Is rectal douching and sharing douching equipment associated with anorectal chlamydia and gonorrhoea? A cross-sectional study among men who have sex with men

INTRODUCTION

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.

METHODS

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.

RESULTS

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).

CONCLUSIONS

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.

T- and B-areas in immune reactions. Volume changes in T and B cell compartments of the rat spleen following intravenous administration of a thymus-dependent (SRBC) and a thymus-independent (paratyphoid vaccin-endotoxin) antigen. A histometric study

In the white pulp of rat spleens cell numbers were studied in the different compartments following intravenous administration of comparable doses of paratyphoid vaccine (PTV, thymus-independent) and sheep red blood cells (SRBC, thymus-dependent). In the periarteriolar lymphatic sheaths (PALS) both cell concentration and volume were measured. For the follicles and the marginal zone only volume was recorded in the first 5 days following antigen administration. Additionally, histologic observations were made. In the thymus-dependent area PTV caused oedema 12-24 hours after administration. Following SRBC administration an increase in lymphocyte numbers occurred until the second day, probably representing an influx of T cells from the recirculating pool. Both antigens gave rise to a plasmacellular reaction in the peripheral PALS (2nd-4th day). In the bone marrow-dependent areas a massive shift of medium-sized lymphocytes from the marginal zone to the follicles took place in the first 24 hours following PTV administration. These cells subsequently transformed into blasts. After SRBC (6 and 12 hours) only a few marginal zone lymphocytes seemed to migrate into the follicles. It is aruged that the endotoxin present in PTV is responsible for the fact that, following administration of the antigen, all marginal zone (B) cells responded. Endotoxin stimulation might provide a model for the fate of marginal zone cells stimulated by other agents, such as antigen (stimulating antigen binding B cells) or antigen-antibody complexes (stimulating Fc-receptor B cells).