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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
  1. Peiyang Li1,
  2. Tanwei Yuan2,
  3. Thomas Fitzpatrick3,
  4. Kumi Smith4,
  5. Jin Zhao5,
  6. Guohui Wu6,
  7. Lin Ouyang6,
  8. Ying Wang7,
  9. Kechun Zhang8,
  10. Yiguo Zhou2,
  11. Meijuan Li2,
  12. Dahui Chen2,
  13. Linghua Li9,
  14. Weiping Cai9,
  15. Yong Cai7,
  16. Huachun Zou2,10
  1. 1School of Public Health, Sun Yat-Sen University, Guangzhou, Guangdong, China
  2. 2School of Public Health (Shenzhen), Sun Yat-Sen University, Shenzhen, Guangdong, China
  3. 3University of Washington School of Medicine, Seattle, Washington, USA
  4. 4School of Public Health, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
  5. 5Shenzhen Center for Disease Control and Prevention, Shenzhen, China
  6. 6Institute for AIDS/STD Control and Prevention, Chongqing Center for Disease Control and Prevention, Chongqing, China
  7. 7School of Public Health, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
  8. 8Shenzhen Longhua District Center for Disease Control and Prevention, Shenzhen, China
  9. 9Center for Infectious Diseases, Guangzhou Eighth People's Hospital, Guangzhou, Guangdong, China
  10. 10Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
  1. Correspondence to Professor Huachun Zou, School of Public Health (Shenzhen), Sun Yat-Sen University, Shenzhen, Guangdong, China; zouhuachun{at}mail.sysu.edu.cn; Professor Yong Cai, School of Public Health, Shanghai Jiao Tong University, School of Medicine, Shanghai, China; caiyong202028{at}163.com

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.

  • rectal douching
  • enema
  • men who have sex with men
  • HIV
  • sexually transmitted infections
  • meta-analysis

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Footnotes

  • PL and TY contributed equally.

  • Handling editor Jackie A Cassell

  • Contributors PL and HZ conceived the research topic and study design. PL, TY and HZ designed the protocol and conducted study selection, quality assessment and data extraction. PL contributed to statistical analysis. PL, TY and TF interpreted data. PL, TY, TF and HZ wrote the draft of the manuscript. All authors met ICMJE criteria. All authors contributed to the writing of the manuscript and have seen and approved the final version submitted for publication.

  • 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).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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