1. PROMISCUOUS SEXUAL ACTIVITY IS ASSOCIATED WITH BACTERIAL VAGINOSIS IN YOUNG WOMEN WHO DOUCHE MK Oh, J Schwebke, J Merchant, P Brown, R Desmond, M Jones, H Weiss University of Alabama at Birmingham, Birmingham, AL. NIAID (U19AI3814- UAB CRC)

2. Background  Vaginal douching has been linked to bacterial vaginosis (BV).  The mechanism of this association is unclear.

3. Purpose:Purpose: To determine correlates of BV in adolescent and young women who douche.

4. Methods Study participants*  Women 14-21 years of age  Last douched within past 35 d.  Exclusion: pregnancy, chronic dz * B-WELL study: RCT of douching intervention

5. Methods Baseline data included  Hx of douching  sexual behaviors  STD Hx  Lab tests (STDs, BV)

6. Methods Douching history  Age at the 1st douching  Last douched (# of days ago)  Frequency  Timing  Reasons  Solutions used

7. Methods Sexual behaviors u Freq of sexual intercourse u Last sex (# of days ago) u # of partners (lifetime, in 3-mo.) u Condom use u BC use

8. Methods Laboratory tests  BV (Nugent score ≥7)  C. trachomatis (CT) urine LCR  N. gonorrhoeae (GC) urine LCR  T. vaginalis by culture  HSV type specific serology by ELISA  HIV, VDRL

9. Methods - Analyses Data from BV + at baseline (n=60) were compared with those who were BV negative (n= 84)  Student t-tests  Fisher’s Exact test  Logistic regression analysis

10. Results - 144 participants  Mean age 18.7±1.9 yrs.  age at sexual debut 15.0±1.7 yrs.  42% a history of STD  26% a history of BV

11. Sexual behaviors ( n=144)  Last sex ≤7 days ago: 39%  >3 lifetime partners:50%  >1 partner in past 3 mo: 21%  ≥10 times sex in 3 mo: 48%  Condom used /c last sex:52%  Hormonal BC use, yes: 33%

12. Lab tests (% positive) 144 participants 14% 5% 7% 22% 42%

13. Douching - 144 participants  Age at first douche: 15.8±1.9 yrs  Timing  after menses:89%  after sex: 41%  before sex:15%  before MD vst: 8%  Frequency  44% - more than once a month  32% - douched within the last wk.

14. Variables associated /c BV

15. Independent variables associated /c BV Multiple ptns >1 in 3-mo. Recent sex ≤ 7 days Adjusted O.R. 95% CI 2.58 2.48 1.02, 6.49 1.16, 5.30

16. Among women who douche, BV was not significantly associated with  Frequency of douching  Recency of douching  Timing of douching  Types of solution used  Reasons for douching

18. Limitations  Small sample size  All douched within the past 35 d.  Cross sectional - baseline data  Self-reported historical data

19. Conclusion  BV positive rate was 42% in young women who douche.  Predictors of BV in these women were recent sex, multiple partners in recent 3- mo.

20.  B-WELL study is Supported by a grant from NIAID (U19AI3814- UAB CRC) - Edward W. Hook, III.  Acknowledgement to other coinvestigators on the study Sten Vermund Ellen Funkhouser Diane Grimley

21. Implications  Studies examining effects of vaginal douching must account for confounding sexual behaviors.  Management of women with BV should include assessment for high risk sexual behavior and testing for STDs.