{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T02:04:08Z","timestamp":1793325848897,"version":"4.5.0"},"reference-count":30,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Sex Transm Infect"],"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>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 <jats:italic>Lactobacillus<\/jats:italic> spp evaluated by molecular tools.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>33\u2009women 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 <jats:italic>16S rRNA<\/jats:italic> 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There was no statistically significant change in the odds of molecular-BV versus <jats:italic>Lactobacillus-<\/jats:italic>dominated CSTs comparing the douching cessation interval to douching observation (adjusted OR 1.77, 95%\u2009CI 0.89 to 3.55). Removal of <jats:italic>L. iners<\/jats:italic>-dominated CST III from the outcome did not affect the results. There were no significant changes in the relative abundance of four <jats:italic>Lactobacillus<\/jats:italic> spp and no meaningful changes in other taxa investigated. There was no significant change in bacterial absolute abundance between a participant\u2019s sample collected 3\u2009days prior to and following douching (p=0.46).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec>","DOI":"10.1136\/sextrans-2022-055459","type":"journal-article","created":{"date-parts":[[2022,5,30]],"date-time":"2022-05-30T17:20:14Z","timestamp":1653931214000},"page":"sextrans-2022-055459","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Douching cessation and molecular bacterial vaginosis: a reanalysis of archived specimens"],"prefix":"10.1136","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8354-0077","authenticated-orcid":false,"given":"Sarah Elizabeth","family":"Brown","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"He","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle D","family":"Shardell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0851-2233","authenticated-orcid":false,"given":"Jacques","family":"Ravel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0033-302X","authenticated-orcid":false,"given":"Khalil G","family":"Ghanem","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0244-6973","authenticated-orcid":false,"given":"Jonathan M","family":"Zenilman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8762-6214","authenticated-orcid":false,"given":"Rebecca M","family":"Brotman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,5,30]]},"reference":[{"key":"2022053010200509000_sextrans-2022-055459v1.1","doi-asserted-by":"publisher","DOI":"10.1097\/OLQ.0b013e318074e565"},{"key":"2022053010200509000_sextrans-2022-055459v1.2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1525-1446.2010.00874.x"},{"key":"2022053010200509000_sextrans-2022-055459v1.3","doi-asserted-by":"crossref","unstructured":"Ferranti M . An odor of racism: vaginal deodorants in African-American beauty culture and advertising. Advert Soc Rev 2011;11.doi:10.1353\/asr.2011.0003","DOI":"10.1353\/asr.2011.0003"},{"key":"2022053010200509000_sextrans-2022-055459v1.4","doi-asserted-by":"publisher","DOI":"10.1097\/00007435-200301000-00014"},{"key":"2022053010200509000_sextrans-2022-055459v1.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.annepidem.2007.05.015"},{"key":"2022053010200509000_sextrans-2022-055459v1.6","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwn103"},{"key":"2022053010200509000_sextrans-2022-055459v1.7","doi-asserted-by":"publisher","DOI":"10.1097\/01.aids.0000196165.48518.7b"},{"key":"2022053010200509000_sextrans-2022-055459v1.8","doi-asserted-by":"publisher","DOI":"10.1136\/sextrans-2018-053769"},{"key":"2022053010200509000_sextrans-2022-055459v1.9","doi-asserted-by":"publisher","DOI":"10.1089\/aid.2018.0304"},{"key":"2022053010200509000_sextrans-2022-055459v1.10","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-017-2436-3"},{"key":"2022053010200509000_sextrans-2022-055459v1.11","doi-asserted-by":"publisher","DOI":"10.1136\/sextrans-2014-051764"},{"key":"2022053010200509000_sextrans-2022-055459v1.12","doi-asserted-by":"publisher","DOI":"10.1097\/01.olq.0000216050.41305.c1"},{"key":"2022053010200509000_sextrans-2022-055459v1.13","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2007.11.043"},{"key":"2022053010200509000_sextrans-2022-055459v1.14","doi-asserted-by":"publisher","DOI":"10.1089\/aid.2013.0251"},{"key":"2022053010200509000_sextrans-2022-055459v1.15","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0210825"},{"key":"2022053010200509000_sextrans-2022-055459v1.16","doi-asserted-by":"publisher","DOI":"10.1126\/scitranslmed.3003605"},{"key":"2022053010200509000_sextrans-2022-055459v1.17","doi-asserted-by":"crossref","DOI":"10.1128\/mSystems.00029-19","article-title":"Ultrahigh-Throughput Multiplexing and Sequencing of >500-Base-Pair Amplicon Regions on the Illumina HiSeq 2500 Platform","volume":"4","author":"Holm","year":"2019","journal-title":"mSystems"},{"key":"2022053010200509000_sextrans-2022-055459v1.18","doi-asserted-by":"publisher","DOI":"10.1186\/s40168-020-00934-6"},{"key":"2022053010200509000_sextrans-2022-055459v1.19","doi-asserted-by":"publisher","DOI":"10.1016\/j.tim.2016.11.007"},{"key":"2022053010200509000_sextrans-2022-055459v1.20","doi-asserted-by":"publisher","DOI":"10.1016\/j.resmic.2017.04.001"},{"key":"2022053010200509000_sextrans-2022-055459v1.21","doi-asserted-by":"publisher","DOI":"10.1186\/2049-2618-1-29"},{"key":"2022053010200509000_sextrans-2022-055459v1.22","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0037818"},{"key":"2022053010200509000_sextrans-2022-055459v1.23","doi-asserted-by":"publisher","DOI":"10.1097\/01.olq.0000258435.34879.da"},{"key":"2022053010200509000_sextrans-2022-055459v1.24","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000001932"},{"key":"2022053010200509000_sextrans-2022-055459v1.25","first-page":"333","article-title":"Quantitative and qualitative effects of douche preparations on vaginal microflora","volume":"80","author":"Onderdonk","year":"1992","journal-title":"Obstet Gynecol"},{"key":"2022053010200509000_sextrans-2022-055459v1.26","doi-asserted-by":"publisher","DOI":"10.1097\/01.olq.0000243624.74573.63"},{"key":"2022053010200509000_sextrans-2022-055459v1.27","doi-asserted-by":"publisher","DOI":"10.1097\/OLQ.0b013e31816907fa"},{"key":"2022053010200509000_sextrans-2022-055459v1.28","doi-asserted-by":"publisher","DOI":"10.1016\/j.reprotox.2018.09.001"},{"key":"2022053010200509000_sextrans-2022-055459v1.29","doi-asserted-by":"publisher","DOI":"10.1016\/S0029-7844(01)01759-8"},{"key":"2022053010200509000_sextrans-2022-055459v1.30","doi-asserted-by":"publisher","DOI":"10.1097\/OLQ.0b013e3181ca3cac"}],"container-title":["Sexually Transmitted Infections"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/sextrans-2022-055459","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,5,30]],"date-time":"2022-05-30T17:20:17Z","timestamp":1653931217000},"score":1,"resource":{"primary":{"URL":"https:\/\/sti.bmj.com\/lookup\/doi\/10.1136\/sextrans-2022-055459"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,5,30]]},"references-count":30,"alternative-id":["10.1136\/sextrans-2022-055459"],"URL":"https:\/\/doi.org\/10.1136\/sextrans-2022-055459","relation":{},"ISSN":["1368-4973","1472-3263"],"issn-type":[{"value":"1368-4973","type":"print"},{"value":"1472-3263","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,5,30]]}}}