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On the basis of their results and previous observational work, Chow and colleagues concluded that daily use of an antibacterial mouthwash would have no effect on the risk of acquiring oropharyngeal gonorrhoea, but it might reduce transmission from an infected individual to their sexual partners. Hence, they propose an adapted intervention, in which participants would need to ask their sexual partners to use a mouthwash before sex. On the basis of our findings, we highly doubt the feasibility of such a strategy.
In a similar study,4Van Dijck C Tsoumanis A Rotsaert A et al.Antibacterial mouthwash to prevent sexually transmitted infections in men who have sex with men taking HIV pre-exposure prophylaxis (PReGo): a randomised, placebo-controlled, crossover trial. we asked 343 participants to use an antibacterial mouthwash on a daily basis and before and after sex, and to ask their sex partners to use the mouthwash before and after sex. During the study, we also assessed the acceptability of mouthwash as a sexually transmitted infection (STI) prevention method using 15 in-depth interviews with selected participants and a questionnaire every 3 months for all participants. Elaborating on the findings from this qualitative acceptability substudy, we found that one of the most frequently reported barriers in both the questionnaires and interviews was requesting sex partners to use the mouthwash. The threshold for proposing the mouthwash was much higher with anonymous or new sex partners, when more than one sexual partner was present, and when the sexual encounter occurred in a cruising venue (eg, sex club or sauna). Introducing a mouthwash in such situations was impractical and a “mood killer” (table). In addition, uncertainty about the efficacy of a mouthwash to prevent STIs made it difficult to propose or convince sex partners to use it. Another frequently reported barrier was that mouthwash was impractical to carry around, making it nearly impossible to propose to others. Some participants never proposed the mouthwash out of fear of unpleasant reactions, such as being perceived as having an STI.TableBarriers to proposing mouthwash use to sex partners
As long as mouthwash has no proven preventive effect against STIs, we question whether it will ever be accepted as an STI prevention method. If an effective mouthwash becomes available in the future, we suggest to carefully assess feasibility, in particular when the mouthwash has to be proposed to sexual partners. But currently, mouthwash is neither efficacious nor sexy to propose to a sex partner.
This study was funded by the Belgian Research Foundation – Flanders (FWO 121.00). We declare no competing interests.
References1.Chow EPF Williamson DA Hocking JS et al.Antiseptic mouthwash for gonorrhoea prevention (OMEGA): a randomised, double-blind, parallel-group, multicentre trial.
Lancet Infect Dis. 21: 647-6562.Emerging and reemerging sexually transmitted infections.
N Engl J Med. 382: 2023-20323.Unemo M Bradshaw CS Hocking JS et al.Sexually transmitted infections: challenges ahead.
Lancet Infect Dis. 17: e235-e2794.Van Dijck C Tsoumanis A Rotsaert A et al.Antibacterial mouthwash to prevent sexually transmitted infections in men who have sex with men taking HIV pre-exposure prophylaxis (PReGo): a randomised, placebo-controlled, crossover trial.
Lancet Infect Dis. 21: 657-667Article InfoPublication HistoryIdentificationDOI: https://doi.org/10.1016/S1473-3099(21)00322-4
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