title: High Levels of Inflammatory Cytokines in the Reproductive Tract of Women with BV and Engaging in Intravaginal Douching: A Cross-Sectional Study of Participants in the Women Interagency HIV Study.
abstract: High levels of inflammatory cytokines in the genital tract suggest mucosal vulnerability and increased risk of HIV and sexually transmitted infection (STI) acquisition. Intravaginal douching is associated with bacterial vaginosis (BV) in women in the United States, and both douching and BV are linked to HIV and STI acquisition. This study evaluates inflammatory cytokines in the genital tract to increase understanding of the effects of both BV and intravaginal douching to the vaginal mucosa. A cross-sectional study of participants in the Miami WIHS investigated 72 reproductive age women (45 HIV+and 27 high-risk HIV-) who completed intravaginal douching questionnaires and underwent collection of vaginal swabs and cervicovaginal lavages (CVLs). BV was assessed using the Nugent score. Inflammatory cytokines in the CVLs (interleukin [IL]-6, IL-8, IL-1α, IL-1β, soluble intracellular adhesion molecule-1 [sICAM-1], interferon [IFN]α2, chemokine C ligand 5 (CCL5), vascular endothelial growth factor (VEGF), monocyte chemotactic protein-1 (MCP1), tumor necrosis factor alpha (TNFα), and secretory leukocyte protease inhibitor [SLPI]) were measured. Fourteen (19%) women reported intravaginal douching; 24 (33%) had BV. BV, intravaginal douching, and HIV were associated with higher levels of inflammatory cytokines. After controlling for demographic and risk factors and HIV status, women who had BV and douched had higher levels of inflammatory cytokines than those without BV and who did not douche, or who only had BV or only douched. These findings suggest that BV and douching are associated with greater mucosal inflammation and may facilitate HIV acquisition and transmission. Although longitudinal studies are needed to determine temporal associations and causality, interventions to decrease rates of intravaginal douching and BV could significantly decrease women's risks of acquiring STIs and HIV and limit the spread of HIV.
authors.affiliation: 1 Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine , Miami, Florida.
authors.forename: Maria L
authors.initials: ML
authors.lastname: Alcaide
authors.affiliation: 2 Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine , Miami, Florida.
authors.forename: Violeta J
authors.initials: VJ
authors.lastname: Rodriguez
authors.affiliation: 2 Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine , Miami, Florida.
authors.forename: Megan R
authors.initials: MR
authors.lastname: Brown
authors.affiliation: 3 Department of Microbiology and Immunology, University of Miami Miller School of Medicine , Miami, Florida.
authors.forename: Suresh
authors.initials: S
authors.lastname: Pallikkuth
authors.affiliation: 4 Department of Epidemiology and Public Health, University of Miami Miller School of Medicine , Miami, Florida.
authors.forename: Kristopher
authors.initials: K
authors.lastname: Arheart
authors.affiliation: 3 Department of Microbiology and Immunology, University of Miami Miller School of Medicine , Miami, Florida.
authors.forename: Octavio
authors.initials: O
authors.lastname: Martinez
authors.affiliation: 3 Department of Microbiology and Immunology, University of Miami Miller School of Medicine , Miami, Florida.
authors.forename: Margaret
authors.initials: M
authors.lastname: Roach
authors.affiliation: 5 Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School , Boston, Massachusetts.
authors.forename: Raina N
authors.initials: RN
authors.lastname: Fichorova
authors.affiliation: 2 Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine , Miami, Florida.
authors.forename: Deborah L
authors.initials: DL
authors.lastname: Jones
authors.affiliation: 3 Department of Microbiology and Immunology, University of Miami Miller School of Medicine , Miami, Florida.
authors.forename: Savita
authors.initials: S
authors.lastname: Pahwa
authors.affiliation: 1 Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine , Miami, Florida.
authors.forename: Margaret A
authors.initials: MA
authors.lastname: Fischl
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D016207:Cytokines / Q000032:analysis*; D005260:Female; D015658:HIV Infections / Q000453:epidemiology; D006801:Humans; D008875:Middle Aged; D009092:Mucous Membrane / Q000473:pathology*; D011795:Surveys and Questionnaires; D014481:United States; D014621:Vagina / Q000473:pathology*; D044364:Vaginal Douching / Q000009:adverse effects*; D016585:Vaginosis, Bacterial / Q000150:complications / Q000473:pathology*; D055815:Young Adult
chemical_list: D016207:Cytokines
keywords: bacterial vaginosis; genital cytokines; vaginal douches; women and HIV