Lubrication Practices and Receptive Anal Sex: Implications for STI Transmission and Prevention

Austin Lee; Thomas W Gaither; Marvin E Langston; Stephanie E Cohen; Benjamin N Breyer

doi:10.1016/j.esxm.2021.100341

Lubrication Practices and Receptive Anal Sex: Implications for STI Transmission and Prevention

Sex Med. 2021 Jun;9(3):100341. doi: 10.1016/j.esxm.2021.100341. Epub 2021 Mar 28.

Authors

Austin Lee¹, Thomas W Gaither², Marvin E Langston³, Stephanie E Cohen⁴, Benjamin N Breyer⁵

Affiliations

¹ Department of Urology, University of California-San Francisco, San Francisco, CA, USA.
² Department of Urology, University of California-San Francisco, San Francisco, CA, USA; Department of Urology, University of California-Los Angeles, Los Angeles, CA, USA.
³ Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.
⁴ Population Health Division, San Francisco Department of Public Health, San Francisco, CA, USA; Division of Infectious Diseases, University of California-San Francisco, San Francisco, CA, USA.
⁵ Department of Urology, University of California-San Francisco, San Francisco, CA, USA; Department of Biostatistics and Epidemiology, University of California-San Francisco, San Francisco, CA, USA. Electronic address: Benjamin.Breyer@ucsf.edu.

Abstract

Introduction: Implications of lubricant use in men having sex with men (MSM) are poorly characterized, particularly associations with sexual behavior and rectal sexually transmitted infection (STI) risk.

Aim: We sought to clarify covariates associated with lubrication type including differing sexual preferences and rectal STI prevalence.

Methods: Primary English-speaking individuals ≥18 years old visiting San Francisco City Clinic (SFCC) between April and May of 2018 who endorsed lubricant use during receptive anal sex within the last 3 months were studied. Associations between lubrication type used and collected covariates were assessed using Kruskal-Wallis analysis of variance for continuous variables and Chi-squared test for categorical variables. We used logistic regression to examine the association between lubrication type and rectal STI test result.

Main outcome measures: Rectal STI test positivity.

Results: From all enrolled participants, 179 completed the survey and endorsed use of a lubricant during receptive anal sex within the last 3 months. Silicone lubricant users had the most sexual partners in the last 3 months (13 [mean] ± 30 [SD], P= .0003) and were most likely to have a history of gonorrhea. Oil-based lubricant users had the most partners with whom they had receptive anal sex in the last 3 months (7 ± 6, P= .03). Water-based lubricant users most commonly used a condom in their last sexual encounter and had the fewest sexual partners in the last 3 months (4 ± 4, P= .0003). Spit/saliva lubricant use was associated with positive rectal STI result.

Conclusion: Silicone and oil-based lubricant users were more likely to report condomless receptive anal sex and to have a history of gonorrhea while spit/saliva lubricant use associated with positive rectal STI acquisition. Lee A, Gaither TW, Langston ME, et al. Lubrication Practices and Receptive Anal Sex: Implications for STI Transmission and Prevention. Sex Med 2021;9:100341.

Keywords: Anorectal; Lubrication; Practice; Sexually Transmitted Infection.

Grants and funding

K12 DK111028/DK/NIDDK NIH HHS/United States