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Genital tract abnormalities among female sex workers who douche with lemon/lime juice in northern Nigeria
Presented by Atiene Sagay, Nigeria.
Sagay A.1, Imade G.1, Egah D.2, Onwuliri V.3, Adisa J.4, Grigg M.5, Musa J.1, Thacher T.6, Potts M.7, Short R.5
1University of Jos/Jos University Teaching Hospital, Jos, Dept of Obstetrics and Gynaecology, Jos, Nigeria, 2University of Jos/Jos University Teaching Hospital, Jos, Dept of Medical Microbiology, Jos, Nigeria, 3University of Jos, Dept of Biochemistry, Jos, Nigeria, 4Jos University Teaching Hospital, Dept of Histopathology, Jos, Nigeria, 5University of Melbourne, Faculty of Medicine, Melbourne, Australia, 6Jos University Teaching Hospital, Dept of Family Medicine, Jos, Nigeria, 7University of California, School of Public Health, Berkeley, California, United States
Objectives: Female sex workers (FSWs) in Nigeria commonly use a variety of vaginal cleansing agents including lemon/lime juice for genital hygiene. Recent non clinical studies suggest that douching with lemon or lime juice may destroy the lower genital tract epithelium. We examined the lower genital tract of FSWs who use lemon/lime and compared the findings with that of nonusers.
Methods: This is a cross-sectional observational study of consecutive volunteers. Consenting brothel-based FSWs were recruited for this study in Jos between May and September 2006. A structured questionnaire, including information on vaginal douching with lemon or lime juice, was administered by a trained nurse. A specialist gynaecologist who was not privy to the questionnaire’s responses then obtained a Pap smear and performed colposcopy examination of the vulva, vagina and cervix with the application of 3% acetic acid. Abnormalities were treated accordingly. The findings were analysed using Epi-Info version 3.3.2.
Results: A total of 374 FSWs comprising 81 Lemon users (LUs) and 293 non lemon users (NLUs) were recruited and examined. Their mean age was 27.8 ± 6.7 (range 16-63) years. Colposcopy showed 17/374 (4.5%) with genital warts [LUs 5/81(6.2%) versus NLUs 12/293(4.1%) p=0.43], 61/374 (16.3%) with CIN [LUs 17/81(21.0%) versus NLUs 44/293(15.0%) p=0.20] and 65/374 (17.4%) had other findings. Cytology of Pap smears showed that 87/354 (24.6%) had CIN [LUs 26/78(33.3%) versus NLUs 61/276(22.1%) p=0.03]. Lemon/lime use was associated with cervical dysplasia after controlling for HIV status (Adjusted Odds Ratio=1.76; 95% CI, 1.0-3.0). We were unable to control for frequency of condom use, timing of douching and degree of citrus juice dilution.
Conclusions: Our findings suggest that the practice of douching with citrus juice may be an independent risk factor for cervical dysplasia. Further studies to explore this association are warranted in communities where this practice is rife.
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