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

Abstract

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. (Sex Transm Inf 2001;77:271-275)

HIV-infected women of Burkina Faso: a “reservoir” of mycoplasma infection

“…The reason for higher BV in HIV-positive women in the African population is not known, but the correlation between HIV serostatus and lifestyle practice such as vaginal douching and no use of condoms could explain this increased prevalence of BV [13,14,15]. However, this association may be influenced by the level of education and other socio-economic and behavioural factors which must be taken into consideration.…”

Anal sex and associated HIV-related sexual risk factors among female sex workers in Andhra Pradesh, India

“…One study conducted in Rwanda and Kenya showed that~5% of FSWs reported ever practicing anal sex, 2 but many other studies in Kenya indicate higher prevalence levels of anal sex among FSWs ranging between 14% and 40%. [19][20][21][22][23] A study conducted in South Africa suggests that more than 40% of the FSWs soliciting at truck stops had engaged in anal sex. 24 Other research in South Africa suggests that FSWs, on average, engage in five anal sex acts per week.…”

Vaginal Douching, Condom Use, and Sexually Transmitted Infections Among Chinese Female Sex Workers

“…is a common practice among women around the world. 7,8 There is some evidence that frequent vaginal douching may increase a woman's susceptibility to sexually transmitted agents through modification of the vaginal flora. A meta-analysis reviewing 13 studies revealed that frequent douching appears to be highly associated with pelvic inflammatory disease (PID) and modestly associated with ectopic pregnancy and cervical cancer.…”