Vaginal douching in Cambodian women: its prevalence and association with vaginal candidiasis.

BACKGROUND: We determined the prevalence of vaginal douching (cleansing of the vagina with liquid) in a sample of Cambodian women, and examined the associations of douching with genitourinary symptoms and infections, after controlling for potential confounding factors, including genitourinary symptoms and sociodemographic factors. METHODS: A total of 451 adolescent and adult females aged 15 to 49 years who attended 17 maternal and child health (MCH) clinics in 7 provinces of Cambodia in 2001 were consecutively enrolled as a part of the Sexually Transmitted Infection Sentinel Survey. Sociodemographic factors, genitourinary symptoms, and frequency of douching were assessed by face-to-face interviews using a structured questionnaire. Vaginal infections were examined by using standard diagnostic procedures specific to each pathogen. RESULTS: The proportion of participants who douched at least once a week was 76.7% (n = 346). Douching was significantly more prevalent in urban than in rural women (85.7%, n = 198 vs 67.3%, n = 148; P < 0.001). Frequency of douching was significantly associated with genitourinary symptoms, which were most prevalent in participants who douched from several times a week to once a day; genitourinary symptoms were less prevalent in those who douched more than once a day. Douching was significantly associated with vaginal candidiasis, but not with trichomoniasis or bacterial vaginosis, and this association persisted even after controlling for sociodemographic factors and genitourinary symptoms. CONCLUSIONS: Vaginal douching was very common among Cambodian women visiting MCH clinics. Further investigations are warranted to elucidate the reasons for douching. In addition, women should be informed that douching may endanger their reproductive health.

Changes in STI services following a community based STI-intervention project in Cambodia.

The aim of this study was to assess changes in sexually transmitted infections (STI) related care following a STI project with a particular focus on registered brothel-based (direct) female sex workers (DFSWs) in four border provinces of Cambodia. A survey of health care facilities providing STI care was undertaken and the results compared with a baseline survey done two years previously. The main components of the project were: renovation of the STI clinics, STI training, formation of mobile teams, provision of STI drugs, and the introduction of basic laboratory tests at STI clinics. Interviews were held with health care providers and STI patients and a manual check was made of the STI register and special forms for DFSWs. Clinical management of STI cases was assessed for DFSWs, women with vaginal discharge and men with urethral discharge. Advice given to clients about condom use, partner notification and STI education was assessed and availability of STI drugs was reviewed. STI clinic attendance by DFSWs each month increased from 72% (296/412) to 93% (459/496). The proportion of DFSWs diagnosed with presumed STIs decreased from 86.5% (256/296) to 25.5% (117/459) and cervicitis from 32.8% (135/412) to 12.6% (58/459). The percentage of men attending STI clinics decreased from 26.9% (251/933) to 9.4% (102/1,080). The proportion of presumed STI cases/all cases attending health centers decreased from 7.0% (934/13,177) to 4.3% (739/17,224). The introduction of laboratory tests coincided with a marked reduction in DFSWs diagnosed with cervicitis. Further validation studies are required to determine whether this reduction was accompanied by a real decrease in gonorrhea and chlamydia.