Work

Association between vaginal washing and detection ofLactobacillusby culture and quantitative PCR in HIV-seronegative Kenyan women: a cross-sectional analysis

Year: 2019

Type: article

Abstract: Objectives Vaginal washing has been associated with reductions in cultivableLactobacillusand an increased risk of both bacterial vaginosis (BV) and HIV infection. The effect of vaginal washing on the quantity of individualLactobacillusspecies is not well characterised. This analysis tested the hypothesis that vaginal washing would be associated with a lower likelihood ofLactobacillusspp. detected by both culture and quantitative PCR (qPCR). Methods We conducted a cross-sectional study of 272 HIV-seronegative women enrolled in an open-cohort study in Mombasa, Kenya. Vaginal washing and sexual risk behaviours were assessed using face-to-face interviews. VaginalLactobacillusspp. were detected using cultivation and PCR methods, withL. crispatus,L. jensenii and L. inersconcentrations measured using qPCR assays targeting the 16S rRNA gene. Poisson regression with robust SEs was used to assess associations between vaginal washing andLactobacillusdetection by culture and qPCR. Results Eighty percent (n=217) of participants reported vaginal washing in the prior week. One-fifth (n=58) of participants had BV by Nugent score. In unadjusted analysis, vaginal washing was associated with a 45% decreased likelihood ofLactobacillusspp. detection by culture (prevalence ratio (PR): 0.55, 95% CI 0.37 to 0.82). Adjusting for age and condomless sex in the prior week did not change the magnitude of the association (adjusted PR (aPR): 0.56, 95% CI (0.37 to 0.85). Vaginal washing was associated with approximately a 40% reduction inL. crispatusdetection (aPR: 0.57, 95% CI 0.36 to 0.92), but was not significantly associated withL. jensenii(aPR: 0.68, 95% CI 0.42 to 1.09) orL. inersdetection (aPR: 1.03, 95% CI 0.92 to 1.15). Conclusions Vaginal washing in the prior week was associated with a significantly reduced likelihood of detecting cultivableLactobacillusandL. crispatusby qPCR. Given associations betweenLactobacillusdetection and improved reproductive health outcomes, these results provide motivation for additional study of vaginal washing cessation interventions to improve vaginal health.

Source: Sexually Transmitted Infections

DOI: 10.1136/sextrans-2018-053769