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.
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.
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DOI：
10.1136/sextrans-2017-053484
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发表时间：
2018-11
影响因子：
3.6
通讯作者：
Morris SR
中科院分区：
文献类型：
--
作者：
Hassan A;Blumenthal JS;Dube MP;Ellorin E;Corado K;Moore DJ;Morris SR
直肠灌洗/灌肠（RD）是男男性行为者（MSM）为性行为做准备的常见做法。RD可破坏直肠粘膜屏障并可能影响直肠微生物组，然而，尚不清楚这是否与获得性直肠感染（RI）伴直肠淋病（NG）和/或衣原体（CT）相关。从2013年到2015年，395名未感染艾滋病毒的成年男男性行为者参加了一项随机对照研究，以进行暴露前预防（PrEP），并进行常规性风险调查和检测。使用来自该队列的数据，使用Pearson卡方和Wilcoxon-Mann-Whitney检验评估RI的基线差异。采用多变量逻辑回归模型对RD和RI之间的关联进行建模，该模型针对先验选择的潜在混杂因素（性行为、药物使用和年龄）进行了调整。还进行了男性伴侣数量的效应修正和敏感性分析，以排除反向因果关系。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。无安全套肛交次数（中位数：4，p<0.001）、男性伴侣（中位数：6，p<0.001）和物质使用（甲基苯丙胺/致幻剂/分离性/poppers）（p<0.001）与RI的几率增加相关。控制潜在的混杂因素，与不冲洗相比，每周冲洗或更长时间时，普遍RI的比值为3.59（p<0.001，95% CI 1.90-6.78），偶发RI为3.87（p=0.001，95% CI 1.78-8.39）。与不冲洗相比，有6个以上男性伴侣的MSM在每周或更多次冲洗时RI的几率增加5.41（p=0.002，95%CI 1.84-15.97）。在这项研究中，RD直肠卫生是未感染艾滋病毒的MSM在PrEP中的常见做法（66%），这增加了获得直肠NG和/或CT的几率，与性风险行为，物质使用和其他因素无关。这表明针对直肠卫生产品和做法的干预方法可以减少性传播感染。
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, however, it is unclear if this is associated with acquiring rectal infections (RI) with either rectal gonorrhoea (NG) and/or chlamydia (CT). From 2013–2015, 395 adult HIV-uninfected MSM were enrolled in a randomized 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 Chi-square 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. 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 1.90–6.78) and incident RI 3.87 (p=0.001, 95% CI 1.78–8.39) when douching weekly or more compared to not douching. MSM with more than six male partners had 5.41 (p=0.002, 95% CI 1.84–15.97) increased odds of RI when douching weekly or more compared to not douching. 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.
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