TY - JOUR
T1 - Douching cessation and molecular bacterial vaginosis
T2 - A reanalysis of archived specimens
AU - Brown, Sarah Elizabeth
AU - He, Xin
AU - Shardell, Michelle D.
AU - Ravel, Jacques
AU - Ghanem, Khalil G.
AU - Zenilman, Jonathan M.
AU - Brotman, Rebecca M.
N1 - Funding Information:
Handling editor Jonathan Ross Acknowledgements We thank Courtney Robinson for contributing to sample DNA preparation. Contributors RMB, KGG and JMZ designed and implemented the study. SEB analysed the data with statistical support from XH and MDS. JR provided microbiology and genomics expertise. SEB wrote the first draft. RB acted as the guarantor. All authors read, revised and approved the final manuscript. Funding This work was funded by the National Institutes of Allergy and Infectious Diseases (NIAID) grants R03-AI061131 (JMZ), K01-AI080974 (RMB) and R01-AI119012 (RMB). The funders had no role in study design, data collection, analysis, writing or the decision to submit this manuscript.
Publisher Copyright:
© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2023/5/1
Y1 - 2023/5/1
N2 - Objectives Observational studies demonstrate an association between vaginal douching and bacterial vaginosis (BV) characterised by Gram stain. We sought to describe the effect of a douching cessation intervention on the composition and structure of the vaginal microbiota and molecular-BV, a state defined by low levels of Lactobacillus spp evaluated by molecular tools. Methods 33 women self-collected mid-vaginal swabs twice weekly (982 samples) during a douching observation phase (4 weeks) followed by a douching cessation phase (12 weeks) in a 2005 single crossover pilot study conducted in Baltimore, Maryland. Vaginal microbiota were characterised by 16S rRNA gene amplicon sequencing (V3-V4) and clustered into community state types (CSTs). Conditional logistic regression modelling allowed each participant to serve as their own control. Wilcoxon signed-rank tests were used to evaluate changes in microbiota between phases. Broad-range qPCR assays provided estimates of bacterial absolute abundance per swab in a subsample of seven participants before and after douching. A piecewise linear mixed effects model was used to assess rates of change in bacterial absolute abundance before and after douching. Results There was no statistically significant change in the odds of molecular-BV versus Lactobacillus-dominated CSTs comparing the douching cessation interval to douching observation (adjusted OR 1.77, 95% CI 0.89 to 3.55). Removal of L. iners-dominated CST III from the outcome did not affect the results. There were no significant changes in the relative abundance of four Lactobacillus spp and no meaningful changes in other taxa investigated. There was no significant change in bacterial absolute abundance between a participant's sample collected 3 days prior to and following douching (p=0.46). Conclusions In this pilot study, douching cessation was not associated with major changes in vaginal microbiota. Douching cessation alone may not durably shift the vaginal microbiota and additional interventions may be needed to restore optimal vaginal microbiota among those who douche.
AB - Objectives Observational studies demonstrate an association between vaginal douching and bacterial vaginosis (BV) characterised by Gram stain. We sought to describe the effect of a douching cessation intervention on the composition and structure of the vaginal microbiota and molecular-BV, a state defined by low levels of Lactobacillus spp evaluated by molecular tools. Methods 33 women self-collected mid-vaginal swabs twice weekly (982 samples) during a douching observation phase (4 weeks) followed by a douching cessation phase (12 weeks) in a 2005 single crossover pilot study conducted in Baltimore, Maryland. Vaginal microbiota were characterised by 16S rRNA gene amplicon sequencing (V3-V4) and clustered into community state types (CSTs). Conditional logistic regression modelling allowed each participant to serve as their own control. Wilcoxon signed-rank tests were used to evaluate changes in microbiota between phases. Broad-range qPCR assays provided estimates of bacterial absolute abundance per swab in a subsample of seven participants before and after douching. A piecewise linear mixed effects model was used to assess rates of change in bacterial absolute abundance before and after douching. Results There was no statistically significant change in the odds of molecular-BV versus Lactobacillus-dominated CSTs comparing the douching cessation interval to douching observation (adjusted OR 1.77, 95% CI 0.89 to 3.55). Removal of L. iners-dominated CST III from the outcome did not affect the results. There were no significant changes in the relative abundance of four Lactobacillus spp and no meaningful changes in other taxa investigated. There was no significant change in bacterial absolute abundance between a participant's sample collected 3 days prior to and following douching (p=0.46). Conclusions In this pilot study, douching cessation was not associated with major changes in vaginal microbiota. Douching cessation alone may not durably shift the vaginal microbiota and additional interventions may be needed to restore optimal vaginal microbiota among those who douche.
KW - MICROBIOLOGY
KW - MOLECULAR EPIDEMIOLOGY
KW - REPRODUCTIVE HEALTH
KW - Sexual Behaviour
KW - Vaginosis, Bacterial
UR - http://www.scopus.com/inward/record.url?scp=85131799041&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85131799041&partnerID=8YFLogxK
U2 - 10.1136/sextrans-2022-055459
DO - 10.1136/sextrans-2022-055459
M3 - Article
C2 - 35636931
AN - SCOPUS:85131799041
SN - 1368-4973
VL - 99
SP - 156
EP - 161
JO - Sexually transmitted infections
JF - Sexually transmitted infections
IS - 3
ER -