# Presentation: 353721

## PROMISCUOUS SEXUAL ACTIVITY IS ASSOCIATED WITH BACTERIAL VAGINOSIS IN YOUNG WOMEN WHO DOUCHE

- _MK Oh_, J Schwebke, J Merchant,
- P Brown, R Desmond, M Jones, H Weiss
- University of Alabama at Birmingham,
- Birmingham, AL.

- NIAID (U19AI3814- UAB CRC)

**Notes:**
Power Point on PC
Text
Note pages

## Background

- Vaginal douching has been linked to bacterial vaginosis (BV).
- The mechanism of this association is unclear.

**Notes:**
Vaginal douching has been linked to a variety of adverse health outcomes including BV.

The mechanism of such association is unclear, however.

## Purpose:

- To determine correlates of BV in adolescent and young women who douche.

## Methods

- _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

**Notes:**
The study subjects were participants in the B-well study, an on-going RCT of a douching intervention.

The inclusion critera are:

Immunosuppressive conditions, AIDS, on steroids, DM.

## Methods

- Baseline data included
- Hx of douching
- sexual behaviors
- STD Hx
- Lab tests (STDs, BV)

**Notes:**
----- were obtained at baseline

## Methods

- Douching history
- Age at the 1st douching
- Last douched (# of days ago)
- Frequency
- Timing
- Reasons
- Solutions used

## Methods

**Sexual behaviors**
- Freq of sexual intercourse
- Last sex (# of days ago)
- # of partners (lifetime, in 3-mo.)
- Condom use
- BC use

## Methods

**Laboratory 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

**Notes:**
At baseline, CT was detected by urine LCR

Type specific antibody is detected using HSV-1 and HSV-2 ELISA (enzyme-linked immunosorbent assays).  The ELISA is done according to the package insert from MRL Diagnostics (Cypress, CA 90630).

Lactobacilli - large gram positive rods (4-0)
Gardnerella and bacteriodes/Prevotella -small gran-variable rolds (0-4)
Mobiluncus species - curved rods (0-2)

## Methods - Analyses

- Data 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 - 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

**Notes:**
Baseline data from 144 participants were available for analysis.

history of STD - GC, CT, syphilis, Trich, genital warts, genital herpes, other..

## Sexual behaviors (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) 144 participants

**14%**

**5%**

**7%**

**22%**

**42%**

**Notes:**
No HIV positive, No syphilis cases

## Douching - 144 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 BV

## Independent variables  associated /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

**Notes:**
Among women who douche, the risk of BV is increased 2.6 fold by multiple partners in recent 3-mo.
Recent sexual intercourse (within past week) increase the risk 2.5 fold.

## Among women who douche, BV was not significantly associated with

- Frequency of douching
- Recency of douching
- Timing of douching
- Types of solution used
- Reasons for douching

**Notes:**
Among women who douche, 
Frequency of douching
Recency of douching
Timing of doucing
Types of solution used
Reasons for douching   ....were not predictors of BV.

38%  of BV +  and 27% of BV Negative women douched within last 1 week. (p=0.17)

Mean douche days ago:  16.7 ± 10 d for BV pos. VS. 14.6 ±10 d for BV neg

## Slide 17

## Limitations

- Small sample size
- All douched within the past 35 d.
- Cross sectional - baseline data
- Self-reported historical data

## Conclusion	

- 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.

**Notes:**
..... Perhaps, indicating existence of other high-risk sexual behaviors

## 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 Vermund
		Ellen Funkhouser
		Diane Grimley

- Acknowledgement  to other coinvestigators on the study
- 		Sten Vermund
- 		Ellen Funkhouser
- 		Diane Grimley

## Implications

- 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.