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Understanding risk factors for oropharyngeal gonorrhoea among sex workers attending sexual health clinics in two Australian cities: a mixed methods study
Tiffany R Phillips;
Christopher K Fairley;
Kate Maddaford;
Anna McNulty;
Basil Donovan;
Rebecca Guy;
Ruthy McIver;
Rebecca Wigan;
Rick Varma;
Jason J Ong;
Denton Callander;
Gabrielle Skelsey;
Mish Pony;
Dylan O'Hara;
Jade E Bilardi;
Eric PF Chow
ABSTRACT
Background:
The risk factors for oropharyngeal gonorrhoea have not been examined in sex workers, despite the increasing prevalence of gonorrhoea infection.
Objective:
This study aimed to determine the risk factors for oropharyngeal gonorrhoea in female and gender diverse sex workers (SWs) (including cisgender and transgender women) and gender diverse sex workers (including non-binary, gender fluid or those with a different identity), and examine kissing, oral sex, and mouthwash practices with clients.
Methods:
This mixed methods case-control study was conducted from 2018-2020 at two sexual health clinics in Melbourne and Sydney. We recruited 83 SWs diagnosed with oropharyngeal gonorrhoea (cases) and 581 SWs without (controls). Semi-structured interviews with 19 SWs from Melbourne were conducted.
Results:
In the case-control study, the median age of 664 SWs was 30 years (IQR: 25-36). Performing condomless fellatio with clients was the only behaviour associated with oropharyngeal gonorrhoea (adjusted odds ratio[aOR]: 3.6; 95%CI: 1.7-7.6; P=0.001). The majority of participants used mouthwash frequently (521; 78.5%). In the qualitative study, almost all SW reported kissing clients due to demand and generally reported following clients’ lead with kissing style and duration. However, they used condoms for fellatio because they considered it a risky practice for contracting STIs, unlike cunnilingus without a dental dam. Almost 30% of SW reported performing some condomless fellatio on clients and this practice was associated with oropharyngeal gonorrhoea diagnosis.
Conclusions:
Our study shows that condomless fellatio is a risk-factor for oropharyngeal gonorrhoea among FSWs, and that future research is warranted into the role of mouthwash use in relation to gonorrhoea transmission given the high rates of use in this population Clinical Trial: n/a
Citation
Please cite as:
Phillips TR, Fairley CK, Maddaford K, McNulty A, Donovan B, Guy R, McIver R, Wigan R, Varma R, Ong JJ, Callander D, Skelsey G, Pony M, O'Hara D, Bilardi JE, Chow EP
Understanding Risk Factors for Oropharyngeal Gonorrhea Among Sex Workers Attending Sexual Health Clinics in 2 Australian Cities: Mixed Methods Study