Antiviral Research Center, University of California San Diego School of Medicine, San Diego, California, USA.
Department of Medicine, University of Southern California Keck School of Medicine, Los Angeles, California, USA.
Sex Transm Infect. 2018 Nov;94(7):508-514. doi: 10.1136/sextrans-2017-053484. Epub 2018 Jun 15.
OBJECTIVES: Rectal douching/enema (RD) is a common practice among men who have sex with men (MSM) in preparation for sex. RD can break down the rectal mucosal barrier and potentially affect the rectal microbiome. The objective of this study was to understand if RD is associated with acquiring rectal infections (RI) with rectal gonorrhoea (NG) and/or chlamydia (CT). METHODS: From 2013 to 2015, 395 adult HIV-uninfected MSM were enrolled in a randomised controlled study for pre-exposure prophylaxis (PrEP) adherence with routine sexual risk survey and testing. Using data from this cohort, baseline differences by RI were assessed using Pearson's χ² and Wilcoxon-Mann-Whitney test. Association between RD and RI was modelled using multivariable logistic regression adjusted for potential confounders (sexual behaviour, substance use and age) selected a priori. Effect modification by number of male partners and sensitivity analysis to rule out reverse causality were also conducted. RESULTS: Of 395 participants, 261 (66%) performed RD and 133 (33%) had at least one NG/CT RI over 48 weeks. Number of condomless anal receptive sex (med: 4, p<0.001), male partners (med:6, p<0.001) and substance use (any of methamphetamine/hallucinogens/dissociative/poppers) (p<0.001) were associated with increased odds of RI. Controlling for potential confounders, odds of prevalent RI were 3.59 (p<0.001, 95% CI 1.90 to 6.78) and incident RI 3.87 (p=0.001, 95% CI 1.78 to 8.39) when douching weekly or more compared with not douching. MSM with more than six male partners had 5.34 (p=0.002, 95% CI 1.87 to 15.31) increased odds of RI when douching weekly or more compared with not douching. CONCLUSION: Rectal hygiene with RD is a common practice (66%) among HIV-uninfected MSM on PrEP in this study, which increases the odds of acquiring rectal NG and/or CT independent of sexual risk behaviour, substance use and other factors. This suggests interventional approaches targeting rectal hygiene products and practices could reduce sexually transmitted infections.
目的：直肠灌洗/灌肠（RD）是男男性行为者（MSM）在进行性行为前的常见做法。RD 可能会破坏直肠黏膜屏障，并可能影响直肠微生物群。本研究的目的是了解 RD 是否与直肠淋病（NG）和/或衣原体（CT）的直肠感染（RI）有关。
方法：2013 年至 2015 年，395 名未感染 HIV 的成年 MSM 参加了一项随机对照研究，以了解暴露前预防（PrEP）的依从性，同时进行常规性风险调查和检测。利用该队列的数据，使用 Pearson χ²和 Wilcoxon-Mann-Whitney 检验评估 RI 之间的基线差异。使用多变量逻辑回归模型，在预先选择的潜在混杂因素（性行为、药物使用和年龄）调整后，对 RD 与 RI 之间的关联进行建模。还进行了效应修饰，以评估性伴侣数量的影响，并进行敏感性分析以排除反向因果关系。
结果：在 395 名参与者中，261 名（66%）进行了 RD，133 名（33%）在 48 周内至少有一次 NG/CT RI。无保护肛交接受性性行为的次数（中位数：4，p<0.001）、性伴侣数量（中位数：6，p<0.001）和药物使用（安非他命/致幻剂/分离剂/催泪瓦斯）（p<0.001）与 RI 的可能性增加相关。在控制潜在混杂因素后，与不 RD 相比，每周或更多次 RD 的 RI 患病率的比值比（OR）为 3.59（p<0.001，95%CI 1.90 至 6.78），RI 发生率的 OR 为 3.87（p=0.001，95%CI 1.78 至 8.39）。与不 RD 相比，性伴侣超过 6 名的 MSM 每周或更多次 RD 的 RI 可能性增加 5.34（p=0.002，95%CI 1.87 至 15.31）。
结论：在这项研究中，接受 PrEP 的 HIV 未感染 MSM 中，RD 是一种常见的直肠卫生习惯（66%），它增加了获得直肠 NG 和/或 CT 的可能性，独立于性风险行为、药物使用和其他因素。这表明针对直肠卫生产品和实践的干预措施可能会降低性传播感染的风险。
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