Copyright © 2005 by the Johns Hopkins Bloomberg School of Public Health
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Douching, Pelvic Inflammatory Disease, and Incident Gonococcal and Chlamydial Genital Infection in a Cohort of High-Risk Women
1 Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA.
2 Department of Obstetrics/Gynecologic and Reproductive Science, Division of Reproductive Infectious Disease, Magee-Women’s Hospital of UPMC, Pittsburgh, PA.
3 Department of Obstetrics and Gynecology, Division of Medical Surgical Gynecology, University of Alabama School of Medicine, Birmingham, AL.
4 Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC.
5 Department of Obstetrics and Gynecology, Denver Health Medical Center, Denver, CO.
6 Department of Medicine, Section of Infectious Diseases, Boston Medical Center, Maxwell Finland Laboratory, Boston, MA.
7 Department of Obstetrics and Gynecology, Section of Infectious Diseases, University of California, Davis, CA.
Douching has been linked to gonococcal or chlamydial cervicitis and pelvic inflammatory disease (PID) in retrospective studies. The authors conducted a 1999–2004 prospective observational study of 1,199 US women who were at high risk of acquiring chlamydia and were followed for up to 4 years. Cervical Neisseria gonorrhoeae and Chlamydia trachomatis were detected from vaginal swabs by nucleic acid amplification. PID was characterized by histologic endometritis or pelvic pain and tenderness plus one of the following: oral temperature >38.3°C, leukorrhea or mucopus, erythrocyte sedimentation rate >15 mm/hour, white blood cell count >10,000, or gonococcal/chlamydial lower genital tract infection. Associations between douching and PID or gonococcal/chlamydial genital infections were assessed by proportional hazards models. The 4-year incidence rate of PID was 10.9% and of gonococcal and/or chlamydial cervicitis was 21.9%. After adjustment for confounding factors, douching two or more times per month at baseline was associated with neither PID (adjusted hazard ratio = 0.76, 95% confidence interval: 0.42, 1.38) nor gonococcal/chlamydial genital infection (adjusted hazard ratio = 1.16, 95% confidence interval: 0.76, 1.78). Frequency of douching immediately preceding PID or gonococcal/chlamydial genital infection was not different between women who developed versus did not develop outcomes. These data do not support an association between douching and development of PID or gonococcal/chlamydial genital infection among predominantly young, African-American women.
cervicitis; chlamydia; Chlamydia trachomatis; endometritis; Neisseria gonorrhoeae; pelvic inflammatory disease; prospective studies; women
Abbreviations: CI, confidence interval; HR, hazard ratio; PID, pelvic inflammatory disease.
Reprint requests to Dr. Roberta B. Ness, University of Pittsburgh, Graduate School of Public Health, Room A530 Crabtree Hall, 130 DeSoto Street, Pittsburgh, PA 15261 (e-mail: repro{at}pitt.edu).
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