Department of Medicine, University of Washington, Seattle, WA, United States of America.
Department of Global Health, University of Washington, Seattle, WA, United States of America.
PLoS One. 2019 Jan 24;14(1):e0210825. doi: 10.1371/journal.pone.0210825. eCollection 2019.
Vaginal washing is a common practice associated with adverse outcomes including bacterial vaginosis (BV) and HIV infection. Prior studies have not examined the associations between vaginal washing and individual vaginal bacteria, or whether these associations are independent of the effect of vaginal washing on BV. The purpose of this study was to characterize the association between vaginal washing and the presence and concentrations of vaginal bacteria associated with optimal and sub-optimal vaginal states. The analysis utilized data from participants in the placebo arm of the Preventing Vaginal Infections trial, which enrolled HIV-uninfected women from the United States and Kenya. Detection of bacterial taxa associated with BV was compared between visits with versus without reported vaginal washing. The effect of vaginal washing on a number of vaginal bacteria differed substantially (p<0.05) between the US and Kenya, so results were stratified by country. In US women, vaginal washing was associated with a significantly higher likelihood of detection of BV associated bacterium 1 (BVAB1) (relative risk [RR] 1.55, 95% confidence interval [CI] 1.15-2.09, p = 0.004), BVAB2 (RR 1.99, 95%CI 1.46-2.71, p<0.001), Mageeibacillus indolicus (RR 2.08, 95%CI 1.46-2.96, p<0.001), Atopobium vaginae (RR 1.34, 95%CI 1.13-1.59, p = 0.001), Leptotrichia/Sneathia species (RR 1.66, 95% CI 1.33-2.09, p<0.001), Megasphaera species (RR 1.78, 95%CI 1.34-2.37, p<0.001) and Gardnerella vaginalis (RR 1.08, 95%CI 1.01-1.16, p = 0.02). No significant association between vaginal washing and bacterial detection was found in Kenyan women. Adjustment for bacterial vaginosis diagnosed by Gram stain did not alter these results. This study provides evidence that the association between vaginal washing and detection of individual bacterial taxa can vary regionally. For some vaginal bacteria, the association with vaginal washing may be independent of the effect on Gram stain detection of BV. Larger prospective studies in diverse geographic settings should explore whether eliminating vaginal washing impacts the presence and concentrations of key vaginal bacteria.
阴道冲洗是一种常见的做法，与包括细菌性阴道病（BV）和 HIV 感染在内的不良后果有关。先前的研究并未检查阴道冲洗与个体阴道细菌之间的关联，也未检查这些关联是否独立于阴道冲洗对 BV 的影响。本研究的目的是描述阴道冲洗与与最佳和次优阴道状态相关的阴道细菌的存在和浓度之间的关联。该分析利用了来自美国和肯尼亚的未感染 HIV 的女性参加的预防阴道感染试验安慰剂组参与者的数据。比较了有和没有报告阴道冲洗的就诊时与 BV 相关细菌的检测情况。阴道冲洗对许多阴道细菌的影响在很大程度上（p<0.05）因美国和肯尼亚而异，因此按国家进行了分层。在美国女性中，阴道冲洗与 BV 相关细菌 1（BVAB1）（相对风险 [RR] 1.55，95%置信区间 [CI] 1.15-2.09，p = 0.004）、BVAB2（RR 1.99，95%CI 1.46-2.71，p<0.001）、Mageeibacillus indolicus（RR 2.08，95%CI 1.46-2.96，p<0.001）、Atopobium vaginae（RR 1.34，95%CI 1.13-1.59，p = 0.001）、Leptotrichia/Sneathia 种（RR 1.66，95%CI 1.33-2.09，p<0.001）、Megasphaera 种（RR 1.78，95%CI 1.34-2.37，p<0.001）和 Gardnerella vaginalis（RR 1.08，95%CI 1.01-1.16，p = 0.02）的检测之间存在显著关联。在肯尼亚女性中，阴道冲洗与细菌检测之间未发现显著关联。调整细菌性阴道病的革兰氏染色诊断并未改变这些结果。本研究提供的证据表明，阴道冲洗与个体细菌分类群的检测之间的关联可能因地区而异。对于某些阴道细菌，与阴道冲洗的关联可能独立于对 BV 的革兰氏染色检测的影响。在不同地理环境中进行更大规模的前瞻性研究，应探讨消除阴道冲洗是否会影响关键阴道细菌的存在和浓度。
