title: Effect of intravaginal practices on the vaginal and cervical mucosa of Zimbabwean women.
abstract: OBJECTIVE
  Lesions on the vaginal and cervical mucosa may facilitate transmission of HIV and other sexually transmitted diseases (STDs). We evaluated the relationship between intravaginal practices and the presence of colposcopic lesions in Zimbabwean women.
  
  
  METHODS
  Users and nonusers of intravaginal practices were seen at enrollment, and at 1 and 6 months. Interviewing, counseling, and pelvic and colposcopic examinations were performed at each study visit. Specimens were collected at enrollment and 6 months.
  
  
  RESULTS
  Colposcopic lesions were found at least once in 83% of the participants (n = 162), and in 66% of all exams (n = 430). Most lesions were classified as related to infection with human Papillomavirus (HPV) (58%) or another pathogen (20%), but 11% of lesions could have been caused by intravaginal practices (signal lesions). Intravaginal practices were not associated with an increased incidence in signal lesions (95 and 124 lesions per 100 person-years of follow-up for users and nonusers respectively; p = .290), nor with the presence of signal lesions in multivariate baseline (odds ratio [OR], 1.32; 95% confidence interval [CI], 0.37-4.72; p = .666) and six month transition models (OR, 1.67; 95% CI, 0.59-4.70; p = .333).
  
  
  CONCLUSIONS
  No associations between intravaginal practices and colposcopic lesions were found in this study. However, the potential effect of intravaginal practices on the cervical and vaginal mucosa, and on subsequent HIV and STD transmission, warrants further study. The usefulness of colposcopy as a research tool in areas with high prevalences of HIV and HPV is questioned.
authors.affiliation: University of Zimbabwe, Harare. jvandewijgert@popcouncil.org.
authors.forename: J H
authors.initials: JH
authors.lastname: van de Wijgert
authors.forename: Z M
authors.initials: ZM
authors.lastname: Chirenje
authors.forename: V
authors.initials: V
authors.lastname: Iliff
authors.forename: M T
authors.initials: MT
authors.lastname: Mbizvo
authors.forename: P R
authors.initials: PR
authors.lastname: Mason
authors.forename: L
authors.initials: L
authors.lastname: Gwanzura
authors.forename: S
authors.initials: S
authors.lastname: Shiboski
authors.forename: N S
authors.initials: NS
authors.lastname: Padian
mesh_terms: D000293:Adolescent; D000328:Adult; D002584:Cervix Uteri / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000453:epidemiology; D006801:Humans; D008875:Middle Aged; D009092:Mucous Membrane / Q000473:pathology; D011446:Prospective Studies; D012725:Sexual Behavior; D012749:Sexually Transmitted Diseases / Q000453:epidemiology; D014621:Vagina / Q000473:pathology*; D015030:Zimbabwe / Q000453:epidemiology