Combinations of Sexual Activities During a Sex Episode with Recent Casual Male Partner Among Men Who Have Sex with Men: A Cross-Sectional Study.

We examined combinations of nine sexual activities that occurred during a sex episode with a recent male partner among men who have sex with men (MSM) who attended an urban sexual health clinic from April-2017 to September-2017. We collected the following sexual activities: tongue-kissing, penises touching, using saliva during mutual masturbation, performed rimming, received rimming, performed fellatio, received fellatio, insertive anal sex, and receptive anal sex. During a single-sex episode, the most common combinations of sexual activities involved all nine activities (10.6%, 166/1542). We assessed the agreement between any two sexual activities that occurred together during a sex episode. Agreement was highest for receiving rimming and receptive anal sex ( kappa  = 0.40; 95% CI: 0.35, 0.45), and performing rimming and insertive anal sex ( kappa  = 0.38; 95% CI: 0.33, 0.42). Agreement was lowest for insertive anal sex and receiving fellatio ( kappa  = -0.01; 95% CI: -0.05, 0.03), and receptive anal sex and insertive anal sex ( kappa  = -0.08; 95% CI: -0.13, 0.03). The sexual activities that occur between men are correlated with one another and this will influence transmission between anatomical sites.