Frequent Douching and Clinical Outcomes Among HIV-Infected Women

In Brief Objective: To determine the prevalence of douching among a cohort of HIV-infected women and to examine clinical outcomes associated with frequent douching—namely bacterial vaginosis, presence of a sexually-transmitted infections, and genital tract HIV-1 RNA shedding. Study Design: Participants included a concurrent cohort of 187 women attending an HIV outpatient clinic in New Orleans, LA. Subjects underwent clinical examinations and answered questions in a computer-assisted survey at each visit. Results: At baseline, 1-, and 3-month follow-ups, 64.2%, 56.5%, and 54.7% of women, respectively, indicated that they douched. In multivariable analyses, douching >1 time a month was independently associated with the outcomes of bacterial vaginosis and presence of a selected sexually transmitted infection (Trichomonas vaginalis, Neisseria gonorrhea, or Chlamydia trachomatis). Although not significant, women who douched >1 time a month were also twice as likely to have genital tract HIV-1 RNA shedding as nondouchers. Conclusions: This is the first study performed in women infected with HIV to link a significant dose–response relationship between douching and the clinical outcomes of bacterial vaginosis and presence of a sexually transmitted infection, and to examine the association between douching and genital tract HIV-1 RNA shedding. This study found a dose–response relationship between douching and the clinical outcomes of bacterial vaginosis and selected sexually transmitted infection prevalence. Although not significant, women who douched >1 time a month were more likely to have genital tract HIV-1 RNA shedding.