PROMISCUOUS SEXUAL PROMISCUOUS SEXUAL ACTIVITY IS ASSOCIATED WITH ACTIVITY IS ASSOCIATED WITH
BACTERIAL VAGINOSIS IN BACTERIAL VAGINOSIS IN YOUNG WOMEN WHO DOUCHEYOUNG WOMEN WHO DOUCHE
MK Oh, J Schwebke, J Merchant,
P Brown, R Desmond, M Jones, H WeissUniversity of Alabama at Birmingham,
Birmingham, AL.
NIAID (U19AI3814- UAB CRC)
BackgroundBackground
Vaginal douching has been linked to bacterial vaginosis (BV).
The mechanism of this association is unclear.
Purpose:Purpose:Purpose:Purpose:
To determine correlates of BV in adolescent and young women who douche.
MethodsMethods
Study participants* Women 14-21 years of age Last douched within past 35 d. Exclusion: pregnancy, chronic dz
* B-WELL study: RCT of douching intervention
MethodsMethods
Baseline data included Hx of douching sexual behaviors STD Hx Lab tests (STDs, BV)
MethodsMethodsDouching history Age at the 1st douching Last douched (# of days ago) Frequency Timing Reasons Solutions used
MethodsMethodsSexual behaviorsFreq of sexual intercourseLast sex (# of days ago)# of partners (lifetime, in 3-mo.)Condom useBC use
MethodsMethodsLaboratory tests BV (Nugent score ≥7) C. trachomatis (CT) urine LCR N. gonorrhoeae (GC) urine LCR T. vaginalis by culture HSV type specific serology by ELISA HIV, VDRL
Methods - AnalysesMethods - AnalysesData from BV + at baseline (n=60)
were compared with those who
were BV negative (n= 84) Student t-tests Fisher’s Exact test Logistic regression analysis
Results - Results - 144 participants 144 participants
Mean age 18.7±1.9 yrs. age at sexual debut 15.0±1.7 yrs. 42% a history of STD 26% a history of BV
Sexual behaviors Sexual behaviors ((n=144)n=144)
Last sex ≤7 days ago: 39% >3 lifetime partners: 50% >1 partner in past 3 mo: 21% ≥10 times sex in 3 mo: 48% Condom used /c last sex: 52% Hormonal BC use, yes: 33%
Lab tests (% positive)Lab tests (% positive) 144 participants144 participants
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
CT GC Trich HSV-2serology
BV
14%
5%7%
22%
42%
Douching - Douching - 144 participants144 participants Age at first douche: 15.8±1.9 yrs Timing
after menses: 89% after sex: 41% before sex: 15% before MD vst: 8%
Frequency 44% - more than once a month 32% - douched within the last wk.
Variables associated /c Variables associated /c BVBV
BV-n=84
BV+n=60 P
CrudeO.R.
# prtn in 3-mo.
> one
Recent sexŠ 7 days
13.7%
35.8%
30.6%
53.4%
.02
.04
2.78
2.06
GC pos 1.2% 10.0% .02 3.66
Independent variables Independent variables associated /c BVassociated /c BV
Multiple ptns
>1 in 3-mo.Recent sex
≤ 7 days
Adjusted O.R. 95% CI
2.58
2.48
1.02, 6.49
1.16, 5.30
Among women who douche, Among women who douche, BV was BV was notnot significantly significantly associated withassociated with
Frequency of douching Recency of douching Timing of douching Types of solution used Reasons for douching
BV - BV + pDouche>1/mo.
DouchedŠ7 d.
39%
27%
52%
38%
0.14
0.17
D d. agoMean±sd
16.7±10 14.6 ±10 0.52
Trich + 5.9% 8.3% 0.59
LimitationsLimitations
Small sample size All douched within the past 35 d. Cross sectional - baseline data Self-reported historical data
ConclusionConclusion BV positive rate was 42% in
young women who douche. Predictors of BV in these
women were recent sex, multiple partners in recent 3-mo.
B-WELL study is Supported by a grant from NIAID (U19AI3814- UAB CRC) - Edward W. Hook, III.
Acknowledgement to other coinvestigators on the study
Sten VermundEllen FunkhouserDiane Grimley
ImplicationsImplications Studies examining effects of
vaginal douching must account for confounding sexual behaviors.
Management of women with BV should include assessment for high risk sexual behavior and testing for STDs.