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Unraveling The Complex Web Of Rectal Infections And The Microbiome In MSM
In a recent study published in PLOS ONE, researchers examine the interplay between Neisseria gonorrhoeae, Chlamydia trachomatis, Torquetenovirus, high-risk human papillomavirus (HPV), and the anorectal microbiome in cases of sexually transmitted rectal infections in men who have sex with men (MSM).
MSM have a high prevalence of sexually transmitted infections (STIs) in the rectal region, with N. Gonorrhoeae and C. Trachomatis the most common pathogens responsible for these infections. These infections are typically asymptomatic, thus resulting in higher transmission rates and patients often serving as reservoirs for the pathogens.
Untreated N. Gonorrhoeae and C. Trachomatis infections can also lead to severe sequelae and complications, such as an increased risk of acquiring human immunodeficiency virus (HIV). MSM who are HIV positive are also more vulnerable to high-risk HPV infections, which contribute significantly to anal neoplasia.
Characterizing microbial communities in the mucosa of the anorectal region, which is the origin and proliferation site of gonococcal or chlamydial and HPV infections, is essential in understanding the pathogenesis of sexually transmitted rectal infections and developing effective prevention strategies and therapies.
About the studyIn the present study, researchers examine the interplay between N. Gonorrhoeae, C. Trachomatis, Torquetenovirus, high-risk HPV, and the anorectal microbiome in MSM based on the presence and absence of N. Gonorrhoeae and C. Trachomatis infections. For each individual, the positivity of each type of high-risk HPV was assessed using 16S ribosomal ribonucleic acid (rRNA) sequencing to determine the bacterial community composition, whereas real-time polymerase-chain-reaction (RT-PCR) assay was used to measure Torquetenovirus titers.
Previously, the researchers of this study reported that in individuals with sexually transmitted rectal infections, the anorectal microbiome exhibited a reduced abundance of Escherichia and an increased abundance of anaerobic bacteria such as Peptostreptococcus, Peptoniphilus, and Parvimonas. HIV infections further impacted the bacterial composition, with alterations in the abundance of genera such as Corynebacterium, Lactobacillus, Gardnerella, and Sutterella.
Previous studies also showed that MSM with suppressed viral loads of HIV and concurrent HPV-16 infection had an abundance of bacteria from the phylum Fusobacteria. However, there remains a lack of data on the association between the microbiome of the anorectal region and Torquetenovirus, which primarily replicates in T lymphocytes. Although this single-stranded deoxyribonucleic acid (DNA) virus is an endogenous non-pathogenic virus, the viral titers of Torquetenovirus are an indicator of immune function.
Herein, study participants were over 18 years of age, had not undergone any antimicrobial treatments one month before enrollment, and did not have infectious gastroenteritis or inflammatory bowel diseases. Anorectal swabs were used to determine the presence of N. Gonorrhoeae, C. Trachomatis, Torquetenovirus, and HPV and analyze the anorectal microbiome. The Aptima HPV assay was also used to determine the types of high-risk HPV.
Study findingsThe incidence of high-risk HPV rectal infections was 61% among MSM. Among HIV-positive MSM with concurrent N. Gonorrhoeae or C. Trachomatis infections, the incidence rates were higher at 70.2% and 84%, respectively. The prevalence of Torquetenovirus was also higher among MSM with N. Gonorrhoeae and C. Trachomatis infections than in uninfected subjects.
The anorectal microbiome evaluation showed that the abundance of Escherichia was lower among individuals infected with either N. Gonorrhoeae, C. Trachomatis, or both. Furthermore, a significantly higher abundance of Bacteroides was associated with the presence of Torquetenovirus.
The types of high-risk HPV positively correlated with Corynebacterium and Escherichia, while Oscillospira, Prevotella, Sutterella, and the phylum Firmicutes were negatively associated with high-risk HPV types. Although the presence of Torquetenovirus alone did not significantly impact the rectal microbiome, the presence of both Torquetenovirus and N. Gonorrhoeae or C. Trachomatis infections was associated with changes in the beta-diversity of the anorectal microbiome.
High-risk HPV infections were more prevalent among MSM; however, concurrent HIV and N. Gonorrhoeae or C. Trachomatis infections increased incidence rates. Furthermore, the presence of Torquetenovirus, N. Gonorrhea, and C. Trachomatis infections had a significant impact on the abundance of various bacteria in the anorectal microbiome.
The study findings highlight the need to test for the concurrent presence of various STIs to form effective prevention and treatment strategies.
Journal reference:
How Long Does It Take For Gonorrhea To Appear?
The incubation period for gonorrhea is 1 to 14 days. If a gonorrhea test is negative, you may have gonorrhea, but only experienced exposure in the past few days.
If you've recently had sex with a new partner, it may be a good idea to get tested again in a couple of weeks.
Fact Check: Can Longer Toilet Breaks Lead To Piles And Infection Risks?
CLAIM:
Sitting for extended periods in a toilet can cause piles.
FACT:
Prolonged sitting on the toilet does increase pressure on rectal veins and can contribute to piles. Experts advise limiting toilet time to 2–3 minutes, avoiding straining, and skipping phone use to reduce both hemorrhoid and infection risks.
An Instagram reel by fitness coach and influencer Priyank Mehta has sparked widespread discussion online over claims that sitting for too long on the toilet can cause piles.
The post has gone viral, with over 6.8 million views, 54,000 likes, and more than 316,000 shares.
What are piles? How is it caused and what are the symptoms?Piles, medically known as hemorrhoids, are swollen veins located around the anus or in the lower rectum. They are extremely common, with about half of all adults experiencing symptoms by the age of 50.
Hemorrhoids can be internal, developing inside the anus or rectum, or external, forming outside the anus. External hemorrhoids are often the most painful, leading to swelling, itching, and discomfort while sitting, while internal hemorrhoids can cause bleeding during bowel movements or even prolapse, where the tissue bulges out of the anus.
Although hemorrhoids are uncomfortable, they are not life-threatening and often improve on their own with lifestyle changes and treatment. However, persistent bleeding, black stools, or symptoms that do not improve within a week should be evaluated by a doctor.
The main reason hemorrhoids occur is pressure on the veins around the anus. This pressure can come from straining during bowel movements, constipation, diarrhea, pregnancy, obesity, or even heavy lifting.
One of the lesser-discussed but important causes is prolonged sitting on the toilet. When you sit for long periods, particularly on a seated toilet, gravity and pressure can affect rectal veins, contributing to the development of piles.
How does sitting for extended periods in a toilet cause piles?
Researchers have investigated whether prolonged toilet sitting is linked to hemorrhoids. A 2020 study surveyed 52 adult non-obese patients with diagnosed internal or external hemorrhoids. The participants filled out an anonymous questionnaire about their toilet habits, and researchers divided them into four groups based on the average time spent on the toilet.
The study found a strong linear relationship between the amount of time spent sitting and the severity of hemorrhoids (R² = 0.95). The authors concluded that modifying toilet habits could be advised as both a preventive and treatment measure for patients with hemorrhoids, although they noted that further research with larger groups was needed.
In fact, another study involving 100 patients with proctoscopically confirmed hemorrhoids found that they spent significantly more time sitting on seated toilets, often while reading, compared to a control group. This evidence has led to recommendations that bowel movements should ideally be limited to three to five minutes. Similarly, guidance published in the Journal of the American Medical Association (JAMA) states that anything that increases pressure on veins in the lower body, such as straining, constipation, diarrhea, obesity, pregnancy, aging, or prolonged sitting on the toilet, can contribute to the development of hemorrhoids.
Health risks are not limited to hemorrhoids alone. A 2017 study of high school students' cell phones revealed that they frequently harboured bacteria such as E. Coli. Supporting this, a British industry report found that the average smartphone screen carried more bacteria than a toilet seat. Since flushing generates tiny invisible droplets, known as aerosols, that can settle on surfaces including phones, using a mobile in the bathroom raises the chances of transferring germs to the face and mouth.
"Sitting for long periods on the toilet can increase pressure on rectal veins, raising the chances of one suffering from hemorrhoids, commonly known as piles. This is not a misconception, as prolonged straining and sitting can lead to piles," Dr Shankar Zanwar, Senior Consultant - Gastroenterologist, Gleneagles Hospital, Parel, said.
"Spending 2-3 minutes in the toilet is advisable. If you are unable to poop, then don't pressurise and just come out. Try later, but avoid straining. Spending a longer time, like 10-15 minutes, is not advisable at all. Some also spend about 30 minutes as they are on the phone or reading newspapers inside the washroom. That is also not advisable at all," Dr Zanwar emphasised.
He also pointed out that mobile phone use in bathrooms is a double risk: it extends toilet time, increasing hemorrhoid risk, and exposes the phone to harmful microbes. Phones can easily pick up bacteria such as E. Coli from aerosols generated after flushing.
To prevent hemorrhoids, Dr Zanwar recommended lifestyle measures such as eating a high-fiber diet, drinking at least 12–15 glasses of water daily, and avoiding straining or prolonged sitting. For those already experiencing symptoms like pain or bleeding, he suggested warm sitz baths and gentle cleaning to help manage discomfort.
This story is done in collaboration with First Check, which is the health journalism vertical of DataLEADS.
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