Sexually transmitted infections and vaginal douching in a population of female sex workers in Nairobi, Kenya

Objective: To assess the association between vaginal douching and sexually transmitted infections (STI) among a group of female sex workers (FSWs) in Nairobi, Kenya. Methods: This study was part of a randomised, placebo controlled trial of monthly prophylaxis with 1 g of azithromycin to prevent STIs...

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Bibliographic Details
Published in:Sexually transmitted infections 2001-08, Vol.77 (4), p.271-275
Main Authors: Fonck, K, Kaul, R, Keli, F, Bwayo, J J, Ngugi, E N, Moses, S, Temmerman, M
Format: Article
Language:English
Subjects:
Adult
Age
Alcohol use
Biological and medical sciences
Birth control
Demographics
Disease prevention
Disease transmission
Female
female sex workers
General aspects
Gonorrhea
Heterosexuality
HIV
HIV Infections - epidemiology
HIV Infections - etiology
HIV-1
Human immunodeficiency virus
Human infectious diseases. Experimental studies and models
Humans
Infections
Infectious diseases
Kenya - epidemiology
Logistic Models
Marital status
Medical sciences
Multivariate Analysis
Original
Pelvic inflammatory disease
Questionnaires
Risk
Seroepidemiologic Studies
Sex industry
Sex Work
Sexual behavior
Sexually transmitted diseases
Sexually Transmitted Diseases - epidemiology
Sexually Transmitted Diseases - etiology
sexually transmitted infections
STD
Therapeutic Irrigation - adverse effects
Tropical medicine
Ulcers
Vagina
vaginal douching
Vaginosis, Bacterial - epidemiology
Vaginosis, Bacterial - etiology
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Summary:Objective: To assess the association between vaginal douching and sexually transmitted infections (STI) among a group of female sex workers (FSWs) in Nairobi, Kenya. Methods: This study was part of a randomised, placebo controlled trial of monthly prophylaxis with 1 g of azithromycin to prevent STIs and HIV infection in a cohort of Nairobi FSWs. Consenting women were administered a questionnaire and screened for STIs. Results: The seroprevalence of HIV-1 among 543 FSWs screened was 30%. HIV infection was significantly associated with bacterial vaginosis (BV), trichomoniasis, gonorrhoea, and the presence of a genital ulcer. Regular douching was reported by 72% of the women, of whom the majority inserted fluids in the vagina, generally after each sexual intercourse. Water with soap was the fluid most often used (81%), followed by salty water (18%), water alone (9%), and a commercial antiseptic (5%). Douching in general and douching with soap and water were significantly associated with bacterial vaginosis (p = 0.05 and p = 0.04 respectively). There was a significant trend for increased frequency of douching and higher prevalence of BV. There was no direct relation observed between douching and risk for HIV infection or other STIs. Conclusion: The widespread habit of douching among African female sex workers was confirmed. The association between vaginal douching and BV is of concern, given the increased risk of HIV infection with BV, which has now been shown in several studies. It is unclear why we could not demonstrate a direct association between douching and HIV infection. Further research is required to better understand the complex relation between douching, risk for bacterial vaginosis, and risk for HIV and other STIs.
ISSN:1368-4973
1472-3263
DOI:10.1136/sti.77.4.271