title: Use of saliva as a lubricant in anal sexual practices among homosexual men.
abstract: OBJECTIVE
  Compared with other sexually active adults, men who have sex with men (MSM) are more frequently infected with several pathogens including cytomegalovirus, hepatitis B virus, and Kaposi sarcoma-associated herpesvirus. Because one common element between these organisms is their presence in saliva, we evaluated saliva exposure among MSM in a heretofore relatively unrecognized route-via use of saliva as a lubricant in anal sex.
  
  
  METHODS
  MSM in a San Francisco population-based cohort were interviewed regarding use of saliva by the insertive partner as a lubricant in various anal sexual practices.
  
  
  RESULTS
  Among 283 MSM, 87% used saliva as a lubricant in insertive or receptive penile-anal intercourse or fingering/fisting at some point during their lifetime; 31%-47% did so, depending upon the act, in the prior 6 months. Saliva use as a lubricant was more common among younger men and among HIV-infected men when with HIV-infected partners. Even among MSM following safe sex guidelines by avoiding unprotected penile-anal intercourse, 26% had anal exposure to saliva via use as a lubricant.
  
  
  CONCLUSIONS
  Among MSM, use of saliva as a lubricant is a common, but not ubiquitous, practice in anal sex. The findings provide the rationale for formal investigation of whether saliva use in this way contributes to transmission of saliva-borne pathogens in MSM.
authors.affiliation: From the Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA 94105, USA. lbutler@psg.ucsf.edu
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Butler
authors.forename: Dennis H
authors.initials: DH
authors.lastname: Osmond
authors.forename: Alison Graves
authors.initials: AG
authors.lastname: Jones
authors.forename: Jeffrey N
authors.initials: JN
authors.lastname: Martin
mesh_terms: D000293:Adolescent; D000328:Adult; D015658:HIV Infections / Q000517:prevention & control / Q000635:transmission*; D018451:Homosexuality, Male; D006801:Humans; D054327:Lubricants; D008297:Male; D012463:Saliva; D012725:Sexual Behavior / Q000706:statistics & numerical data*; D012747:Sexual Partners; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D054327:Lubricants