TY - JOUR
T1 - Effects of an over-the-counter lactic-acid containing intra-vaginal douching product on the vaginal microbiota
AU - van der Veer, C
AU - Bruisten, S M
AU - van Houdt, R
AU - Matser, A A
AU - Tachedjian, G
AU - van de Wijgert, J H H M
AU - de Vries, H J C
AU - van der Helm, J J
N1 - Funding Information:
This study was financed by the Public Health Service of Amsterdam, the Netherlands. GT is funded by the National Health and Medical Research Council of Australia (NHMRC) Senior Research Fellowship GNT1117748 and project grant GNT1164982. AM is funded by The European Society of Contraception and Reproductive Health, ESC grantnr. P-2016-B-03 (2016). The authors wish to thank Titia Heijman for coordinating the study procedures at the PHS clinic in Amsterdam and for anonymizing the clinical data. Special thanks are given to the nurses who were involved in this study; Jacqueline Woutersen, Claudia Owuso and Myra van Leeuwen. The authors also wish to thank Leila Dembinski, Naziha Kassimi and Juul Rutten for performing the data entry and also thank Juul Rutten, Sahare Gashi, Michelle Himschoot and Akke Cornelissen for their contribution to sample preparation and David Tyssen for performing the lactic acid quantitation.
Funding Information:
This study was financed by the Public Health Service of Amsterdam, the Netherlands. GT is funded by the National Health and Medical Research Council of Australia (NHMRC) Senior Research Fellowship GNT1117748 and project grant GNT1164982. AM is funded by The European Society of Contraception and Reproductive Health, ESC grantnr. P-2016-B-03 (2016).
Publisher Copyright:
© 2019 The Author(s).
PY - 2019/7/25
Y1 - 2019/7/25
N2 - BACKGROUND: Over-the-counter intra-vaginal lactic-acid containing douches are marketed as vaginal hygiene products that support optimal vaginal pH balance. We report the effect of a commercially available douche (Etos®) on the vaginal microbiota (VM) in a prospective study.RESULTS: Twenty-five healthy women were recruited through advertisements in 2015-2017 (ethical approval: METC-2014_413) and followed over three menstrual cycles. The participants had a median age of 24 years [IQR: 22-29], were mostly Dutch-Caucasian (88%), and 60% used combined oral contraceptives. All participants douched three times a week during the second cycle, starting on the first day of that cycle. Participants completed a questionnaire at baseline, kept a daily diary to report douching, menses, and sexual activity, self-collected vaginal swabs every other day during the first and third cycle and daily during the second cycle, and measured vaginal pH mid-cycle. A median of 44 vaginal swabs [inter-quartile range (IQR): 41-50] were assessed per participant by 16S rRNA gene (V3-V4 region) sequencing and a Candida albicans PCR was done at four time-points. At baseline, 21 participants (84%) had Lactobacillus-dominated VM (Lactobacillus crispatus (n = 14), L. iners (n = 6), or diverse Lactobacillus species (n = 1) and 4 participants (16%) had VM consisting of diverse anaerobes. In multinomial logistic regression models, a trend towards increased odds were observed for having diverse anaerobic VM in the second and third cycle, compared to the first cycle, after adjusting for menses [odds ratio (OR) = 1.4 (95% CI: 0.9-2.1) and OR = 1.7 (95% CI: 0.9-3.1), respectively] (p = 0.376). Douching did not affect vaginal pH. Menses increased the odds for having VM consisting of diverse anaerobes almost two-fold (OR = 1.7; 95% CI: 1.0-2.8), while douching during menses increased the odds 2.6 fold (OR = 2.6; 95% CI: 1.0-6.5), compared to not menstruating (p = 0.099). Participants were more likely to test positive for C. albicans after cycle 2, compared to cycle 1 [OR = 3.0 (95% CI: 1.2-7.2); p = 0.017].CONCLUSION: The Etos® douche did not significantly affect the vaginal pH or VM composition, although increased odds for having diverse anaerobic VM was observed, especially when douching during menses. Furthermore, douching may promote C. albicans infections.
AB - BACKGROUND: Over-the-counter intra-vaginal lactic-acid containing douches are marketed as vaginal hygiene products that support optimal vaginal pH balance. We report the effect of a commercially available douche (Etos®) on the vaginal microbiota (VM) in a prospective study.RESULTS: Twenty-five healthy women were recruited through advertisements in 2015-2017 (ethical approval: METC-2014_413) and followed over three menstrual cycles. The participants had a median age of 24 years [IQR: 22-29], were mostly Dutch-Caucasian (88%), and 60% used combined oral contraceptives. All participants douched three times a week during the second cycle, starting on the first day of that cycle. Participants completed a questionnaire at baseline, kept a daily diary to report douching, menses, and sexual activity, self-collected vaginal swabs every other day during the first and third cycle and daily during the second cycle, and measured vaginal pH mid-cycle. A median of 44 vaginal swabs [inter-quartile range (IQR): 41-50] were assessed per participant by 16S rRNA gene (V3-V4 region) sequencing and a Candida albicans PCR was done at four time-points. At baseline, 21 participants (84%) had Lactobacillus-dominated VM (Lactobacillus crispatus (n = 14), L. iners (n = 6), or diverse Lactobacillus species (n = 1) and 4 participants (16%) had VM consisting of diverse anaerobes. In multinomial logistic regression models, a trend towards increased odds were observed for having diverse anaerobic VM in the second and third cycle, compared to the first cycle, after adjusting for menses [odds ratio (OR) = 1.4 (95% CI: 0.9-2.1) and OR = 1.7 (95% CI: 0.9-3.1), respectively] (p = 0.376). Douching did not affect vaginal pH. Menses increased the odds for having VM consisting of diverse anaerobes almost two-fold (OR = 1.7; 95% CI: 1.0-2.8), while douching during menses increased the odds 2.6 fold (OR = 2.6; 95% CI: 1.0-6.5), compared to not menstruating (p = 0.099). Participants were more likely to test positive for C. albicans after cycle 2, compared to cycle 1 [OR = 3.0 (95% CI: 1.2-7.2); p = 0.017].CONCLUSION: The Etos® douche did not significantly affect the vaginal pH or VM composition, although increased odds for having diverse anaerobic VM was observed, especially when douching during menses. Furthermore, douching may promote C. albicans infections.
UR - http://www.scopus.com/inward/record.url?scp=85069762227&partnerID=8YFLogxK
U2 - 10.1186/s12866-019-1545-0
DO - 10.1186/s12866-019-1545-0
M3 - Article
C2 - 31345159
SN - 1471-2180
VL - 19
JO - BMC Microbiology [E]
JF - BMC Microbiology [E]
IS - 1
M1 - 168
ER -