Correlates of Rectal Douching Practices Among Men Who Have Sex With Men in Kenya

BackgroundMen who have sex with men (MSM) are disproportionately affected by HIV and other STIs worldwide. Rectal douching, which is commonly used by MSM in preparation for anal sex, may increase the risk of HIV and other STIs by injuring the rectal mucosa. Results from individual studies reporting associations between rectal douching and HIV and other STIs among MSM are inconsistent. We performed a systematic review and meta-analysis to estimate the association between rectal douching and HIV and other STIs among MSM.MethodsWe searched PubMed, Embase, Scopus and Web of Science for studies published from January 1970 to November 2018. Studies that reported ORs and 95% CIs of associations between rectal douching and infection with HIV/STIs, or reported enough data to calculate these estimates, were included. We assessed risk of bias using the Newcastle-Ottawa Scale. ORs were pooled using a random effects model.ResultsTwenty-eight eligible studies were identified in our review, of which 24 (20 398 participants) were included in the meta-analysis. Rectal douching was associated with increased odds of infection with HIV (OR 2.80, 95% CI 2.32 to 3.39), and any STI other than HIV (including hepatitis B virus (HBV), hepatitis C virus (HCV), chlamydia, gonorrhoea, syphilis and human papillomavirus) (OR 2.46, 95% CI 1.95 to 3.11) among MSM. For specific STIs, douching was associated with increased odds of viral hepatitis (HBV, HCV) (OR 3.29, 95% CI 2.79 to 3.87), and chlamydia or gonorrhoea (OR 3.25, 95% CI 2.02 to 5.23). These associations remained significant in studies that adjusted for potential confounders.ConclusionRectal douching may put MSM at increased risk for infection with HIV and other STIs. Longitudinal studies are needed to clarify this association, and health education materials should inform men of the potential for increased risk of infection with rectal douching.

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Effect of Rectal Hygiene on Sexually Transmitted Infections Among HIV-Negative Men Who Have Sex with Men (MSM)

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx163.092 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S103-S103

Author(s):

Adiba Hassan ◽

Jill Blumenthal ◽

Michael Dube ◽

Eric Ellorin ◽

Katya Corado ◽

...

Keyword(s):

Sexually Transmitted Infection ◽

Text Messaging ◽

Controlled Study ◽

Sex Partners ◽

Transmitted Infection ◽

Nutritional Habits ◽

Sexually Transmitted ◽

Rectal Douching ◽

Sex With Men ◽

Hiv Negative

Abstract Background Rectal gonorrhea (NG) and chlamydia (Connecticut) infections are common among men who have sex with men (MSM). Rectal douching/enema (RDE) is a common practice among MSM that can affect the rectal microbiome. It is unclear if this practice is associated with acquiring rectal infections (RI) with either NG or CT. Methods From 2013–2015, 398 adult HIV-negative MSM and transwomen were enrolled in a randomized controlled study on text messaging for adherence to pre-exposure prophylaxis (PrEP). Participants were surveyed on sexual behavior, frequency of RDE, drug use, and nutritional habits in conjunction with routine sexually transmitted infection testing. Pearson’s χ 2 and two sample t-tests were used to measure significance of RDE and other risk factors with RI. Multivariable logistic regression model was used to control for confounding and assess the association of RDE with RIs. Confounders (i.e., age, number anal receptive sex, number sex partners) were selected a priori for inclusion in the final model based on a causal model and statistical significance. Results Of 397 participants, 262 (67%) performed RDE and 132 (33%) had at least one NG or CT rectal infection over 48 weeks. Number of condomless anal receptive sex acts (mean = 19, P < 0.001), condom use for anal receptive sex (P = 0.017), number of male sex partners in past 3 months (mean = 14, P = 0.001), and the use of poppers (P < 0.001) were associated with RI. There was no significant association between nutritional habits, probiotic foods or supplements and RI, with the exception of energy bars (P = 0.029). Controlling for confounders, RI was associated with RDE less than weekly with OR = 1.02 (95% CI 0.52–1.99) while RDE weekly or more had OR = 2.08 (95% CI 1.03–4.17). Stratified by number of partners, MSMs with more than the median (>6) number of partners had OR = 4.96 (95% CI 1.29–19.03) if performing RDE less than weekly, and OR = 6.03 (95% CI 1.55–23.49) if weekly or more. Conclusion Rectal hygiene with douching/enemas is a common practice among MSMs on PrEP, which increases the odds of acquiring rectal NG and/or CT. This finding is suggestive for the use of rectal hygiene products/practices as potential targets for sexually transmitted infection prevention. Disclosures All authors: No reported disclosures.

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An Event-Level Comparison of Risk-Related Sexual Practices Between Black and Other-Race Men Who Have Sex with Men: Condoms, Semen, Lubricant, and Rectal Douching

AIDS Patient Care and STDs ◽

10.1089/apc.2012.0355 ◽

2013 ◽

Vol 27 (2) ◽

pp. 77-84 ◽

Cited By ~ 23

Author(s):

Sarah K. Calabrese ◽

Joshua G. Rosenberger ◽

Vanessa R. Schick ◽

David S. Novak ◽

Michael Reece

Keyword(s):

Sexual Practices ◽

Rectal Douching ◽

Sex With Men

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Rectal douching among Peruvian men who have sex with men, and acceptability of a douche-formulated rectal microbicide to prevent HIV infection

Sexually Transmitted Infections ◽

10.1136/sextrans-2012-050630 ◽

2012 ◽

Vol 89 (1) ◽

pp. 62-62 ◽

Cited By ~ 14

Author(s):

Janni J Kinsler ◽

Jerome T Galea ◽

Javier R Lama ◽

Patricia Segura ◽

Jesús Peinado ◽

...

Keyword(s):

Hiv Infection ◽

Rectal Douching ◽

Sex With Men ◽

Rectal Microbicide

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Getting Clear About Rectal Douching Among Men Who Have Sex With Men

Archives of Sexual Behavior ◽

10.1007/s10508-021-01933-w ◽

2021 ◽

Author(s):

Christian Grov ◽

Drew Westmoreland ◽

Pedro B. Carneiro ◽

Jose A. Bauermeister ◽

Adam W. Carrico

Keyword(s):

Rectal Douching ◽

Sex With Men

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Insert Discourse: Rectal Douching Among Young HIV-Positive and HIV-Negative Men Who Have Sex with Men in Vancouver, Canada

Sexuality & Culture ◽

10.1007/s12119-010-9077-7 ◽

2010 ◽

Vol 14 (4) ◽

pp. 327-343 ◽

Cited By ~ 4

Author(s):

Arn J. Schilder ◽

Treena R. Orchard ◽

Christopher S. Buchner ◽

Steffanie A. Strathdee ◽

Robert S. Hogg

Keyword(s):

Hiv Positive ◽

Rectal Douching ◽

Sex With Men ◽

Hiv Negative

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Rectal douching and anal human papillomavirus among young men who have sex with men in China

Sexually Transmitted Diseases ◽

10.1097/olq.0000000000001392 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Peiyang Li ◽

Song Fan ◽

Tanwei Yuan ◽

Lin Ouyang ◽

Hui Gong ◽

...

Keyword(s):

Human Papillomavirus ◽

Young Men ◽

Rectal Douching ◽

Sex With Men

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Lubricants and rectal douching: associations with rectal gonorrhea, chlamydia, and/or syphilis infection among men who have sex with men

International Journal of STD & AIDS ◽

10.1177/0956462420938485 ◽

2020 ◽

Vol 31 (11) ◽

pp. 1040-1046

Author(s):

Cheríe S Blair ◽

Marjan Javanbakht ◽

W Scott Comulada ◽

E India Richter ◽

Robert Bolan ◽

...

Keyword(s):

Los Angeles ◽

Anal Intercourse ◽

Receptive Anal Intercourse ◽

Predominantly Black ◽

Syphilis Infection ◽

Barrier Methods ◽

Sexually Transmitted ◽

Latino Msm ◽

Rectal Douching ◽

Sex With Men

Despite widespread prevalence of lubricant use and rectal douching for receptive anal intercourse (RAI) among men who have sex with men (MSM), research evaluating the association of these behaviors with sexually transmitted infections (STIs) is limited. This is an observational analysis of a longitudinal cohort of predominantly Black/Latino MSM in Los Angeles. Every six months from August 2014 to January 2018, participants received STI screening and surveys evaluating lubricant use, douching, substance use, and sexual risk behaviors. General estimating equations evaluated the association between consistent lubricant use and douching for RAI with positive rectal Neisseria gonorrhoeae, Chlamydia trachomatis, and/or syphilis (positive STI). Among 313 participants across 552 study visits, 16.5% (91/552) had positive STI. Consistent lubricant use was reported in 52.7% (243/552) and rectal douching in 57.6% (318/552) of study visits. Consistent lubricant use was associated with STI diagnosis (adjusted OR [AOR] 1.81; 95% CI 1.11–2.96; p = 0.018). Each episode of rectal douching before RAI was associated with 2% increased odds of positive STI (AOR 1.02; 95% CI 1.00–1.04; p = 0.041). Among this cohort of HIV-positive and high-risk HIV-negative MSM, lubricant use and douching was common and independently associated with an STI, suggesting the utility of prevention messaging around barrier methods/condoms for sexual encounters involving douching/lubricant use.

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