{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,7]],"date-time":"2026-11-07T14:10:39Z","timestamp":1794060639696,"version":"4.8.0"},"reference-count":57,"publisher":"BMJ","issue":"6","funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["71603166"],"award-info":[{"award-number":["71603166"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["71673187"],"award-info":[{"award-number":["71673187"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["81573211"],"award-info":[{"award-number":["81573211"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["81703278"],"award-info":[{"award-number":["81703278"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Australian National Health and Medical Research Council Early Career Fellowship","award":["APP1092621"],"award-info":[{"award-number":["APP1092621"]}]},{"name":"Joint-innovation Program in Healthcare for Special Scientific Research Projects of Guangzhou, China","award":["201803040002"],"award-info":[{"award-number":["201803040002"]}]},{"name":"Doris Duke International Clinical Research Fellowship, Medical Research Project Chongqing","award":["2017ZDXM001"],"award-info":[{"award-number":["2017ZDXM001"]}]},{"name":"National Science and Technology Major Project of China","award":["2018ZX10721102"],"award-info":[{"award-number":["2018ZX10721102"]}]},{"name":"the Sanming Project of Medicine in Shenzhen, China","award":["SZSM201811071"],"award-info":[{"award-number":["SZSM201811071"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Sex Transm Infect"],"accepted":{"date-parts":[[2019,4,18]]},"published-print":{"date-parts":[[2019,9]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Men who have sex with men (MSM) are disproportionately affected by HIV and other STIs worldwide. Rectal douching, which is commonly used by MSM in preparation for anal sex, may increase the risk of HIV and other STIs by injuring the rectal mucosa. Results from individual studies reporting associations between rectal douching and HIV and other STIs among MSM are inconsistent. We performed a systematic review and meta-analysis to estimate the association between rectal douching and HIV and other STIs among MSM.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We searched PubMed, Embase, Scopus and Web of Science for studies published from January 1970 to November 2018. Studies that reported ORs and 95% CIs of associations between rectal douching and infection with HIV\/STIs, or reported enough data to calculate these estimates, were included. We assessed risk of bias using the Newcastle-Ottawa Scale. ORs were pooled using a random effects model.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Twenty-eight eligible studies were identified in our review, of which 24 (20 398 participants) were included in the meta-analysis. Rectal douching was associated with increased odds of infection with HIV (OR 2.80, 95% CI 2.32 to 3.39), and any STI other than HIV (including hepatitis B virus (HBV), hepatitis C virus (HCV), chlamydia, gonorrhoea, syphilis and human papillomavirus) (OR 2.46, 95% CI 1.95 to 3.11) among MSM. For specific STIs, douching was associated with increased odds of viral hepatitis (HBV, HCV) (OR 3.29, 95% CI 2.79 to 3.87), and chlamydia or gonorrhoea (OR 3.25, 95% CI 2.02 to 5.23). These associations remained significant in studies that adjusted for potential confounders.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Rectal douching may put MSM at increased risk for infection with HIV and other STIs. Longitudinal studies are needed to clarify this association, and health education materials should inform men of the potential for increased risk of infection with rectal douching.<\/jats:p><\/jats:sec>","DOI":"10.1136\/sextrans-2019-053964","type":"journal-article","created":{"date-parts":[[2019,5,9]],"date-time":"2019-05-09T21:28:25Z","timestamp":1557437305000},"page":"428-436","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":27,"title":["Association between rectal douching and HIV and other sexually transmitted infections among men who have sex with men: a systematic review and meta-analysis"],"prefix":"10.1136","volume":"95","author":[{"given":"Peiyang","family":"Li","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tanwei","family":"Yuan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Fitzpatrick","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kumi","family":"Smith","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3266-0594","authenticated-orcid":false,"given":"Jin","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guohui","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lin","family":"Ouyang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3126-1134","authenticated-orcid":false,"given":"Ying","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kechun","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yiguo","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meijuan","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dahui","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linghua","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weiping","family":"Cai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yong","family":"Cai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8161-7576","authenticated-orcid":false,"given":"Huachun","family":"Zou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,5,9]]},"reference":[{"key":"2024092304500590000_95.6.428.1","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0159309","article-title":"Syphilis trends among men who have sex with men in the United States and Western Europe: a systematic review of trend studies published between 2004 and 2015","volume":"11","author":"Abara","year":"2016","journal-title":"Plos One"},{"key":"2024092304500590000_95.6.428.2","doi-asserted-by":"publisher","DOI":"10.1586\/14787210.2014.901169"},{"key":"2024092304500590000_95.6.428.3","doi-asserted-by":"publisher","DOI":"10.1097\/COH.0b013e32832c3bb3"},{"key":"2024092304500590000_95.6.428.4","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1011205"},{"key":"2024092304500590000_95.6.428.5","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1001401","article-title":"The cost and impact of scaling up pre-exposure prophylaxis for HIV prevention: a systematic review of cost-effectiveness modelling studies","volume":"10","author":"Gomez","year":"2013","journal-title":"PLoS Med"},{"key":"2024092304500590000_95.6.428.6","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)60821-6"},{"key":"2024092304500590000_95.6.428.7","doi-asserted-by":"publisher","DOI":"10.1097\/QCO.0000000000000020"},{"key":"2024092304500590000_95.6.428.8","doi-asserted-by":"crossref","first-page":"882","DOI":"10.1007\/s10461-014-0921-x","article-title":"Relative risk for HIV infection among men who have sex with men engaging in different roles in anal sex: a systematic review and meta-analysis on global data","volume":"19","author":"Meng","year":"2015","journal-title":"AIDS Behav"},{"key":"2024092304500590000_95.6.428.9","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyq057"},{"key":"2024092304500590000_95.6.428.10","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1016\/1047-2797(93)90073-D","article-title":"A comparison of risk factors for human immunodeficiency virus and hepatitis B virus infections in homosexual men","volume":"3","author":"Koziol","year":"1993","journal-title":"Ann Epidemiol"},{"key":"2024092304500590000_95.6.428.11","doi-asserted-by":"publisher","DOI":"10.1007\/s10508-013-0203-0"},{"key":"2024092304500590000_95.6.428.12","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1016\/j.jsxm.2016.01.001","article-title":"Beyond anal sex: sexual practices of men who have sex with men and associations with HIV and other sexually transmitted infections","volume":"13","author":"Rice","year":"2016","journal-title":"J Sex Med"},{"key":"2024092304500590000_95.6.428.13","doi-asserted-by":"crossref","first-page":"2555","DOI":"10.1007\/s10461-015-1221-9","article-title":"Rectal douching prevalence and practices among Peruvian men who have sex with men and transwomen: implications for rectal microbicides","volume":"20","author":"Galea","year":"2016","journal-title":"AIDS Behav"},{"key":"2024092304500590000_95.6.428.14","doi-asserted-by":"crossref","DOI":"10.1136\/sextrans-2012-050630","article-title":"Rectal douching among Peruvian men who have sex with men, and acceptability of a douche-formulated rectal microbicide to prevent HIV infection","volume":"89","author":"Kinsler","year":"2013","journal-title":"Sex Transm Infect"},{"key":"2024092304500590000_95.6.428.15","doi-asserted-by":"publisher","DOI":"10.1136\/sextrans-2016-052777"},{"key":"2024092304500590000_95.6.428.16","doi-asserted-by":"publisher","DOI":"10.1097\/OLQ.0b013e3182354e81"},{"key":"2024092304500590000_95.6.428.17","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2016-011122","article-title":"Prevalence and types of rectal douches used for anal intercourse among men who have sex with men in Brazil","volume":"7","author":"Lamblet","year":"2017","journal-title":"BMJ Open"},{"key":"2024092304500590000_95.6.428.18","doi-asserted-by":"crossref","unstructured":"Javanbakht M , Stahlman S , Pickett J , et al . Prevalence and types of rectal douches used for anal intercourse: results from an international survey. BMC Infect Dis 2014;14.doi:10.1186\/1471-2334-14-95","DOI":"10.1186\/1471-2334-14-95"},{"key":"2024092304500590000_95.6.428.19","doi-asserted-by":"publisher","DOI":"10.1097\/OLQ.0b013e31815abb08"},{"key":"2024092304500590000_95.6.428.20","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0156280","article-title":"Cytological anal squamous intraepithelial lesions associated with anal high-risk human papillomavirus infections among men who have sex with men in northern Thailand","volume":"11","author":"Ruanpeng","year":"2016","journal-title":"Plos One"},{"key":"2024092304500590000_95.6.428.21","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-007-9301-0"},{"key":"2024092304500590000_95.6.428.22","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-151-4-200908180-00136"},{"key":"2024092304500590000_95.6.428.23","doi-asserted-by":"crossref","unstructured":"Stovold E , Beecher D , Foxlee R , et al . Study flow diagrams in Cochrane systematic review updates: an adapted PRISMA flow diagram. Syst Rev 2014;3.doi:10.1186\/2046-4053-3-54","DOI":"10.1186\/2046-4053-3-54"},{"key":"2024092304500590000_95.6.428.24","doi-asserted-by":"crossref","unstructured":"Herzog R , \u00c1lvarez-Pasquin M\u00aa Jos\u00e9 , D\u00edaz C , et al . Are healthcare workers\u2019 intentions to vaccinate related to their knowledge, beliefs and attitudes? A systematic review. BMC Public Health 2013;13.doi:10.1186\/1471-2458-13-154","DOI":"10.1186\/1471-2458-13-154"},{"key":"2024092304500590000_95.6.428.25","unstructured":"Wells G , Shea B , O\u2019connell D , et al . The Newcastle-Ottawa scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. 2009. Ottawa, ON: Ottawa Hospital Research Institute, 2016."},{"key":"2024092304500590000_95.6.428.26","doi-asserted-by":"publisher","DOI":"10.1037\/\/1082-989X.3.4.486"},{"key":"2024092304500590000_95.6.428.27","unstructured":"Borenstein M , Hedges LV , Higgins JP , et al . Introduction to meta-analysis. John Wiley & Sons, 2011."},{"key":"2024092304500590000_95.6.428.28","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.327.7414.557"},{"key":"2024092304500590000_95.6.428.29","doi-asserted-by":"publisher","DOI":"10.1037\/1082-989X.11.2.193"},{"key":"2024092304500590000_95.6.428.30","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.315.7109.629"},{"key":"2024092304500590000_95.6.428.31","doi-asserted-by":"publisher","DOI":"10.1177\/0146621608327804"},{"key":"2024092304500590000_95.6.428.32","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0000000000000528"},{"key":"2024092304500590000_95.6.428.33","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1007\/BF01733012","article-title":"Lymphadenopathy and antibodies to HTLV-III in homosexual men. Clinical, laboratory and epidemiological features","volume":"63","author":"Bienzle","year":"1985","journal-title":"Klin Wochenschr"},{"key":"2024092304500590000_95.6.428.34","doi-asserted-by":"crossref","first-page":"729","DOI":"10.1093\/oxfordjournals.aje.a115026","article-title":"Risk factors for HTV infection in male sexual contacts of men with AIDS or an AIDS-related condition","volume":"128","author":"Coates","year":"1988","journal-title":"Am J Epidemiol"},{"key":"2024092304500590000_95.6.428.35","doi-asserted-by":"crossref","first-page":"810","DOI":"10.1007\/BF01711856","article-title":"Syphilis, hepatitis A and hepatitis B seromarkers in homosexual men","volume":"62","author":"Coester","year":"1984","journal-title":"Klin Wochenschr"},{"key":"2024092304500590000_95.6.428.36","doi-asserted-by":"crossref","first-page":"906","DOI":"10.1007\/BF01649037","article-title":"Behavioral characteristics and laboratory parameters in homo- and bisexual men in West Berlin: an evaluation of five years of testing and counselling on AIDS","volume":"68","author":"Deininger","year":"1990","journal-title":"Klin Wochenschr"},{"key":"2024092304500590000_95.6.428.37","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1007\/s10461-017-1873-8","article-title":"Rectal douching among men who have sex with men in Paris: implications for HIV\/STI risk behaviors and rectal microbicide development","volume":"22","author":"Hambrick","year":"2018","journal-title":"AIDS Behav"},{"key":"2024092304500590000_95.6.428.38","doi-asserted-by":"publisher","DOI":"10.1136\/sextrans-2017-053484"},{"key":"2024092304500590000_95.6.428.39","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1990.03450020082031"},{"key":"2024092304500590000_95.6.428.40","doi-asserted-by":"publisher","DOI":"10.1136\/sextrans-2013-051404"},{"key":"2024092304500590000_95.6.428.41","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1097\/00007435-199301000-00010","article-title":"Factors correlated with homosexually acquired human immunodeficiency virus infection in the era of \"safer sex\". Was the prevention message clear and well understood? Alain Brugeat Physician Group","volume":"20","author":"Messiah","year":"1993","journal-title":"Sex Transm Dis"},{"key":"2024092304500590000_95.6.428.42","doi-asserted-by":"crossref","first-page":"1035","DOI":"10.1093\/oxfordjournals.aje.a114619","article-title":"Risk factors for AIDS and HIV seropositivity in homosexual men","volume":"125","author":"Moss","year":"1987","journal-title":"Am J Epidemiol"},{"key":"2024092304500590000_95.6.428.43","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1097\/00007435-198904000-00011","article-title":"Factors influencing the risk of infection with human immunodeficiency virus in homosexual men, Denver 1982-1985","volume":"16","author":"Rietmeijer","year":"1989","journal-title":"Sex Transm Dis"},{"key":"2024092304500590000_95.6.428.44","doi-asserted-by":"crossref","first-page":"e94","DOI":"10.1097\/OLQ.0000000000000890","article-title":"Correlates of rectal douching practices among men who have sex with men in Kenya","volume":"45","author":"Saleska","year":"2018","journal-title":"Sex Transm Dis"},{"key":"2024092304500590000_95.6.428.45","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/146.1.7"},{"key":"2024092304500590000_95.6.428.46","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1986.03370160065028"},{"key":"2024092304500590000_95.6.428.47","doi-asserted-by":"publisher","DOI":"10.1258\/ijsa.2008.008260"},{"key":"2024092304500590000_95.6.428.48","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1987.03390030051019"},{"key":"2024092304500590000_95.6.428.49","first-page":"273","article-title":"[Study on the relationship between behavioral factors, psychological status and HIV infection among men who have sex with men in Beijing]","volume":"31","author":"Zhou","year":"2010","journal-title":"Zhonghua liu xing bing xue za zhi = Zhonghua liuxingbingxue zazhi"},{"key":"2024092304500590000_95.6.428.50","unstructured":"Hylton J , Fuchs E , CJOPpaM H . An assessment of sexual practices affecting the feasibility of microbicide development among MSM 2004."},{"key":"2024092304500590000_95.6.428.51","doi-asserted-by":"publisher","DOI":"10.1086\/511279"},{"key":"2024092304500590000_95.6.428.52","doi-asserted-by":"publisher","DOI":"10.1089\/aid.2013.0189"},{"key":"2024092304500590000_95.6.428.53","first-page":"265","article-title":"Safety and effectiveness of large-volume enema solutions","volume":"17","author":"Schmelzer","year":"2004","journal-title":"Appl Nurs Res"},{"key":"2024092304500590000_95.6.428.54","doi-asserted-by":"crossref","first-page":"1288","DOI":"10.1007\/s10461-017-1959-3","article-title":"Rectal douching associated with receptive anal intercourse: a literature review","volume":"22","author":"Carballo-Di\u00e9guez","year":"2018","journal-title":"AIDS Behav"},{"key":"2024092304500590000_95.6.428.55","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-009-9590-6"},{"key":"2024092304500590000_95.6.428.56","doi-asserted-by":"crossref","unstructured":"Hoang T , Date AA , Ortiz JO , et al . Development of rectal enema as microbicide (DREAM): preclinical progressive selection of a tenofovir prodrug enema 2018.","DOI":"10.1016\/j.ejpb.2018.05.030"},{"key":"2024092304500590000_95.6.428.57","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2796.2011.02454.x"}],"container-title":["Sexually Transmitted Infections"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/sextrans-2019-053964","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,9,23]],"date-time":"2024-09-23T11:51:29Z","timestamp":1727092289000},"score":1,"resource":{"primary":{"URL":"https:\/\/sti.bmj.com\/lookup\/doi\/10.1136\/sextrans-2019-053964"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,5,9]]},"references-count":57,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2019,8,20]]},"published-print":{"date-parts":[[2019,9]]}},"alternative-id":["10.1136\/sextrans-2019-053964"],"URL":"https:\/\/doi.org\/10.1136\/sextrans-2019-053964","relation":{},"ISSN":["1368-4973","1472-3263"],"issn-type":[{"value":"1368-4973","type":"print"},{"value":"1472-3263","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,5,9]]}}}