Cessation of intravaginal practices to prevent bacterial vaginosis: a pilot intervention in Zimbabwean women

Esber, Allahna; Moyo, Precious; Munjoma, Marshall; Francis, Shelley A.; Wijgert, Janneke van de; Chipato, Tsungai; Turner, Abigail Norris

doi:10.1136/sextrans-2014-051764

Cited by 9 publications

(6 citation statements)

References 25 publications

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“…This contrasts with studies from other regions in the world such as sub-Saharan Africa, where the primary motivator for IVP is male partner pleasure 15,27–29. Most studies in the US have evaluated the use of intravaginal douches, but not the use of other products which can also affect the vaginal mucosa and place women at-risk.…”

Section: Discussionmentioning

confidence: 93%

Addressing intravaginal practices in women with HIV and at-risk for HIV infection, a mixed methods pilot study

Alcaide

Fischl

Rodriguez

2017

IJWH

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Intravaginal practices (IVPs), include intravaginal cleansing (cleansing the inside of the vagina) or intravaginal insertion of products for hygiene, health or sexuality reasons. IVPs are associated with adverse female health outcomes, development of bacterial vaginosis, HIV acquisition and transmission. A mixed methods approach was used in this study to examine the prevalence of IVP, assess reasons for engagement, and perceptions of IVP among a sample of minority (African-American and Hispanic) women infected, or at-risk, for HIV in Miami, USA, a city with increasing numbers of sexually transmitted infections (STIs) and HIV. Three focus groups (total n=20) and quantitative assessments (n=72) were conducted with women infected or uninfected with HIV. In the qualitative assessments, most women reported engaging in both intravaginal cleansing and intravaginal insertion, and stated the main motivation for IVP was hygiene. The quantitative assessments confirmed that cleansing with water alone, soap with water or using commercial douches was common, as well as intravaginal insertion using a cloth or a rag in both HIV-infected and uninfected women. Women with HIV infection reported less use of water and water and soap for IVPs, and reported learning about the potential harm of IVP from their HIV health care providers. Despite their health risks, IVP appeared common in both HIV-infected and at-risk minority women, and interventions to decrease IVP could have important health implications among populations with high rates of IVP, STIs and HIV.

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Section: Discussionmentioning

confidence: 93%

Addressing intravaginal practices in women with HIV and at-risk for HIV infection, a mixed methods pilot study

Alcaide

Fischl

Rodriguez

2017

IJWH

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“…New approaches to control BV have included alternative drug regimens [135], probiotics [136], biofilm disruptors [137–143], risk factor modification (e.g. cessation of intravaginal practices) [144, 145], and suppressive regimens administered as PPT and periodic directed treatment [119, 120, 123, 146]. Many of these regimens have reduced BV recurrences.…”

Section: Current Approaches For Modulating the Vaginal Microbiomementioning

confidence: 99%

Vaginal microbiota and susceptibility to HIV

Eastment¹,

McClelland

2018

Aids

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: Bacterial vaginosis, characterized by the replacement of the Lactobacillus-dominant microbiota with anaerobic bacteria and facultative Gram-negative rods, has been associated with adverse reproductive health outcomes including HIV acquisition. With the advent of newer molecular techniques, the vaginal microbiota can be investigated in more detail and the association with HIV examined more thoroughly. This review examines recent evidence suggesting that vaginal dysbiosis with increased microbial diversity, specific vaginal bacterial communities, and the presence and concentrations of some individual bacterial species, may increase HIV susceptibility. Potential mechanisms through which vaginal microbiota could impact HIV susceptibility are discussed. On the basis of the available data, this review finds that there is a modest, but growing, body of evidence linking vaginal microbiota to HIV susceptibility in women. The evidence could be strengthened through two main pathways. First, laboratory studies such as ex-vivo or animal experiments are needed to move from plausible mechanisms towards proven mechanisms that explain an effect of the vaginal microbiota on HIV susceptibility. Second, experimental evidence could directly test the hypothesis that sustaining optimal microbiota reduces HIV risk, though there are important obstacles to conducting such studies. Finally, this review examines strong evidence from a recent publication suggesting that deviations from an optimal vaginal microbiome, and particularly the presence of some bacterial communities with high relative abundance of Gardnerella vaginalis, reduces the efficacy of vaginal tenofovir-based microbicides.

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“…[51][52][53] Some scholars have proposed group delivered interventions for peer support and motivation to facilitate discussion, and possibly cessation, of IVPs may be effective. 54,55 Are intravaginal practices associated with human papillomavirus and the development of cervical cancer? A systematic...…”

Section: Discussionmentioning

confidence: 99%

Are intravaginal practices associated with human papillomavirus and the development of cervical cancer? A systematic literature review

Museba

Howett

Campbell

2021

Journal of Global Health Reports

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Background Intravaginal practices (IVPs) are behaviours undertaken by women in diverse global settings for the promotion of hygiene and sexual health. Although evidence is inconclusive, it has been suggested that they may be harmful and associated with adverse gynaecological outcomes. The objective of this study was to investigate whether there is an association between IVPs, human papillomavirus (HPV) infection and the development of cervical cancer. As human immunodeficiency virus (HIV) infection may be a factor accelerating progression, recent evidence on the association between IVPs and HIV was also considered. Methods A systematic review of primary observational studies was carried out according to PRISMA (Preferred Reporting Items for Systematic Reviews) guidelines. A detailed search strategy was developed and modified for use in six databases and grey literature sources, searching from 01 January 1990 to 03 June 2019. Due to marked heterogeneity, narrative synthesis was used to combine findings. Results Twenty studies met the review criteria. The majority of studies were cross-sectional, and of moderate to low quality. A total of 14,493 participants were included, from 15 countries. IVP prevalence ranged from below 10% to over 90% across study populations. Six of eleven studies found an increased risk of HPV infection with IVPs; five of seven studies found an increased risk of cervical disease with IVPs. Two studies examining association of IVPs with risk of HIV infection were identified: both found associations with intravaginal cleansing, one found an association with intravaginal insertion. Potential moderator variables including the types of substances used, the frequency, timing and duration of IVP use were assessed: evidence was conflicting and inconsistent. Conclusions Current evidence is largely suggestive of a harmful association between IVPs and the development of cervical cancer. However, significant methodological limitations were recognised; there is a need for well-designed studies using consistent definitions and classifications. Intravaginal practices (IVPs) are behaviours undertaken by women for the promotion of hygiene and sexual health in sub-Saharan Africa, SouthEast Asia, and North and South America. A classification of different IVPs has been proposed by the World Health Organization (WHO) Gender, Sexuality and Vaginal Practices (GSVP) Study Group 1,2 (Box 1). Use of IVPs can alter the vaginal micro-environment, and are postulated to lead to several adverse gynaecological outcomes. 3-5 This has been hypothesised to be due to micro-trauma, inflammation and changes to the vaginal pH and vaginal flora thereby interfering with protective immunological mechanisms. 6-8 However, evidence to support this association has been conflicting. Most recently, the association of IVPs with human immunodeficiency virus (HIV) was investigated in two systematic reviews 4,9 and was found to be inconclusive but potentially related to harm. No previous systematic review has assessed the general association ...

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Cessation of intravaginal practices to prevent bacterial vaginosis: a pilot intervention in Zimbabwean women

Abstract: While the intervention was successful in reducing women's self-reported engagement in intravaginal practices, we observed no corresponding benefit to vaginal health.

Cited by 9 publications

References 25 publications

Addressing intravaginal practices in women with HIV and at-risk for HIV infection, a mixed methods pilot study

Addressing intravaginal practices in women with HIV and at-risk for HIV infection, a mixed methods pilot study

Vaginal microbiota and susceptibility to HIV

Are intravaginal practices associated with human papillomavirus and the development of cervical cancer? A systematic literature review

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