title: Frequent douching and clinical outcomes among HIV-infected women.
abstract: 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.
  
  
  METHODS
  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.
authors.affiliation: Department of Medicine, Louisiana State University Health Science Center, USA. rclark@lsuhsc.edu
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Clark
authors.forename: Katherine P
authors.initials: KP
authors.lastname: Theall
authors.forename: Angela M
authors.initials: AM
authors.lastname: Amedee
authors.forename: Patricia J
authors.initials: PJ
authors.lastname: Kissinger
mesh_terms: D000328:Adult; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000821:virology*; D015497:HIV-1 / Q000502:physiology*; D006801:Humans; D008875:Middle Aged; D012367:RNA, Viral / Q000032:analysis; D012749:Sexually Transmitted Diseases / Q000453:epidemiology* / Q000209:etiology; D012996:Solutions; D011795:Surveys and Questionnaires; D014621:Vagina / Q000502:physiology / Q000821:virology; D044364:Vaginal Douching / Q000009:adverse effects* / Q000706:statistics & numerical data*; D016585:Vaginosis, Bacterial / Q000453:epidemiology* / Q000382:microbiology; D017201:Virus Shedding
chemical_list: D012367:RNA, Viral; D012996:Solutions