Sexually transmitted diseases · 2025
Study Design Matters: Using a Rigorous Analytic Design to Examine the Association Between Rectal Douching and Incident Rectal Gonorrhea and Chlamydia.
СтатьяПоддержка NIH: внешняя программаПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Chrzanowski Emma, Barbee Lindley A, Manhart Lisa E, Khosropour Christine M
Аннотация
BACKGROUND: Prior studies have identified an association between rectal douching and prevalent rectal Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT), but few studies have examined associations with incident infections.
METHODS: We used data from ExGen, a 48-week cohort study conducted in Seattle, Washington, 2016 to 2018. Each week, participants completed a survey and self-collected rectal specimens, which were tested for CT/GC at the end of the study. Our primary analysis was a case-crossover analysis. We identified individuals with incident rectal GC or CT and included 1 case-week (the first week of the incident rectal infection) and 2 randomly selected control-weeks (weeks where the participant tested negative for rectal GC/CT). We used multivariate conditional logistic regression to estimate the association between douching and rectal GC/CT. In an exploratory analysis, we created a "synthetic" cross-sectional study of the longitudinal data to mirror the design of other studies.
RESULTS: There were 140 individuals in ExGen. Our case-crossover sample comprised 17 GC case-weeks and 34 matched GC control-weeks, and 22 CT case-weeks and 44 matched CT control-weeks. Participants reported douching during 64.7% of GC case-weeks and 70.6% control-weeks (adjusted odds ratio, 0.47; 95% confidence interval, 0.07-3.10). Douching was reported at a similar frequency among CT case-weeks (45.5%) versus control weeks (47.7%; adjusted odds ratio, 1.16; 95% confidence interval, 0.26-5.07). In our exploratory synthetic cross-sectional study, rectal douching was significantly associated with rectal GC but not CT.
CONCLUSIONS: Douching was not associated with rectal GC/CT in this methodologically rigorous analysis. A better understanding of the mechanisms of douching products and impact of long-term use may be warranted.
METHODS: We used data from ExGen, a 48-week cohort study conducted in Seattle, Washington, 2016 to 2018. Each week, participants completed a survey and self-collected rectal specimens, which were tested for CT/GC at the end of the study. Our primary analysis was a case-crossover analysis. We identified individuals with incident rectal GC or CT and included 1 case-week (the first week of the incident rectal infection) and 2 randomly selected control-weeks (weeks where the participant tested negative for rectal GC/CT). We used multivariate conditional logistic regression to estimate the association between douching and rectal GC/CT. In an exploratory analysis, we created a "synthetic" cross-sectional study of the longitudinal data to mirror the design of other studies.
RESULTS: There were 140 individuals in ExGen. Our case-crossover sample comprised 17 GC case-weeks and 34 matched GC control-weeks, and 22 CT case-weeks and 44 matched CT control-weeks. Participants reported douching during 64.7% of GC case-weeks and 70.6% control-weeks (adjusted odds ratio, 0.47; 95% confidence interval, 0.07-3.10). Douching was reported at a similar frequency among CT case-weeks (45.5%) versus control weeks (47.7%; adjusted odds ratio, 1.16; 95% confidence interval, 0.26-5.07). In our exploratory synthetic cross-sectional study, rectal douching was significantly associated with rectal GC but not CT.
CONCLUSIONS: Douching was not associated with rectal GC/CT in this methodologically rigorous analysis. A better understanding of the mechanisms of douching products and impact of long-term use may be warranted.