title: Does douching increase risk for sexually transmitted infections? A prospective study in high-risk adolescents.
abstract: OBJECTIVE
  The objective of the study was to examine the association between douching and 4 sexually transmitted infections (STIs).
  
  
  METHODS
  We followed up 411 high-risk human immunodeficiency virus-infected and uninfected female adolescents aged 12-19 years over a median 3-year period, both by time from study entry/first STI-free visit until an incident STI for participants who never, intermittently, and always douched and also by reported douching at a given STI-free visit and incidence of STI at the next visit, using adjusted Cox proportional hazards models to calculate hazard ratios (HR).
  
  
  RESULTS
  The time to STI was shorter for adolescents who always (HR, 2.1; 95% confidence interval [CI], 1.2-3.4) and intermittently (HR, 1.5; 95% CI, 1.0-2.2) douched, compared with never-douchers. An adjusted hazard for STI was 1.8 times larger for always-douchers (95% CI, 1.1-3.1) and 1.4 times larger for intermittent douchers (95% CI, 0.9-2.0), compared with never-douchers. When classifying by follow-up after an STI-free visit, always-douchers had a shorter STI-free time than never-douchers (HR(adj), 2.1; 95% CI, 1.5-3.1).
  
  
  CONCLUSIONS
  Counseling to discourage douching may reduce STI risk in adolescents.
authors.affiliation: Institute for Global Health, Vanderbilt University School of Medicine, Nashville, TN, USA.
authors.forename: Cynthia S
authors.initials: CS
authors.lastname: Tsai
authors.forename: Bryan E
authors.initials: BE
authors.lastname: Shepherd
authors.forename: Sten H
authors.initials: SH
authors.lastname: Vermund
mesh_terms: D000293:Adolescent; D000818:Animals; D002648:Child; D002692:Chlamydia trachomatis / Q000302:isolation & purification; D015331:Cohort Studies; D005260:Female; D018258:Herpesvirus 2, Human / Q000302:isolation & purification; D006801:Humans; D015994:Incidence; D007407:Interviews as Topic; D053208:Kaplan-Meier Estimate; D009344:Neisseria gonorrhoeae / Q000302:isolation & purification; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012749:Sexually Transmitted Diseases / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology*; D014246:Trichomonas vaginalis / Q000302:isolation & purification; D044364:Vaginal Douching; D055815:Young Adult