Sexually transmitted infections and vaginal douching in a population of female sex workers in Nairobi, Kenya

Objective: To assess the association between vaginal douching and sexually transmitted infections (STI) among a group of female sex workers (FSWs) in Nairobi, Kenya. Methods: This study was part of a randomised, placebo controlled trial of m onthly prophylaxis with I g of azithromycin to prevent STIs and HIV infecti on in a cohort of Nairobi FSWs. Consenting women were administered a questi onnaire and screened for STIs. Results: The seroprevalence of HIV-1 among 543 FSWs screened was 30%. HIV i nfection was significantly associated with bacterial vaginosis (BV), tricho moniasis, gonorrhoea, and the presence of a genital ulcer. Regular douching was reported by 72% of the women, of whom the majority inserted fluids in the vagina, generally after each sexual intercourse. Water with soap was th e fluid most often used (81%), followed by salty water (18%), water alone ( 9%), and a commercial antiseptic (5%). Douching in general and douching wit h soap and water were significantly associated with bacterial vaginosis (p = 0.05 and p = 0.04 respectively). There was a significant trend for increa sed frequency of douching and higher prevalence of BV. There was no direct relation observed between douching and risk for HIV infection or other STIs . Conclusion: The widespread habit of douching among African female sex worke rs was confirmed. The association between vaginal douching and BV is of con cern, given the increased risk of HIV infection with BV, which has now been shown in several studies. It is unclear why we could not demonstrate a dir ect association between douching and HIV infection. Further research is req uired to better understand the complex relation between douching, risk for bacterial vaginosis, and risk for HIV and other STIs.