gonorrhoea prevention into a public health campaign: identifying current knowledge and research gaps. , 2019, Sexual health.

[15]  J. Hocking,et al.  Kissing may be an important and neglected risk factor for oropharyngeal gonorrhoea: a cross-sectional study in men who have sex with men , 2019, Sexually Transmitted Infections.

[16]  J. Hocking,et al.  Evidence for a new paradigm of gonorrhoea transmission: cross-sectional analysis of Neisseria gonorrhoeae infections by anatomical site in both partners in 60 male couples , 2019, Sexually Transmitted Infections.

[17]  Brian L. Price,et al.  Association of HIV Preexposure Prophylaxis With Incidence of Sexually Transmitted Infections Among Individuals at High Risk of HIV Infection , 2019, JAMA.

[18]  K. McBride Heterosexual Women’s Anal Sex Attitudes and Motivations: A Focus Group Study , 2019, Journal of sex research.

[19]  Febrina Rahmayanti,et al.  Oral sexual behavior and oral hygiene effects on the syphilis incidence in MSM population , 2019 .

[20]  A. Spychała,et al.  The development of mouthwashes without anti-gonococcal activity for controlled clinical trials: an in vitro study , 2019, F1000Research.

[21]  R. Guy,et al.  Gonorrhoea gone wild: rising incidence of gonorrhoea and associated risk factors among gay and bisexual men attending Australian sexual health clinics. , 2019, Sexual health.

[22]  C. Fairley,et al.  Only recent sexual partners contribute to oropharyngeal gonorrhoea positivity: the number of sexual partners over different time periods as an indicator of gonorrhoea and chlamydia infection duration among men who have sex with men. , 2018, Sexual health.

[23]  J. Carlin,et al.  Factors associated with declining to report the number of sexual partners using computer-assisted self-interviewing: a cross-sectional study among individuals attending a sexual health centre in Melbourne, Australia. , 2018, Sexual health.

[24]  A. Nardone,et al.  100 years of STIs in the UK: a review of national surveillance data , 2018, Sexually Transmitted Infections.

[25]  C. Fairley,et al.  New thinking on gonorrhoea control in MSM: are antiseptic mouthwashes the answer? , 2018, Current opinion in infectious diseases.

[26]  C. Fairley,et al.  Trends in gonorrhoea infection and overseas sexual contacts among females attending a sexual health centre in Melbourne, Australia, 2008-2015. , 2018, Communicable diseases intelligence.

[27]  C. Fairley,et al.  Associations between oral sex practices and frequent mouthwash use in men who have sex with men: implications for gonorrhoea prevention. , 2018, Sexual health.

[28]  C. Fairley,et al.  Self-Reported Use of Mouthwash and Pharyngeal Gonorrhoea Detection by Nucleic Acid Amplification Test , 2017, Sexually transmitted diseases.

[29]  M. Gambhir,et al.  Neisseria gonorrhoeae Transmission Among Men Who Have Sex With Men: An Anatomical Site-Specific Mathematical Model Evaluating the Potential Preventive Impact of Mouthwash , 2017, Sexually transmitted diseases.

[30]  J. Hocking,et al.  Sexually Transmitted Infections in Melbourne, Australia from 1918 to 2016: nearly a century of data. , 2017, Communicable diseases intelligence quarterly report.

[31]  C. Fairley,et al.  Could antiseptic mouthwash inhibit pharyngeal Neisseria gonorrhoeae? Further research is required , 2017, Sexually Transmitted Infections.

[32]  J. Kaldor,et al.  A multicentre double-blind randomised controlled trial evaluating the efficacy of daily use of antibacterial mouthwash against oropharyngeal gonorrhoea among men who have sex with men: the OMEGA (Oral Mouthwash use to Eradicate GonorrhoeA) study protocol , 2017, BMC Infectious Diseases.

[33]  C. Fairley,et al.  Increased Detection of Pharyngeal and Rectal Gonorrhea in Men Who Have Sex With Men After Transition From Culture To Nucleic Acid Amplification Testing , 2017, Sexually transmitted diseases.

[34]  J. Hocking,et al.  Frequent Transmission of Gonorrhea in Men Who Have Sex with Men , 2017, Emerging infectious diseases.

[35]  C. Fairley,et al.  Antiseptic mouthwash against pharyngeal Neisseria gonorrhoeae: a randomised controlled trial and an in vitro study , 2016, Sexually Transmitted Infections.

[36]  Richard Gray,et al.  HIV, viral hepatitis and sexually transmissible infections in Australia , 2016 .

[37]  W. Crielaard,et al.  The Effect of Fixed Orthodontic Appliances and Fluoride Mouthwash on the Oral Microbiome of Adolescents – A Randomized Controlled Clinical Trial , 2015, PloS one.

[38]  C. Hung,et al.  Unexpectedly high prevalence of Treponema pallidum infection in the oral cavity of human immunodeficiency virus-infected patients with early syphilis who had engaged in unprotected sex practices. , 2015, Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases.

[39]  J. Hocking,et al.  Oral and anal sex are key to sustaining gonorrhoea at endemic levels in MSM populations: a mathematical model , 2015, Sexually Transmitted Infections.

[40]  E. Sundin,et al.  Use of different mouthrinses in an adult Swedish population. , 2012, Swedish dental journal.

[41]  A. Spencer,et al.  Dental attendance patterns and oral health status , 2011 .

[42]  J. Hocking,et al.  Computer Assisted Self Interviewing in a Sexual Health Clinic as Part of Routine Clinical Care; Impact on Service and Patient and Clinician Views , 2011, PloS one.

[43]  T. Macfarlane,et al.  Mouthwash Use in General Population: Results from Adult Dental Health Survey in Grampian, Scotland , 2010, Journal of oral & maxillofacial research.

[44]  M. Rekart,et al.  Sex-work harm reduction , 2005, The Lancet.