{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T15:08:24Z","timestamp":1771340904471,"version":"3.50.1"},"reference-count":38,"publisher":"CSIRO Publishing","issue":"6","license":[{"start":{"date-parts":[[2025,5,5]],"date-time":"2025-05-05T00:00:00Z","timestamp":1746403200000},"content-version":"vor","delay-in-days":1235,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,1,4]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Neisseria gonorrhoeae can be cultured from saliva in men with pharyngeal gonorrhoea and could theoretically be transmitted from the pharynx to the urethra when saliva is used as a lubricant for masturbation. In this work, we proposed that saliva use during masturbation may be a potential transmission route of gonorrhoea.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analysed the transmission of Neisseria gonorrhoeae at the oropharynx, urethra and anorectum with mathematical models among men who have sex with men using data from six different studies. Model 1 included transmission routes (oral sex, anal sex, rimming, kissing, and three sequential sex practices). In Model 2, we added saliva use during solo masturbation and mutual masturbation to model 1.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Model 2 could replicate single site infection at the oropharynx, urethra and anorectum and multi-site infection across six different datasets. However, the calibration of Model 2 was not significantly different from Model 1 across four datasets. Model 2 generated an incidence of gonorrhoea from masturbation of between 5.2% (95% CI: 3.2\u201310.1) to 10.6% (95% CI: 5.8\u201317.3) across six data sets. Model 2 also estimated that about one in four cases of urethral gonorrhoea might arise from solo masturbation and mutual masturbation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Our models raise the possibility that saliva use during masturbation may play a role in transmitting gonorrhoea. This is an important area to explore because it contributes to the knowledge base about gonorrhoea transmission.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1071\/sh21138","type":"journal-article","created":{"date-parts":[[2021,12,16]],"date-time":"2021-12-16T18:53:45Z","timestamp":1639680825000},"page":"466-474","source":"Crossref","is-referenced-by-count":9,"title":["Modelling the potential role of saliva use during masturbation in the transmission of Neisseria gonorrhoeae at multiple anatomical sites"],"prefix":"10.1071","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1873-4734","authenticated-orcid":true,"given":"Xianglong","family":"Xu","sequence":"first","affiliation":[{"name":"AMelbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Carlton, Vic. 3053, Australia."},{"name":"BFaculty of Medicine, Central Clinical School, Nursing and Health Sciences, Monash University, 99 Commercial Road, Melbourne, Vic. 3004, Australia."},{"name":"CChina Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi\u2019an Jiaotong University Health Science Centre, Xi\u2019an, Shaanxi 710061, PR China."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1766-0657","authenticated-orcid":true,"given":"Eric P. F.","family":"Chow","sequence":"additional","affiliation":[{"name":"AMelbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Carlton, Vic. 3053, Australia."},{"name":"BFaculty of Medicine, Central Clinical School, Nursing and Health Sciences, Monash University, 99 Commercial Road, Melbourne, Vic. 3004, Australia."},{"name":"DCentre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, Vic. 3053, Australia."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5784-7403","authenticated-orcid":true,"given":"Jason J.","family":"Ong","sequence":"additional","affiliation":[{"name":"AMelbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Carlton, Vic. 3053, Australia."},{"name":"BFaculty of Medicine, Central Clinical School, Nursing and Health Sciences, Monash University, 99 Commercial Road, Melbourne, Vic. 3004, Australia."},{"name":"CChina Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi\u2019an Jiaotong University Health Science Centre, Xi\u2019an, Shaanxi 710061, PR China."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mingwang","family":"Shen","sequence":"additional","affiliation":[{"name":"CChina Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi\u2019an Jiaotong University Health Science Centre, Xi\u2019an, Shaanxi 710061, PR China."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chongjian","family":"Wang","sequence":"additional","affiliation":[{"name":"EDepartment of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou 450001, Henan, China."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9329-8501","authenticated-orcid":true,"given":"Jane S.","family":"Hocking","sequence":"additional","affiliation":[{"name":"DCentre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, Vic. 3053, Australia."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher K.","family":"Fairley","sequence":"additional","affiliation":[{"name":"AMelbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Carlton, Vic. 3053, Australia."},{"name":"BFaculty of Medicine, Central Clinical School, Nursing and Health Sciences, Monash University, 99 Commercial Road, Melbourne, Vic. 3004, Australia."},{"name":"CChina Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi\u2019an Jiaotong University Health Science Centre, Xi\u2019an, Shaanxi 710061, PR China."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2343-084X","authenticated-orcid":true,"given":"Lei","family":"Zhang","sequence":"additional","affiliation":[{"name":"AMelbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Carlton, Vic. 3053, Australia."},{"name":"BFaculty of Medicine, Central Clinical School, Nursing and Health Sciences, Monash University, 99 Commercial Road, Melbourne, Vic. 3004, Australia."},{"name":"CChina Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi\u2019an Jiaotong University Health Science Centre, Xi\u2019an, Shaanxi 710061, PR China."},{"name":"EDepartment of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou 450001, Henan, China."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"67","published-online":{"date-parts":[[2021,12,17]]},"reference":[{"issue":"8","key":"2025102419121512000_R1","doi-asserted-by":"publisher","first-page":"548","DOI":"10.6084\/m9.figshare.8187107.v1","article-title":"Chlamydia, gonorrhoea, trichomoniasis and syphilis: global and regional estimates of prevalence and incidence, 2016.","volume":"97","author":"Rowley","year":"2019","journal-title":"Bull World Health Organ"},{"issue":"6","key":"2025102419121512000_R2","doi-asserted-by":"publisher","first-page":"e396","DOI":"10.1016\/S2352-3018(19)30043-8","article-title":"Epidemiology and prevention of sexually transmitted infections in men who have sex with men at risk of HIV.","volume":"6","author":"Chow","year":"2019","journal-title":"Lancet HIV"},{"issue":"10","key":"2025102419121512000_R3","doi-asserted-by":"publisher","first-page":"e360","DOI":"10.1016\/S1473-3099(19)30304-4","article-title":"Models of gonorrhoea transmission from the mouth and saliva.","volume":"19","author":"Fairley","year":"2019","journal-title":"Lancet Infect Dis"},{"issue":"1","key":"2025102419121512000_R4","doi-asserted-by":"publisher","first-page":"102","DOI":"10.3201\/eid2301.161205","article-title":"Frequent transmission of gonorrhea in men who have sex with men.","volume":"23","author":"Fairley","year":"2017","journal-title":"Emerg Infect Dis"},{"issue":"10","key":"2025102419121512000_R5","doi-asserted-by":"publisher","first-page":"e367","DOI":"10.1016\/S1473-3099(19)30306-8","article-title":"Kissing, saliva exchange, and transmission of Neisseria gonorrhoeae.","volume":"19","author":"Hook","year":"2019","journal-title":"Lancet Infect Dis"},{"issue":"Suppl 6","key":"2025102419121512000_R6","doi-asserted-by":"publisher","DOI":"10.1002\/jia2.25354","article-title":"The role of saliva in gonorrhoea and chlamydia transmission to extragenital sites among men who have sex with men: new insights into transmission.","volume":"22","author":"Chow","year":"2019","journal-title":"J Int AIDS Soc"},{"issue":"3","key":"2025102419121512000_R7","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1136\/sextrans-2020-054565","article-title":"Modelling the contribution that different sexual practices involving the oropharynx and saliva have on Neisseria gonorrhoeae infections at multiple anatomical sites in men who have sex with men.","volume":"97","author":"Xu","year":"2021","journal-title":"Sex Transm Infect"},{"issue":"10","key":"2025102419121512000_R8","doi-asserted-by":"publisher","first-page":"586","DOI":"10.1097\/OLQ.0000000000000661","article-title":"Neisseria gonorrhoeae transmission among men who have sex with men: an anatomical site-specific mathematical model evaluating the potential preventive impact of mouthwash.","volume":"44","author":"Zhang","year":"2017","journal-title":"Sex Transm Infect"},{"issue":"Suppl 5","key":"2025102419121512000_R9","doi-asserted-by":"publisher","first-page":"330","DOI":"10.1111\/j.1743-6109.2010.02019.x","article-title":"Sexual health among U.S. black and hispanic men and women: a nationally representative study.","volume":"7","author":"Dodge","year":"2010","journal-title":"J Sex Med"},{"issue":"5","key":"2025102419121512000_R10","doi-asserted-by":"publisher","first-page":"647","DOI":"10.1016\/S1473-3099(20)30704-0","article-title":"Antiseptic mouthwash for gonorrhoea prevention (OMEGA): a randomised, double-blind, parallel-group, multicentre trial.","volume":"21","author":"Chow","year":"2021","journal-title":"Lancet Infect Dis"},{"issue":"3","key":"2025102419121512000_R11","doi-asserted-by":"publisher","DOI":"10.1136\/bmjsrh-2020-200720","article-title":"Age pattern of sexual activities with the most recent partner among men who have sex with men in Melbourne, Australia: a cross-sectional study.","volume":"47","author":"Kilner","year":"2021","journal-title":"BMJ Sex Reprod Health"},{"issue":"6","key":"2025102419121512000_R12","doi-asserted-by":"publisher","first-page":"395","DOI":"10.1136\/sti.51.6.395","article-title":"Gonorrhoea of the throat at a venereological clinic. Incidence and results of treatment.","volume":"51","author":"Hallqvist","year":"1975","journal-title":"Br J Vener Dis"},{"issue":"5","key":"2025102419121512000_R13","doi-asserted-by":"publisher","first-page":"347","DOI":"10.1136\/sextrans-2015-052399","article-title":"Detection of Neisseria gonorrhoeae in the pharynx and saliva: implications for gonorrhoea transmission.","volume":"92","author":"Chow","year":"2016","journal-title":"Sex Transm Infect"},{"issue":"5","key":"2025102419121512000_R14","doi-asserted-by":"publisher","first-page":"655","DOI":"10.7326\/0003-4819-104-5-655","article-title":"Epidemiology and treatment of oropharyngeal gonorrhea.","volume":"104","author":"Hutt","year":"1986","journal-title":"Ann Intern Med"},{"issue":"10","key":"2025102419121512000_R15","doi-asserted-by":"publisher","first-page":"2485","DOI":"10.1128\/JCM.01186-16","article-title":"Neisseria gonorrhoeae bacterial DNA load in the pharynges and saliva of men who have sex with men.","volume":"54","author":"Chow","year":"2016","journal-title":"J Clin Microbiol"},{"issue":"5","key":"2025102419121512000_R16","doi-asserted-by":"publisher","first-page":"321","DOI":"10.1097\/OLQ.0000000000000953","article-title":"Assessing uncertainty in an anatomical site-specific gonorrhea transmission model of men who have sex with men.","volume":"46","author":"Spicknall","year":"2019","journal-title":"Sex Transm Dis"},{"key":"2025102419121512000_R17","doi-asserted-by":"publisher","first-page":"sextrans-2020-054632","DOI":"10.1136\/sextrans-2020-054632","article-title":"Comparison of the patterns of chlamydia and gonorrhoea at the oropharynx, anorectum and urethra among men who have sex with men.","author":"Tabesh","year":"2021","journal-title":"Sex Transm Infect"},{"issue":"4","key":"2025102419121512000_R18","doi-asserted-by":"publisher","first-page":"944","DOI":"10.1093\/cid\/ciz964","article-title":"What is the optimal testing strategy for oropharyngeal Neisseria gonorrhoeae in men who have sex with men? Comparing selective testing versus routine universal testing from Dutch STI clinic data (2008\u20132017).","volume":"71","author":"van Liere","year":"2020","journal-title":"Clin Infect Dis"},{"issue":"6","key":"2025102419121512000_R19","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2018-028162","article-title":"Correlations of chlamydia and gonorrhoea among pharyngeal, rectal and urethral sites among Thai men who have sex with men: multicentre community-led test and treat cohort in Thailand.","volume":"9","author":"Hiransuthikul","year":"2019","journal-title":"BMJ Open"},{"key":"2025102419121512000_R20","unstructured":"Pol BVD. Extragenital CT\/GC in MSM. In \u2018The 20th international union against sexually transmitted infections \u2013 Asia pacific conference (IUSTI-AP), 23\u201326 October 2019, Shanghai, China\u2019."},{"issue":"3","key":"2025102419121512000_R21","doi-asserted-by":"publisher","first-page":"158","DOI":"10.1097\/OLQ.0000000000001115","article-title":"Performance of 4 molecular assays for detection of chlamydia and gonorrhea in a sample of human immunodeficiency virus-positive men who have sex with men.","volume":"47","author":"Footman","year":"2020","journal-title":"Sex Transm Dis"},{"issue":"1","key":"2025102419121512000_R22","doi-asserted-by":"publisher","first-page":"326","DOI":"10.1186\/s12916-020-01796-3","article-title":"Chlamydia trachomatis transmission between the oropharynx, urethra and anorectum in men who have sex with men: a mathematical model.","volume":"18","author":"Xu","year":"2020","journal-title":"BMC Med"},{"key":"2025102419121512000_R23","doi-asserted-by":"publisher","first-page":"e216","DOI":"10.1017\/S0950268821001941","article-title":"Role of saliva use during masturbation in the transmission of Chlamydia trachomatis in men who have sex with men.","volume":"149","author":"Xu","year":"2021","journal-title":"Epidemiology and Infection"},{"key":"2025102419121512000_R24","doi-asserted-by":"publisher","first-page":"7528154","DOI":"10.1155\/2019\/7528154","article-title":"The application of the logistic equation model to predict the remineralization characteristics of desensitizing paste.","volume":"2019","author":"Onwubu","year":"2019","journal-title":"Int J Dent"},{"issue":"3","key":"2025102419121512000_R25","doi-asserted-by":"publisher","first-page":"279","DOI":"10.4300\/JGME-D-12-00156.1","article-title":"Using effect size\u2014or why the P value is not enough.","volume":"4","author":"Sullivan","year":"2012","journal-title":"J Grad Med Educ"},{"key":"2025102419121512000_R26","unstructured":"Bettinardi RG. computeCohen_d(x1, x2, varargin). 2020. Available at: https:\/\/au.mathworks.com\/matlabcentral\/fileexchange\/62957-computecohen_d-x1-x2-varargin"},{"issue":"9","key":"2025102419121512000_R27","doi-asserted-by":"publisher","first-page":"917","DOI":"10.1093\/jpepsy\/jsp004","article-title":"How to select, calculate, and interpret effect sizes.","volume":"34","author":"Durlak","year":"2009","journal-title":"J Pediatr Psychol"},{"issue":"1","key":"2025102419121512000_R28","doi-asserted-by":"publisher","first-page":"2227","DOI":"10.1038\/s41598-020-59008-0","article-title":"Differences in transcriptional dynamics between t-cells and macrophages as determined by a three-state mathematical model.","volume":"10","author":"DeMarino","year":"2020","journal-title":"Sci Rep"},{"issue":"Suppl 5","key":"2025102419121512000_R29","doi-asserted-by":"publisher","first-page":"291","DOI":"10.1111\/j.1743-6109.2010.02009.x","article-title":"Sexual behaviors, relationships, and perceived health among adult men in the United States: results from a national probability sample.","volume":"7","author":"Reece","year":"2010","journal-title":"J Sex Med"},{"issue":"7","key":"2025102419121512000_R30","doi-asserted-by":"publisher","first-page":"532","DOI":"10.1136\/sextrans-2015-052502","article-title":"Saliva use as a lubricant for anal sex is a risk factor for rectal gonorrhoea among men who have sex with men, a new public health message: a cross-sectional survey.","volume":"92","author":"Chow","year":"2016","journal-title":"Sex Transm Infect"},{"issue":"4","key":"2025102419121512000_R31","doi-asserted-by":"publisher","first-page":"362","DOI":"10.1177\/0956462417727669","article-title":"Saliva use in sex: associations with use of smartphone dating applications in men who have sex with men.","volume":"29","author":"Chow","year":"2018","journal-title":"Int J STD AIDS"},{"issue":"8","key":"2025102419121512000_R32","doi-asserted-by":"publisher","first-page":"506","DOI":"10.1097\/OLQ.0000000000000800","article-title":"Associations between anorectal chlamydia and oroanal sex or saliva use as a lubricant for anal sex: a cross-sectional survey.","volume":"45","author":"Cornelisse","year":"2018","journal-title":"Sex Transm Dis"},{"issue":"6","key":"2025102419121512000_R33","doi-asserted-by":"publisher","first-page":"452","DOI":"10.1136\/sextrans-2020-054764","article-title":"Incidence and duration of incident oropharyngeal gonorrhoea and chlamydia infections among men who have sex with men: prospective cohort study.","volume":"97","author":"Chow","year":"2021","journal-title":"Sex Transm Infect"},{"issue":"11","key":"2025102419121512000_R34","doi-asserted-by":"publisher","first-page":"3040","DOI":"10.1111\/j.1743-6109.2011.02438.x","article-title":"Sexual behaviors and situational characteristics of most recent male-partnered sexual event among gay and bisexually identified men in the United States.","volume":"8","author":"Rosenberger","year":"2011","journal-title":"J Sex Med"},{"issue":"10","key":"2025102419121512000_R35","doi-asserted-by":"publisher","first-page":"e360","DOI":"10.1016\/S1473-3099(19)30304-4","article-title":"Models of gonorrhoea transmission from the mouth and saliva.","volume":"19","author":"Fairley","year":"2019","journal-title":"Lancet Infect Dis"},{"issue":"4","key":"2025102419121512000_R36","doi-asserted-by":"publisher","first-page":"317","DOI":"10.1136\/sti.50.4.317","article-title":"Transfer of gonococcal pharyngitis by kissing?","volume":"50","author":"Willmott","year":"1974","journal-title":"Br J Vener Dis"},{"issue":"5","key":"2025102419121512000_R37","doi-asserted-by":"publisher","first-page":"581","DOI":"10.1080\/09540129947730","article-title":"Changing sexual attitudes and behaviour in China: implications for the spread of HIV and other sexually transmitted diseases.","volume":"11","author":"Zhang","year":"1999","journal-title":"AIDS Care"},{"key":"2025102419121512000_R38","doi-asserted-by":"publisher","first-page":"ciab680","DOI":"10.1093\/cid\/ciab680","article-title":"The natural history of rectal gonococcal and chlamydial infections: the exgen study.","author":"Barbee","year":"2021","journal-title":"Clin Infect Dis"}],"container-title":["Sexual Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/connectsci.au\/sh\/article-pdf\/18\/6\/466\/149833\/sh21138.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/connectsci.au\/sh\/article-pdf\/18\/6\/466\/149833\/sh21138.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,24]],"date-time":"2025-10-24T23:12:19Z","timestamp":1761347539000},"score":1,"resource":{"primary":{"URL":"https:\/\/connectsci.au\/sh\/article\/18\/6\/466\/21612\/Modelling-the-potential-role-of-saliva-use-during"}},"subtitle":[],"editor":[{"given":"Matthew","family":"Hogben","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2021,12,17]]},"references-count":38,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2022,1,4]]}},"URL":"https:\/\/doi.org\/10.1071\/sh21138","relation":{},"ISSN":["1448-5028","1449-8987"],"issn-type":[{"value":"1448-5028","type":"print"},{"value":"1449-8987","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,12,17]]}}}