Effect of Intravaginal Practices on the Vaginal and Cervical Mucosa of Zimbabwean Women : JAIDS Journal of Acquired Immune Deficiency Syndromes

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Effect of Intravaginal Practices on the Vaginal and Cervical Mucosa of Zimbabwean Women

van de Wijgert, Janneke H. H. M.*†; Chirenje, Zvavahera M.*; Iliff, Virginia*; Mbizvo, Michael T.*‡; Mason, Peter R.§; Gwanzura, Lovemore§; Shiboski, Stephen∥; Padian, Nancy S.*†

Author Information

*University of Zimbabwe University of California at San Francisco Collaborative Research Programme in Women's Health, Harare, Zimbabwe; †Department of Obstetrics, Gynecology, and Reproductive Science, University of California at San Francisco, San Francisco, California, U.S.A.; ‡World Health Organization, Special Program of Research Development and Research Training in Human Reproduction, Geneva, Switzerland; §University of Zimbabwe, Department of Medical Laboratory Sciences, Harare, Zimbabwe; and ∥Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, California, U.S.A.

Address correspondence and reprint requests to Janneke van de Wijgert, The Population Council, One Dag Hammarskjold Plaza, New York, NY 10017, U.S.A.; email: [email protected].

Manuscript received August 16, 1999; accepted February 16, 2000.

JAIDS Journal of Acquired Immune Deficiency Syndromes 24(1):p 62-67, May 1, 2000.
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Abstract

Objectives: 

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.

© 2000 Lippincott Williams & Wilkins, Inc.