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

doi:10.1136/sextrans-2019-053964

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

Epidemiology

Research output: Contribution to journal › Review article › peer-review

15 Scopus citations

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	https://doi.org/10.1136/sextrans-2019-053964
State	Published - Sep 1 2019

Bibliographical note

Funding Information:
Funding This work was funded by National Natural Science Foundation of China (81703278, 71603166, 81573211, 71673187), National Science and Technology Major Project of China (2018ZX10721102), Australian National Health and Medical Research Council Early Career Fellowship (APP1092621), Sanming Project of Medicine in Shenzhen, China (SZSM201811071), Doris Duke International Clinical Research Fellowship, USA, Medical Research Project Chongqing (2017ZDXM001) and Joint-Innovation Program in Healthcare for Special Scientific Research Projects of Guangzhou, China (201803040002).

Publisher Copyright:
© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.

Keywords

Enema
HIV
Men who have sex with men
Meta-analysis
Rectal douching
Sexually transmitted infections

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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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, 95(6), 428-436. https://doi.org/10.1136/sextrans-2019-053964

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

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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.",

keywords = "Enema, HIV, Men who have sex with men, Meta-analysis, Rectal douching, Sexually transmitted infections",

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

note = "Funding Information: Funding This work was funded by National Natural Science Foundation of China (81703278, 71603166, 81573211, 71673187), National Science and Technology Major Project of China (2018ZX10721102), Australian National Health and Medical Research Council Early Career Fellowship (APP1092621), Sanming Project of Medicine in Shenzhen, China (SZSM201811071), Doris Duke International Clinical Research Fellowship, USA, Medical Research Project Chongqing (2017ZDXM001) and Joint-Innovation Program in Healthcare for Special Scientific Research Projects of Guangzhou, China (201803040002). Publisher Copyright: {\textcopyright} Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.",

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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

N1 - Funding Information: Funding This work was funded by National Natural Science Foundation of China (81703278, 71603166, 81573211, 71673187), National Science and Technology Major Project of China (2018ZX10721102), Australian National Health and Medical Research Council Early Career Fellowship (APP1092621), Sanming Project of Medicine in Shenzhen, China (SZSM201811071), Doris Duke International Clinical Research Fellowship, USA, Medical Research Project Chongqing (2017ZDXM001) and Joint-Innovation Program in Healthcare for Special Scientific Research Projects of Guangzhou, China (201803040002). Publisher Copyright: © Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.

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

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Association between rectal douching and HIV and other sexually transmitted infections among men who have sex with men: A systematic review and meta-analysis

Abstract

Bibliographical note

Keywords

UN SDGs

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