VAGINAL DOUCHING AS A RISK FACTOR FOR VAGINITIS

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DESCRIPTION: (Adapted from investigator's abstract) Incident and recurrent vaginitis are highly prevalent health problems in women of reproductive age resulting in significant medical care costs and limitation of work activity. The symptoms of excessive vaginal discharge, malodor and intensive vulvovaginal pruritus can seriously impair women=s productivity and social life. Vaginitis also facilitates HIV transmission. Bacterial vaginosis and candidiasis are the most common causes of vaginitis. However, despite their high prevalence, risk factors for developing these infections remain unclear. The investigators hypothesize that frequent vaginal douching increases the risk of bacterial vaginosis and candidiasis by disturbing the normal vaginal microflora and immunologic defense system. To test this hypothesis, it is proposed to recruit a cohort of 1260 black women seeking treatment at Mount Sinai Hospital's outpatient gynecologic/family planning clinic between January, 1999 and June, 2000. A standardized questionnaire will be used to collect detailed information on douching practices and other risk factors for vaginitis, with particular attention to the three months prior to the clinic visit. In addition to recording clinical symptoms and signs, samples of vaginal discharge will be collected for diagnostic verification using Gram stain with scoring (for bacterial vaginosis) and culture (or Candida albicans). Subjects will also be tested for trichomoniasis (culture), gonorrhea and chlamydia (DNA probe tests); those with symptomatic infections will be excluded. The association between vaginal douching in the previous three months and risk of bacterial vaginosis and between douching and candidacies will be examined using multiple logistic regression models to control for confounding variables. In addition, frequency of douching and duration of douching practice will be examined to test a dose-response pattern. The investigators state that the elucidation of the role of douching practices in the etiology of vaginitis will have important public health implications and could make a major contribution to promoting women's health. Further, both douching and vaginitis are very common in minority heterosexual women, among whom the prevalence of AIDS is growing fastest. In the era of the AIDS epidemic, this study will have public health significance beyond vaginitis.