Background: Little data exists on the association between rectal hygiene behaviors and sexually transmitted infections (STIs) in men.
Objectives: Determine associations between rectal hygiene behaviors and STIs among men who have sex with men (MSM).
Methods: 430 MSM in Los Angeles recruited by Friends Research Institute, AIDS Project Los Angeles, and UCLA’s CARE clinic completed a computer assisted self interview (CASI) on sexual and hygiene behaviors and were tested for gonorrhea with the Aptima Combo 2 assay by PCR from rectal specimens and syphilis with Rapid Plasma Reagin (RPR) and Treponema Pallidum-Particle Agglutination (TPPA) on blood specimens. Rectal hygiene behaviors included douche or enema use before last receptive anal intercourse (RAI). Univariate associations and multivariate analysis assessed associations with these hygiene behaviors and positive GC/syphilis test.
Results: The median age was 40 years (18-72), 24% were Hispanic, 37% African American, and 34% White, 51% were HIV positive (following sampling design), and the median number of sex partners in the past 30 days was 2 (IQR: 1-3). Overall 8% tested positive for either rectal gonorrhea or recent syphilis. Of those with STI, 56% reported douching or enema use before last RAI whereas of those with no STI only 20% reported these behaviors (p<0.001). In multivariable analysis, douching or enema use was significantly associated with prevalent STI (OR: 5.3; 95% CI: 1.7-16.6); HIV status, number of partners in the past month, age, and condom use at last RAI were not significant.
Conclusions: This study suggests MSM practicing risky sex should be counseled about potential risk from rectal hygiene behaviors before sex in addition to condom use to reduce their STI risk.
Implications for Programs, Policy, and/or Research: Findings warrant further study into associations between rectal hygiene and STIs, suggesting STI prevention programs may consider counseling MSM to use caution when practicing rectal hygiene before RAI.