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Associations Between Intravaginal Practices and Bacterial Vaginosis in Kenyan Female Sex Workers Without Symptoms of Vaginal Infections

Hassan, Wisal M. MBChB, MPH; Lavreys, Ludo MD, MSc, PhD; Chohan, Vrasha BSc§; Richardson, Barbra A. PhD; Mandaliya, Kishorchandra MBChB, FRCP; Ndinya-Achola, Jeckoniah O. MBChB, MSc§; Kiarie, James MBChB, MMed, MPH; Jaoko, Walter MBChB, MTMed, PhD§; Holmes, King K. MD, PhD*†; McClelland, R Scott MD, MPH*†§

Sexually Transmitted Diseases: June 2007 - Volume 34 - Issue 6 - p 384-388
doi: 10.1097/01.olq.0000243624.74573.63

Background: Bacterial vaginosis (BV) is highly prevalent among African women and has been associated with adverse pregnancy outcomes, sexually transmitted diseases, and HIV-1.

Goal: The goal of this study was to analyze the relationship among intravaginal practices, bathing, and BV.

Study Design: The authors conducted a cross-sectional study of HIV-1-seronegative Kenyan female sex workers without symptoms of vaginal infections.

Results: Of 237 women enrolled, 206 (87%) reported vaginal washing using either a finger or cloth. Increasing frequency of vaginal washing was associated with a higher likelihood of BV (χ2 test for trend, P = 0.05). In multivariate analysis, vaginal lubrication with petroleum jelly (odds ratio [OR] = 2.8, 95% confidence interval [CI] = 1.4–5.6), lubrication with saliva (OR = 2.3, 95% CI = 1.1–4.8), and bathing less than the median for the cohort (14 times/week; OR = 4.6, 95% CI = 1.2–17.5) were associated with a significantly higher likelihood of BV.

Conclusions: Modification of intravaginal and general hygiene practices should be evaluated as potential strategies for reducing the risk of BV.

Among Kenyan female sex workers, lubrication with petroleum jelly, lubrication with saliva, and less frequent bathing were identified as novel risk factors for bacterial vaginosis.

From the Departments of *Epidemiology, †Medicine, and ‡Biostatistics, University of Washington, Seattle, Washington; the Departments of §Medical Microbiology and |Obstetrics and Gynecology, University of Nairobi, Nairobi; and ¶Coast Provincial General Hospital, Mombasa, Kenya

The authors thank Kenya HIV/STD Research Project staff, laboratory personnel and study participants for making this study a success.

This research was supported through National Institutes of Health Grant K23 AI-52480. W. M. Hassan was supported by Fogarty International Center grant D43-TW00007.

Correspondence: Wisal M. Hassan, MBChB, MPH, International AIDS Research and Training Program, University of Washington, Box 359909, 325 Ninth Avenue, Seattle, WA 98104. E-mail:

Received for publication March 1, 2006, and accepted August 15, 2006.

© Copyright 2007 American Sexually Transmitted Diseases Association