Pernell R. Brown

Early onset of vaginal douching is associated with false beliefs and high-risk behavior.

Background Vaginal douching in young women has been linked to a variety of adverse reproductive health consequences. Objectives To explore associations with early onset (≤15 years old) of douching. Study Design A confidential survey was self-administered to convenience samples of women attending seven primary care clinics. Results The mean age of the 726 evaluable participants was 27.9 years (ranges, 14–63 years). Twenty-two percent of participants believed douching “kills germs that cause infections,” and 27% agreed that “women believe douching prevents pregnancy.” A history of having ever used douching products was reported by 73%. Of those who had douched, 24% began the practice at age ≤15 years. Compared with those who began at a later age, those who began at age ≤15 years were also more likely to have begun sexual intercourse under 16 years of age (AOR 2.63; P < 0.001), to believe that douching kills germs that cause STDs (AOR = 2.15 P = 0.004), and to currently douche more than once per month (AOR = 2.08; P = 0.009). Conclusion This study indicates that early onset of vaginal douching is associated with false beliefs and sexual debut at younger age.

Single dose of azithromycin for the treatment of genital chlamydial infections in adolescents

We compared a single 1 gm dose of azithromycin with the standard 7-day course of doxycycline for the treatment of uncomplicated chlamydial genital infection in sexually active adolescents. Seventy-three adolescents (65 female) with a cervical or urethral culture positive for Chlamydia trachomatis were enrolled in the study; 46 received azithromycin and 27 received doxycycline. Follow-up evaluations were done 1, 2, and 4 weeks after treatment with azithromycin or initiation of treatment with doxycycline. There were four treatment failures (8.7%) among the patients who received azithromycin and four in the doxycycline-treated group (14.8%); all were female. Six of these girls (three treated with azithromycin and three with doxycycline) gave histories of unprotected intercourse with an untreated partner and were probably reinfected. Almost half the patients were clinically symptom free. The clinical response rate for the remaining patients with symptoms was 97.4% at 4 weeks. Nineteen percent of the azithromycin-treated patients and 33.3% of those treated with doxycycline had mild to moderate drug-related side effects, which were predominantly gastrointestinal. We conclude that treatment with a single oral dose of azithromycin appears to be as safe and efficacious as a 7-day course of doxycycline for the treatment of uncomplicated genital chlamydial infection in adolescents.

Douching Behavior in High-Risk Adolescents: What Do They Use, When and Why Do They Douche?☆

OBJECTIVES To describe feminine hygiene practices and douching behavior in adolescent women. DESIGN A cross-sectional anonymous survey. SUBJECTS Adolescents (majority rural) admitted to a correctional institution for girls. MAIN OUTCOME MEASURES Description of feminine hygiene practices, prevalence of vaginal douching, types of substances used, reported reasons for, and timing of douching. RESULTS In a period of 16 weeks, 104 girls were surveyed within a week of admission. The mean age was 15.4 (SD 1.5; range 12-18) yr, and age at sexual debut 13.1 (SD 1.4) yr. Use of feminine hygiene products was reported by: 9% for feminine suppository, 33% towelettes, 40% spray, 67% feminine wash; only 18% reported no use of those feminine hygiene products listed. A history of ever having douched was reported by 79%; the mean first douching age was 14.0 (SD 1.3; range 11-16). Douching product users were significantly more likely to know someone who douches regularly (P <.0001) and have watched douche commercials (P =.0001) than those who did not douche. A majority used store-bought products, vinegar in water and scented solution being the most popular; baking soda, Betadine, Pine-sol, and Lysol were other products used. Commonly cited reasons for douching included to feel good and fresh (60%), and to rid of odor and of blood (47% each). Other reasons cited were to please partner (12%) and to avoid going to a doctor (6%). Timing of douching included: after period (69%), after sex (52%), before sex (16%), before going to a doctor (17%). Among those who douched, 51% douched once a month, and an additional 32% more often than that. CONCLUSION This study provides troublesome findings regarding the feminine hygiene practices of mostly rural southern teenagers who have been incarcerated.

High prevalence of Chlamydia trachomatis infections in adolescent females not having pelvic examinations: Utility of PCR-based urine screening in urban adolescent clinic setting

PURPOSE To determine utility of polymerase chain reaction (PCR)-based urine screening for Chlamydia trachomatis in the care of adolescent females in an urban clinic. METHODS Females > or = 15 years of age attending an adolescent clinic were approached consecutively. Each enrollee was interviewed to determine the primary reason(s) for the clinic visit and was queried about genitourinary symptoms. Nonsterile voided urine specimens were tested for C. trachomatis using PCR-based analysis. Endocervical C. trachomatis cultures were obtained from the subjects who had a pelvic examination. Main outcome measures were chlamydia infection rates in clinic attendees whether a pelvic examination was performed or not. RESULTS A total of 315 (99.4%) of 317 patients approached agreed to participate. Overall, 47 (14.9%) patients had positive urine PCR tests. The chlamydia infection rate detected by urine PCR was 22.1% (19 of 86) among those who had pelvic examinations performed and 12.2% (28 of 229) among those who did not (p = .03; odds ratio 2.04; 95% confidence interval 1.02, 4.06). Sixty percent (28 of 47) of chlamydia infections identified during the study period were identified by the urine screening test. CONCLUSION Urine screening was accepted by vast majority of female adolescents attending the clinic irrespective of reason for the clinic visit, and was highly effective in identifying unsuspected C. trachomatis infections, particularly among girls attending the clinic for reasons unrelated to reproductive health care and as an interim screening tool for adolescent family-planning clients.

Predictors of bacterial vaginosis in young women who douche

Conclusion: Bacterial vaginosis in douching women may indicate existence of other high-risk sexual behaviors. Management of adolescent women with bacterial vaginosis should include assessment for high-risk sexual behavior and testing for STDs. (excerpt)