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ObjectivesOropharyngeal gonorrhoea is common among men who have sex with men (MSM). We aimed to clarify which oral sex practices were independent risk factors for oropharyngeal gonorrhoea: tongue kissing, receptive oro-penile sex (fellatio) or insertive oro-anal sex (rimming), and whether daily use of mouthwash and recent antibiotic use was protective.MethodsIn 2015, we conducted an age-matched case–control study of MSM who attended the Melbourne Sexual Health Centre. Cases had tested positive for oropharyngeal gonorrhoea by nucleic acid amplification testing, and controls had tested negative. Questionnaire items included tongue kissing, oral sex practices, condom use, recent antibiotic use, mouthwash use and alcohol consumption.ResultsWe identified 177 cases, age matched to 354 controls. In univariable analyses, cases were 1.90 times (95% CI 1.13 to 3.20) more likely than controls to have had casual sexual partners (CSP) in the preceding 3 months, were 2.17 times (95% CI 1.31 to 3.59) more likely to have kissed CSP and were 2.04 times (95% CI 1.26 to 3.30) more likely to have had receptive oro-penile sex with CSP. Oropharyngeal gonorrhoea was not associated with insertive oro-anal sex or mouthwash use. The number of CSP for tongue kissing and receptive oral sex and total CSP were highly correlated, and in multivariable analysis neither kissing nor receptive oro-penile sex was significantly associated with having oropharyngeal gonorrhoea, after adjusting for total number of CSP.ConclusionsThe finding that oropharyngeal gonorrhoea was associated with a higher number of sexual partners but not specific sexual practices highlights the need for further research in the area of gonorrhoea transmission to define the probability of transmission from specific sex acts.

ObjectivesAlthough sex work is frequently characterised as a practice with high risk for HIV and other STIs, little is known about the epidemiology of these infections among men who sell sex in Australia. This study reports the prevalence of chlamydia, gonorrhoea, infectious syphilis and HIV among men who have sex with men attending Australian publicly funded sexual health clinics and compares prevalence between sex workers and non-sex workers.MethodsFrom 2011 to 2014, de-identified patient data were extracted from 40 sexual health clinics in four Australian jurisdictions. The χ2and multiple logistic regression analyses were used to compare the prevalence of HIV and STIs among men attending these services who did and did not report sex work in the 12 months prior to consultation. All analyses were restricted to men who reported sex with other men and to each patient's first consultation at participating services.ResultsIn total, 27 469 gay, bisexual and other men who have sex with men attended participating clinics; 443 (1.6%) reported sex work. At first consultation, 18% of sex workers and 17% of non-sex workers were diagnosed with HIV or an STI (p=0.4): 13% of sex workers were newly diagnosed with chlamydia, 15% with gonorrhoea, 0.5% with infectious syphilis and 0.6% with HIV. After controlling for demographic and behavioural factors, sex work was not independently associated with an HIV or STI diagnosis.ConclusionsThese findings provide estimates of HIV and STI prevalence among men who sell sex in Australia and they challenge assumptions of sex work as inherently risky to the sexual health of gay bisexual and other men who have sex with men.

BackgroundWith increasing use of non-condom-based HIV risk reduction strategies by gay and bisexual men (GBM), we compared occasions of condomless anal intercourse with casual partners (CLAIC) that resulted in HIV transmission and similar occasions when HIV transmission did not occur.MethodsWe compared two demographically similar samples of Australian GBM. The HIV Seroconversion Study (SCS) was an online cross-sectional survey of GBM recently diagnosed with HIV. The Pleasure and Sexual Health (PASH) study was an online cross sectional survey of GBM generally. Using logistic regression, we compared accounts of CLAIC reported by men in SCS as being the event which led to them acquiring HIV, with recent CLAIC reported by HIV-negative men in PASH.ResultsIn SCS, 85.1% of men reported receptive CLAIC, including 51.8% with ejaculation; 32.1% reported having previously met this partner and 28.6% believed this partner to be HIV-negative. Among HIV-negative men in PASH reporting recent CLAIC, 65.5% reported receptive CLAIC, including 29.9% with ejaculation; 59.3% reported having previously met this partner and 70.1% believed this partner to be HIV-negative.ConclusionsWhile both groups of men engaged in CLAIC, how they engaged in CLAIC differed, and the context in which they did so was different. A generic measure of CLAIC conceals the critical elements of HIV risk, particularly the role of receptive CLAIC, among GBM that distinguish those who seroconverted and those who did not. Detailed information about the context and nature of the practise of CLAIC is required for a more complete understanding of HIV risk among GBM.

IntroductionGlobally, community-based HIV testing models are recommended to improve access to testing with less focus on optimising existing clinical services. In the past 5 years, public-funded sexual health clinics (SHCs) in New South Wales (NSW, Australia) have taken a range of initiatives to improve efficiencies such as triage to divert low-risk heterosexuals, express clinics, online booking, self-registration and SMS reminders. We analysed temporal trends in HIV testing among gay and bisexual men (GBM) attending SHCs in this period and assessed if testing was targeted to high-risk GBM.MethodsWe used retrospective data from 32 SHCs in NSW participating in a surveillance network. HIV-negative GBM were categorised based on client type (new or existing), risk status (using partner numbers and/or recent rectal sexually transmitted infection), and recent HIV testing (past 6 months for high-risk, past 12 months for low-risk GBM). We used repeated measures Poisson regression to assess trends in attendance, tests and contribution to total tests by GBM categories.ResultsFrom 2009–2015, unique GBM attending increased by 82% (5,477 to 9,983), and HIV tests increased by 155% (4,779 to 12,173) with significant increase in all categories and greatest increase in existing high-risk clients. Of 58,377 HIV tests done, 74% were in existing and 35% in high-risk clients. Over time, existing high-risk clients with recent testing had an increasingly larger contribution to total tests (13% annual increase, 95% CI:8%–18%,p<0.001). There was a simultaneous annual decline in contribution by these low-risk categories: new clients (5% decline, 95% CI:2%–7%,p<0.001); existing clients with no recent testing (6% decline, 95% CI:5%–7%,p<0.001). There were no changes in contribution by other categories (new high-risk clients; existing high-risk clients with no recent testing; existing low-risk clients with recent testing).ConclusionSHCs in NSW have successfully increased HIV testing among GBM, with greatest increase in high-risk men. The strategies adopted could be translated to other settings.