Effect of rectal douching/enema on rectal gonorrhoea and chlamydia among a cohort of men who have sex with men on HIV pre-exposure prophylaxis

Hassan, Adiba; Blumenthal, Jill; Dubé, Michael P.; Ellorin, Eric; Corado, Katya; Moore, David J.; Morris, Sheldon R.

doi:10.1136/sextrans-2017-053484

Cited by 20 publications

(18 citation statements)

References 27 publications

(38 reference statements)

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“…5,9 Common MSM rectal hygiene practices (douching/enemas) can affect microbiome composition in some people [11][12][13] and have been associated with increased infection by HIV and other STIs in MSM. 14,15 Additionally, repeat use of hyperosmotic lubricants significantly decreased Bacteroides and trended toward increasing Prevotella, which could contribute to microbiome shifts. 16 A further, little understood, factor that may influence the microbiome in MSM is the degree to which MSM-associated microbes are spread through intimate contact.…”

Section: Msm-associated Microbes Of Interestmentioning

confidence: 99%

Can gut microbiota of men who have sex with men influence HIV transmission?

Coleman

Neff

et al. 2020

Gut Microbes

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2020) Can gut microbiota of men who have sex with men influence HIV transmission?, Gut Microbes, 11:3, 610-619, ABSTRACTGaining a complete understanding of transmission risk factors will assist in efforts to reduce new HIV infections, especially within the disproportionally affected population of men who have sex with men (MSM). We recently reported that the fecal microbiota of MSM elevates immune activation in gnotobiotic mice and enhances HIV infection in vitro over that of fecal microbiota from men who have sex with women. We also demonstrated elevation of the gut homing marker CD103 (integrin αE) on CD4 + T cells by MSM-microbiota. Here we provide additional evidence that the gut microbiota is a risk factor for HIV transmission in MSM by showing elevated frequencies of the HIV co-receptor CCR5 on CD4 + T cells in human rectosigmoid colon biopsies. We discuss our interest in specific MSM-associated bacteria and propose the influx of CD103 + and CCR5 + CD4 + T cells into the colon as a potential link between the MSM microbiota and HIV transmission. ARTICLE HISTORY

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Section: Msm-associated Microbes Of Interestmentioning

confidence: 99%

Can gut microbiota of men who have sex with men influence HIV transmission?

Coleman

Neff

et al. 2020

Gut Microbes

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“…These gures suggest that RD might be a common practice among MSM in urban China whatever their economic level. The prevalence of RD behavior among MSM in China is close to that of the USA (66%), Kenya (63%) [12,13], the UK, Brazil, and France (53.4-54.3%) [11,14,15], but higher than that in Peru (18.2-27.0%) [28,29] and the Netherlands (13.6-46%) [30,31]. Despite this high prevalence among MSM worldwide, scienti c data for and knowledge of RD in the Chinese MSM population is still insu cient.…”

Section: Discussionmentioning

confidence: 85%

“…This behavior is common among MSM globally, both before and after anal sex. In the previous studies, around 66% and 63% of MSM in the USA and Kenya, respectively, were found to have conducted RD [12,13]. The percentages of MSM employing RD hover around 53.4-54.0% in the UK, Brazil, and France [11,14,15].…”

Section: Introductionmentioning

confidence: 99%

The use of inappropriate anal douching tool associates with increased HIV infection among men who have sex with men: a cross-sectional study in Shenyang, China

Chu¹,

Shen

Hu³

et al. 2020

Preprint

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Background: Rectal douching (RD) is widely practiced by men who have sex with men (MSM), and is correlated with increased risk of HIV infection. However, the mechanism of how RD increases the risk of HIV infection is not well understood, and there is limited data on RD behavior in MSM practicing anal sex in China. We examine the purpose of RD, its timing in relation to anal sex, the types of RD products used, and risky sexual behaviors among MSM reporting anal sex.Methods: Between August 2017 and December 2018, a cross-sectional study was conducted among adult MSM in Shenyang, China. Data were collected on demographics, sexual behaviors, and RD for the most recent sexual intercourse by means of interviewer-administered face-to-face questionnaires. Blood samples were collected to test for antibodies to HIV and syphilis. Multivariable logistic regression models were used to assess the risk factors associated with HIV infection.Results: A total of 515 eligible MSM participated in this survey (median age: 31 years). During the most recent anal intercourse, 28.3% (146/515) had condomless receptive anal intercourse (CRAI), 21.4% (110/515) practiced serosorting, and more than half (61.6%, 317/515) reported RD before or after anal sex. Of those practicing RD, 96.8% (307/317) conducted RD before sex, while 62.5% (198/317) conducted RD after sex. The douching devices used were primarily shower hoses (85.3%, 262/307), and relatively few MSM used commercial RD products (8.1%, 25/307) before sex. The prevalence of HIV-1 and syphilis was 11.7% and 13.2%, respectively. HIV infection was positively associated with RD (adjusted odds ratio (AOR), 2.8; 95% confidence interval (CI), 1.4-5.5), practicing RD before sex (AOR, 2.3; 95% CI, 1.2–4.3), practicing RD after sex (AOR, 1.8; 95% CI, 1.0–3.1), using a shower hose for RD (AOR, 3.5; 95% CI, 1.1–13.0), CRAI (AOR, 2.9; 95% CI, 1.6–5.5), and an interaction effect of RD and CRAI (AOR = 4.2; 95 % CI, 2.2- 8.1) in the most recent anal intercourse.Conclusions: RD is popular among Chinese MSM. Improper noncommercial RD tools use (such as shower hose), the interaction effect between RD and CRAI associated with HIV infection. Public health workers and the MSM community should publicize scientific knowledge and prevention approaches relating to RD and HIV transmission to MSM. We recommend that cohort studies should be conducted to confirm the causal relationship between RD and acquiring HIV.

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“…Thus, RD is commonly and routinely used globally by MSM in preparation for anal sex. In two studies, around 66% and 63% of MSM in the USA and Kenya, respectively, were found to have conducted RD [5,6]. The percentages of MSM employing RD hover around 53.4-54.0% in the UK, Brazil, and France [4,7,8].…”

Section: Introductionmentioning

confidence: 99%

Rectal douching before sexual intercourse and inappropriate douching tool use associated with increased HIV infection among men who have sex with men: a cross-sectional study from Shenyang, China

Chu¹,

Shen²,

Hu³

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Rectal douching (RD) is widely practiced by men who have sex with men (MSM), and is correlated with increased risk of HIV infection. However, the mechanism of how RD increases the risk of HIV infection is not well understood, and there is limited data on RD behavior in MSM practicing anal sex in China. We examine the purpose of RD, its timing in relation to anal sex, the types of RD products used, and risky sexual behaviors among MSM reporting anal sex.Methods: Between August 2017 and December 2018, a cross-sectional study was conducted among adult MSM in Shenyang, China. Data were collected on demographics, sexual behaviors, and RD for the most recent sexual intercourse by means of interviewer-administered face-to-face questionnaires. Blood samples were collected to test for antibodies to HIV and syphilis. Multivariable logistic regression models were used to assess the risk factors associated with HIV infection.Results: A total of 515 eligible MSM participated in this survey (median age: 31 years). During the most recent anal intercourse, 28.3% (146/515) had condomless receptive anal intercourse (CRAI), 21.4% (110/515) practiced serosorting, and more than half (61.6%, 317/515) reported RD before or after anal sex. Of those practicing RD, 96.8% (307/317) conducted RD before sex, while 62.5% (198/317) conducted RD after sex. The douching devices used were primarily shower hoses (85.3%, 262/307), and relatively few MSM used commercial RD products (8.1%). The prevalence of HIV-1 and syphilis was 11.7% and 13.2%, respectively. HIV infection was positively associated with RD (adjusted odds ratio (AOR), 2.8; 95% confidence interval (CI), 1.4-5.5), practicing RD before sex (AOR, 2.3; 95% CI, 1.2–4.3), practicing RD after sex (AOR, 1.8; 95% CI, 1.0–3.1), using a shower hose for RD (AOR, 3.5; 95% CI, 1.1–13.0), condomless receptive anal intercourse (CRAI) (AOR, 2.9; 95% CI, 1.6–5.5), and using nitrite inhalants (AOR, 2.8; 95 % CI, 1.6-5.1) in the most recent anal intercourse.Conclusions: RD is popular among Chinese MSM. Improper noncommercial RD tools increase the rates of HIV infection. Public health workers and the MSM community should publicize scientific knowledge and prevention approaches relating to RD and HIV transmission to MSM, and we recommend that better tools be offered to assist in RD in order to decrease the risk of acquiring HIV.

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Effect of rectal douching/enema on rectal gonorrhoea and chlamydia among a cohort of men who have sex with men on HIV pre-exposure prophylaxis

Cited by 20 publications

References 27 publications

Can gut microbiota of men who have sex with men influence HIV transmission?

Can gut microbiota of men who have sex with men influence HIV transmission?

The use of inappropriate anal douching tool associates with increased HIV infection among men who have sex with men: a cross-sectional study in Shenyang, China

Rectal douching before sexual intercourse and inappropriate douching tool use associated with increased HIV infection among men who have sex with men: a cross-sectional study from Shenyang, China

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