Sexual hygiene: Is it time for a renewed focus for HIV/STI prevention?

Condomless anal intercourse is recognized as the primary transmission route for most human immunodeficiency virus (HIV) epidemics. However, considering the recent advancements in a range of biomedical strategies, voluntary medical circumcision, and the improved knowledge of behavioral preventative methods, using all forms of condomless anal intercourse indiscriminately does not expose the true complexity of sexual risk. Recognizing the potential of pre-exposure prophylaxis (PrEP), post-exposure prophylaxis (PEP), antiretroviral therapy (ART), and Undetectable equals Untransmittable (U=U), increasing the accessibility and acceptance of these options have shown to be critical for HIV/acquired immune deficiency syndrome (AIDS) prevention. Despite proven HIV/AIDS protection, these recent advances may be accompanied by sexual behavioral changes that lead to increases in other sexually transmitted infections (STIs), specifically Neisseria gonorrhea/Chlamydia trachomatis (NG/CT), and syphilis. Regardless of this possible trend, key communities at higher risk are not benefiting equally from condoms, PrEP, PEP, ART, or U=U. Collectively, sexual hygiene-based practices may have renewed importance in HIV/STI risk reduction. Yet, there is limited research evaluating the usability and clinical outcomes associated with sexual practices of lubrication, genital cleansing, postcoital urination, and rectal douching (enema use). Promoting these practices’ potential benefits, risks, and safest techniques nevertheless show promise to reduce STI risk and their sequelae. Although the safety and efficacy of some hygiene-based practices are relatively known, literature is lacking on how populations understand and use these practices and the potential interventions that could promote accurate information about them. This article primarily presents a narrative review of the prevalence, safety, and efficacy of common hygiene-based practices. We also briefly highlight the potential acceptability and feasibility of interventions in Peru that leverage mobile technologies. We conclude with future research directions within the context of PrEP, PEP, doxycycline as doxy-PEP, ART, U=U, and Peruvian communities where access to these methods may be limited. Please refer to Supplementary Materials for a full text Spanish version of this article.