title: Is rectal douching and sharing douching equipment associated with anorectal chlamydia and gonorrhoea? A cross-sectional study among men who have sex with men.
abstract: Men who have sex with men (MSM) are at high risk for anorectal chlamydia and gonorrhoea infections. Many MSM use rectal douches in preparation for sex, which might break down the mucosal barrier function and facilitate the acquisition of STI. We determined whether rectal douching or sharing douching equipment was associated with anorectal chlamydia and gonorrhoea.
  
  
  
  In a cross-sectional study among 994 MSM attending the STI outpatient clinic of Amsterdam between February and April 2011, data were collected on rectal douching, sexual behaviour and STI. We used multivariable logistic regression analysis to determine the association between rectal douching, including sharing of douching equipment, and anorectal chlamydia and gonorrhoea for those reporting receptive anal sex. We adjusted for other risk behaviour, that is, condom use, number of partners and HIV status.
  
  
  
  Of 994 MSM, 46% (n=460) practised rectal douching, of whom 25% (n=117) shared douching equipment. Median age was 39 years (IQR 30-47), median number of sex partners in the 6 months prior to consult was five (IQR 3-10) and 289 (29.0%) participants were HIV positive. The prevalence of anorectal chlamydia and/or gonorrhoea for those reporting receptive anal sex was 9.6% (n=96). In multivariable analysis, HIV positivity (aOR=2.2, 95% CI 1.3 to 3.6), younger age (aOR=2.5, CI 1.4 to 4.5 for those aged <35 years compared with those aged ≥45 years), and more sexual partners (aOR=1.2, 95% CI 1.0 to 1.5 for 1 log increase) were significantly associated with anorectal STI. However, rectal douching or sharing douching equipment were not significantly associated with anorectal chlamydia and/or gonorrhoea (p=0.647).
  
  
  
  Almost half of MSM used rectal douching and a quarter of these shared douching equipment. Though using douching equipment does not appear to contribute to anorectal chlamydia and gonorrhoea in this study, STI prevalence remains high and prevention strategies like early testing and treatment remain of utmost importance.
authors.affiliation: STI outpatient clinic, department of infectious diseases, Public Health Service Amsterdam, Amsterdam, The Netherlands.
authors.forename: Rca
authors.initials: R
authors.lastname: Achterbergh
authors.affiliation: STI outpatient clinic, department of infectious diseases, Public Health Service Amsterdam, Amsterdam, The Netherlands.
authors.forename: J J
authors.initials: JJ
authors.lastname: van der Helm
authors.affiliation: STI outpatient clinic, department of infectious diseases, Public Health Service Amsterdam, Amsterdam, The Netherlands.
authors.forename: W
authors.initials: W
authors.lastname: van den Boom
authors.affiliation: STI outpatient clinic, department of infectious diseases, Public Health Service Amsterdam, Amsterdam, The Netherlands.
authors.forename: T
authors.initials: T
authors.lastname: Heijman
authors.affiliation: STI outpatient clinic, department of infectious diseases, Public Health Service Amsterdam, Amsterdam, The Netherlands.
authors.forename: I G
authors.initials: IG
authors.lastname: Stolte
authors.affiliation: STI outpatient clinic, department of infectious diseases, Public Health Service Amsterdam, Amsterdam, The Netherlands.
authors.forename: M S
authors.initials: MS
authors.lastname: van Rooijen
authors.affiliation: STI outpatient clinic, department of infectious diseases, Public Health Service Amsterdam, Amsterdam, The Netherlands.|Department of Dermatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.|Centre for Infection and Immunity Amsterdam (CINIMA), Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Hjc
authors.initials: H
authors.lastname: de Vries
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000382:microbiology*; D002690:Chlamydia Infections / Q000453:epidemiology / Q000382:microbiology / Q000635:transmission*; D003430:Cross-Sectional Studies; D004866:Equipment Contamination; D006069:Gonorrhea / Q000453:epidemiology / Q000382:microbiology / Q000635:transmission*; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D012309:Risk-Taking; D012725:Sexual Behavior; D007507:Therapeutic Irrigation / Q000009:adverse effects / Q000295:instrumentation
keywords: BACTERIAL INFECTION; GAY MEN; PREVENTION; PUBLIC HEALTH; SEXUAL BEHAVIOUR