Association between rectal douching and HIV and other sexually transmitted infections among men who have sex with men

A systematic review and meta-analysis

Peiyang Li, Tanwei Yuan, Thomas Fitzpatrick, Kumi Smith, Jin Zhao, Guohui Wu, Lin Ouyang, Ying Wang, Kechun Zhang, Yiguo Zhou, Meijuan Li, Dahui Chen, Linghua Li, Weiping Cai, Yong Cai, Huachun Zou

Research output: Contribution to journalReview article

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 languageEnglish (US)
Pages (from-to)428-436
Number of pages9
JournalSexually transmitted infections
Volume95
Issue number6
DOIs
StatePublished - Sep 1 2019

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Therapeutic Irrigation
Sexually Transmitted Diseases
Meta-Analysis
HIV
HIV Infections
Chlamydia
Gonorrhea
Hepatitis B virus
Hepacivirus
Syphilis
Health Education
PubMed
Sexual Behavior
Hepatitis
Longitudinal Studies
Mucous Membrane
Infection

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 journalReview article

Li, P, Yuan, T, Fitzpatrick, T, Smith, K, Zhao, J, Wu, G, Ouyang, L, Wang, Y, Zhang, K, Zhou, Y, Li, M, Chen, D, Li, L, Cai, W, Cai, Y & Zou, H 2019, 'Association between rectal douching and HIV and other sexually transmitted infections among men who have sex with men: A systematic review and meta-analysis', Sexually transmitted infections, vol. 95, no. 6, pp. 428-436. https://doi.org/10.1136/sextrans-2019-053964
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. / Association between rectal douching and HIV and other sexually transmitted infections among men who have sex with men : A systematic review and meta-analysis. In: Sexually transmitted infections. 2019 ; Vol. 95, No. 6. pp. 428-436.
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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.",
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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

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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

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