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Original research
Douching cessation and molecular bacterial vaginosis: a reanalysis of archived specimens
  1. Sarah Elizabeth Brown1,2,
  2. Xin He3,
  3. Michelle D Shardell1,2,
  4. Jacques Ravel1,4,
  5. Khalil G Ghanem5,
  6. Jonathan M Zenilman5,
  7. Rebecca M Brotman1,6
  1. 1Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, Maryland, USA
  2. 2Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
  3. 3Department of Epidemiology and Biostatistics, University of Maryland at College Park, College Park, Maryland, USA
  4. 4Microbiology & Immunology, University of Maryland School of Medicine, Baltimore, Maryland, USA
  5. 5Division of Infectious Diseases, Johns Hopkins Medicine School of Medicine, Baltimore, Maryland, USA
  6. 6Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
  1. Correspondence to Dr Rebecca M Brotman, Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, MD 21201, USA; rbrotman{at}som.umaryland.edu

Abstract

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.

  • Vaginosis, Bacterial
  • REPRODUCTIVE HEALTH
  • MOLECULAR EPIDEMIOLOGY
  • MICROBIOLOGY
  • Sexual Behaviour

Data availability statement

Data may be obtained from a third party and are not publicly available. The datasets are available at the National Center for Biotechnology Information (NCBI) Database of Genotypes and Phenotypes (dbGaP) accession numbers phs000261.v2.p1.

https://doi.org/10.1136/sextrans-2022-055459

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    Data availability statement

    Data may be obtained from a third party and are not publicly available. The datasets are available at the National Center for Biotechnology Information (NCBI) Database of Genotypes and Phenotypes (dbGaP) accession numbers phs000261.v2.p1.

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    Footnotes

    • Handling editor Jonathan Ross

    • 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.

    • Competing interests JR is a co-founder of LUCA Biologics, a biotechnology company focusing on translating microbiome research into live biotherapeutic drugs for women’s health. All other authors have no competing interests to declare.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.