{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T23:04:15Z","timestamp":1788563055258,"version":"build-2803163510"},"reference-count":33,"publisher":"BMJ","issue":"5","funder":[{"name":"AGIS healthcare insurance"},{"name":"Research and Development fund of the Public Health Service of Amsterdam"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2019,2,27]]},"published-print":{"date-parts":[[2019,5]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>\n                      Vaginal steam baths with herb leaves (herb use) is practised by some Surinamese women. We assessed herb use among women from the five most prevalent ethnic groups, and if herb use is associated with\n                      <jats:italic>Chlamydia trachomatis<\/jats:italic>\n                      infection.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Participants were recruited at a sexually transmitted infection (STI) clinic and a family planning clinic (FP) in Paramaribo, Suriname.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>1040 women were included subsequently, comprising the following ethnic groups: Creole (26.7%), Hindustani (24.6%), Javanese (15.7%), Maroon (13.3%) and mixed descent (19.7%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Nurses collected a questionnaire and vaginal swabs for nucleic acid amplification\n                      <jats:italic>C. trachomatis<\/jats:italic>\n                      testing.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary outcomes<\/jats:title>\n                    <jats:p>\n                      Determinants of vaginal herb use and\n                      <jats:italic>C. trachomatis<\/jats:italic>\n                      infection via univariable and multivariable logistic regression.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Herb use was most common among Maroon (68.8%) and Creole women (25.2%). In multivariable analysis including only Maroon and Creole women, determinants significantly associated with vaginal herb use were (OR; 95%\u2009CI): Maroon ethnic descent (5.33; 3.26 to 8.71 vs Creole), recruitment at the STI clinic (2.04; 1.24 to 3.36 vs FP), lower education levels (3.80; 1.68 to 8.57 lower vs higher, and 2.02; 0.90 to 4.51 middle vs higher). Lower age and recruitment at the STI clinic were associated with\n                      <jats:italic>C. trachomatis<\/jats:italic>\n                      infection, but not vaginal herb use.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      In Suriname, vaginal herb use is common among Maroon and Creole women. Education, ethnic group and recruitment site were determinants for herb use. Vaginal herb use was not a determinant of\n                      <jats:italic>C. trachomatis<\/jats:italic>\n                      infection. Future research should focus on the effect of herb use on the vaginal microbiome and mucosal barrier.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2018-025417","type":"journal-article","created":{"date-parts":[[2019,5,17]],"date-time":"2019-05-17T06:16:55Z","timestamp":1558073815000},"page":"e025417","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Vaginal herb use and\n                    <i>Chlamydia trachomatis<\/i>\n                    infection: cross-sectional study among women of various ethnic groups in Suriname"],"prefix":"10.1136","volume":"9","author":[{"given":"Jannie J","family":"Van der Helm","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maarten Franciscus","family":"Schim van der Loeff","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esther","family":"de Vries","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charlotte","family":"van der Veer","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antoon W","family":"Gr\u00fcnberg","sequence":"additional","affiliation":[{"name":"Department of Public Health, Ministry of Health, Paramaribo, Suriname"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dennis","family":"Mans","sequence":"additional","affiliation":[{"name":"Department of Pharmacology, Faculty of Medical Sciences, Anton de Kom University of Suriname, Paramaribo, Suriname"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9784-547X","authenticated-orcid":false,"given":"Henry J C","family":"de Vries","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, The Netherlands"},{"name":"Department of Dermatology, Amsterdam UMC location Academic Medical Centre, Amsterdam Institute for Infection and Immunity (AI&II), Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,5,16]]},"reference":[{"key":"2025121602420607000_9.5.e025417.1","doi-asserted-by":"publisher","DOI":"10.1016\/S1083-3188(03)00027-5"},{"key":"2025121602420607000_9.5.e025417.2","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1016\/j.whi.2006.03.005","article-title":"Variation and predictors of vaginal douching behavior","volume":"16","author":"Misra","year":"2006","journal-title":"Womens Health Issues"},{"key":"2025121602420607000_9.5.e025417.3","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1016\/j.jep.2007.11.003","article-title":"Dry sex in Suriname","volume":"116","author":"van Andel","year":"2008","journal-title":"J Ethnopharmacol"},{"key":"2025121602420607000_9.5.e025417.4","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1000416","article-title":"Intravaginal practices, bacterial vaginosis, and HIV infection in women: individual participant data meta-analysis","volume":"8","author":"Low","year":"2011","journal-title":"PLoS Med"},{"key":"2025121602420607000_9.5.e025417.5","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1016\/S1083-3188(01)00148-6","article-title":"Douching behavior in high-risk adolescents. 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