Transmission of gonorrhea from the oral cavity to the rectal tract: A systematic review.

BackgroundThe antimicrobial resistance of Neisseria gonorrhoeae and the high prevalence of asymptomatic extragenital infections are a worldwide concern. This research investigated whether gonorrhea can be transmitted from the oral cavity to the anorectal tract among men who have sex with men.PurposeThe aim of this research is to find plausible relationships regarding the probability of gonococcal transmission from the oral cavity to the anorectal tract among MSM.Research DesignA research question was defined using the P.I.C.O. strategy (population, intervention or exposure, comparison and outcome), where the target population is MSM, the intervention is exposure to contaminated oral cavity/saliva, the control is the absence of exposure, and the outcome is the acquisition of GC. The eligibility criteria included observational studies involving men who have sex with men, regardless of sexual orientation, aged 16 or older, screened for oropharyngeal and rectal gonorrhea, and examining the role of oral fluids in transmission. Studies involving partners previously diagnosed with urogenital gonorrhea or reporting consistent condom use during receptive penoanal sex were excluded to avoid urethral-to-anorectal transmission bias.Study SampleThe databases employed were PubMed, Scopus, Web of Science, EBSCO, SciELO, and the Virtual Health Library (VHL). A total of 383 studies were identified, however, only 6 were included.Data Collection and/or AnalysisAccording to the Newcastle-Ottawa Scale (NOS), two studies were "very good," two "good," and two "satisfactory". Most studies described a complete methodology according to Strengthening the Reporting of Observational studies in Epidemiology (STROBE).ResultsDifferences in diagnostic methods, methodologies, and variables limited the findings. While the results do not confirm transmission from the oral cavity to the anorectal tract, they suggest its possibility. Further research is needed to better understand this transmission route.ConclusionsTransmissibility of gonorrhea from oropharyngeal via to the anorectal tract cannot be totally establish. However, evidence suggested the existence of this gonorrhea transmission. The fact that men with rectal gonorrhea continue to appear, even in contexts of condom use or the absence of receptive penoanal sex, brings the importance of cases monitoring and the establishment of preventive strategies.