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Systematic review
Giardia duodenalis in men who have sex with men: a systematic review
  1. Vaibhav Dubey1,
  2. Vidhushan Sivachandran1,
  3. Natasha Wahab1,
  4. Carrie Llewellyn1,
  5. Daniel Richardson1,2
  1. 1 Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
  2. 2 University Hospitals Sussex NHS Foundation Trust, Brighton, UK
  1. Correspondence to Professor Daniel Richardson; daniel.richardson7{at}nhs.net

Abstract

Objective Giardia duodenalis causes enteritis and malabsorption and can be sexually transmissible in men who have sex with men (MSM). The aim of this study was to explore factors associated with MSM with G. duodenalis.

Methods MEDLINE, Embase, Emcare, PubMed, Global Health and Web of Science were searched for manuscripts published up to February 2024. The primary author screened manuscript titles and abstracts; two authors independently reviewed full-text manuscripts for eligibility and risk of bias. We only included manuscripts that included MSM with G. duodenalis and explored at least one risk factor or association. Narrative data were synthesised following the population of a predetermined table.

Results Twelve manuscripts were included in this review, including cross-sectional studies (n=7), case series (n=3), cohort study (n=1), case-control study (n=1), from the USA (n=8), the UK (n=1), Cuba (n=1), Spain (n=1) and Canada (n=1) published between 1977 and 2024 and included 191 MSM with G. duodenalis. This review highlighted demographic (living with HIV and living with HIV with a CD4 count <400 cells/mL), biological (coinfection with Neisseria gonorrhoeae, Chlamydia trachomatis, Escherichia coli, Entamoeba histolytica, non-pathogenic enteric parasites, intestinal spirochaetosis, Enterobius vermicularis, previous Treponema pallidum, N. gonorrhoeae, Shigella spp, hepatitis A, E. histolytica and G. duodenalis) and behavioural (lack of anal douching, oral-anal sex, oral sex, anal sex, group sex, use of sex toys, having more than one sexual partner per week, non-condom use, being part of a sexual network or having a sexual partner with G. duodenalis) factors associated with MSM with G. duodenalis.

Conclusion This review has highlighted some demographic, behavioural and biological factors associated with MSM with G. duodenalis, which provide insight for public health control strategies and future research.

PROSPERO registration number CRD42023477691.

  • COLORECTAL DISEASES
  • DIARRHOEA
  • ENTEROPATHY
  • HIV/AIDS
  • INFECTIOUS DIARRHOEA

Data availability statement

No data are available.

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Footnotes

  • Contributors DR and CL developed the study concept. VD, CL and DR designed the study protocol. VD conducted the data search, initial citation and abstract reviews. VD and VS independently reviewed the manuscript's eligibility and conducted the risk of bias assessment. VD and DR conducted the data analysis and synthesis. VD produced the first draft. VD, VS, NW, CL and DR all contributed to the final manuscript. DR is acting as the guarantor for this manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.