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.