Abstract
Background Men 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. Methods We 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. Results Twenty-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. Conclusion Rectal 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.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 428-436 |
| Number of pages | 9 |
| Journal | Sexually transmitted infections |
| Volume | 95 |
| Issue number | 6 |
| DOIs | |
| State | Published - Sep 1 2019 |
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Keywords
- Enema
- HIV
- Men who have sex with men
- Meta-analysis
- Rectal douching
- Sexually transmitted infections
PubMed: MeSH publication types
- Journal Article
- Review
Cite this
Association between rectal douching and HIV and other sexually transmitted infections among men who have sex with men : A systematic review and meta-analysis. / Li, Peiyang; Yuan, Tanwei; Fitzpatrick, Thomas; Smith, Kumi; Zhao, Jin; Wu, Guohui; Ouyang, Lin; Wang, Ying; Zhang, Kechun; Zhou, Yiguo; Li, Meijuan; Chen, Dahui; Li, Linghua; Cai, Weiping; Cai, Yong; Zou, Huachun.
In: Sexually transmitted infections, Vol. 95, No. 6, 01.09.2019, p. 428-436.Research output: Contribution to journal › Review article
}
TY - JOUR
T1 - Association between rectal douching and HIV and other sexually transmitted infections among men who have sex with men
T2 - A systematic review and meta-analysis
AU - Li, Peiyang
AU - Yuan, Tanwei
AU - Fitzpatrick, Thomas
AU - Smith, Kumi
AU - Zhao, Jin
AU - Wu, Guohui
AU - Ouyang, Lin
AU - Wang, Ying
AU - Zhang, Kechun
AU - Zhou, Yiguo
AU - Li, Meijuan
AU - Chen, Dahui
AU - Li, Linghua
AU - Cai, Weiping
AU - Cai, Yong
AU - Zou, Huachun
PY - 2019/9/1
Y1 - 2019/9/1
N2 - Background Men 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. Methods We 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. Results Twenty-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. Conclusion Rectal 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.
AB - Background Men 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. Methods We 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. Results Twenty-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. Conclusion Rectal 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.
KW - Enema
KW - HIV
KW - Men who have sex with men
KW - Meta-analysis
KW - Rectal douching
KW - Sexually transmitted infections
UR - http://www.scopus.com/inward/record.url?scp=85065558895&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85065558895&partnerID=8YFLogxK
U2 - 10.1136/sextrans-2019-053964
DO - 10.1136/sextrans-2019-053964
M3 - Review article
VL - 95
SP - 428
EP - 436
JO - Sexually Transmitted Infections
JF - Sexually Transmitted Infections
SN - 1368-4973
IS - 6
ER -