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The Slippery Slope: Lubricant Use and Rectal Sexually Transmitted Infections: A Newly Identified Risk

Gorbach, Pamina M. DrPH*†**; Weiss, Robert E. PhD; Fuchs, Edward PA-C; Jeffries, Robin A. MS; Hezerah, Marjan PhD§; Brown, Stephen MD§; Voskanian, Alen MD; Robbie, Edward MPH*; Anton, Peter MD**††; Cranston, Ross D. MD

Sexually Transmitted Diseases: January 2012 - Volume 39 - Issue 1 - p 59-64
doi: 10.1097/OLQ.0b013e318235502b
Original Study

Background: Use of lubricant products is extremely common during receptive anal intercourse (RAI) yet has not been assessed as a risk for acquisition of sexually transmitted infections (STIs).

Methods: Between 2006 and 2008, a rectal health and behavior study was conducted in Baltimore and Los Angeles as part of the University of California, Los Angeles Microbicide Development Program (NIAID IPCP# #0606414). Participants completed questionnaires, and rectal swabs were tested for Neisseria gonorrhoeae and Chlamydia trachomatis with the Aptima Combo 2 assay, and blood was tested for syphilis (for RPR and TPHA with titer) and HIV. Of those reporting lubricant use and RAI, STI results were available for 380 participants. Univariate and multivariate regressions assessed associations of lubricant use in the past month during RAI with prevalent STIs.

Results: Consistent lubricant use during RAI in the past month was reported by 36% (137/380) of participants. Consistent past month lubricant users had a higher prevalence of STI than inconsistent users (9.5% vs. 2.9%; P = 0.006). In a multivariable logistic regression model, testing positive for STI was associated with consistent use of lubricant during RAI in the past month (adjusted odds ratio: 2.98 95% confidence interval: 1.09, 8.15) after controlling for age, gender, study location, HIV status, and numbers of RAI partners in the past month.

Conclusions: Findings suggest some lubricant products may increase vulnerability to STIs. Because of wide use of lubricants and their potential as carrier vehicles for microbicides, further research is essential to clarify if lubricant use poses a public health risk.

Higher prevalence of rectal gonorrhea and chlamydia and syphilis was found among individuals reporting frequent lubricant product use during receptive anal intercourse, suggesting an association between lubricant use and rectal infection.

From the *Department of Epidemiology, School of Public Health, University of California, Los Angeles, CA; †Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, CA; ‡Departments of Medicine and Epidemiology, Johns Hopkins University School of Medicine, Baltimore, MD; §AIDS Research Alliance, Los Angeles, CA; and ¶Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA; ∥Department of Biostatistics, School of Public Health, University of California, Los Angeles, Los Angeles, CA; **UCLA AIDS Institute, David Geffen School of Medicine at UCLA, Los Angeles, CA; ††Department of Medicine, Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA

Supported by UCLA Microbicide Development Program funding by the National Institutes of Health (NIAID IPCP #0606414).

Correspondence: Pamina M. Gorbach, MHS, DrPH, Department of Epidemiology, University of California, Los Angeles, Box 95-1772, Los Angeles, CA 90095-1772. E-mail:

Received for publication February 21, 2011, and accepted August 30, 2011.

© Copyright 2012 American Sexually Transmitted Diseases Association