The HPTN 035 trial of the candidate microbicide PRO2000 therefore included a survey of vaginal health practices, counselling against ones associated with a raised risk of BV, and assessing any link between these practices and BV. It found none, though a smaller study of women in Los Angeles did find an association not with douching and BV, but between the use of petroleum jelly as a lubricant and BV.
In the case of rectal douching in women and gay men, there is very little we currently know about the practice. However, findings over the last couple of years that the use of lubricants for anal sex, particularly water-based ones, is associated with higher rates of sexually transmitted infections have raised concerns that other practices that impact on the fragile rectal mucosa may also raise the risk of sexually transmitted infections (STIs) and HIV. International Rectal Microbicide Advocates (IRMA) have therefore conducted a survey of rectal douching practice. Interim results were presented yesterday and the survey is still ongoing.
Vaginal and rectal practices in women in HPTN 035 and in Los Angeles
In HPTN 035, vaginal hygiene practices were assessed at quarterly visits and the 3087 participants were counselled to try not to use the practices. They were divided into women who did not practise vaginal washing, ones who only used water and ones who used other products such as soap and water or commercial douches (Kasaro).
The proportion of women not practising any vaginal hygiene fell from 60% at baseline to 36.5% at last visit, and this was a steady fall over time, not just occurring immediately after the baseline visit.
Bacterial vaginosis (BV) was common at baseline and the proportion of women with it did not change over time – at any visit 36 to 38% of women had BV. There was no association between vaginal hygiene practices and BV.
Another study of women in Los Angeles (Brown) assessed vaginal hygiene and lubricant practices in an observational cohort of 141 women. The cohort was structured to reflect a mix of ethnicity and HIV serostatus: 26% had HIV and 40% were black, 34% white and 26% Latina. Their median age was 33 (range 18-65).