Sexual Health Sexual Health Society
Publishing on sexual health from the widest perspective

Prevalence of HIV and other sexually transmissible infections in relation to lemon or lime juice douching among female sex workers in Jos, Nigeria

Godwin Imade A G , Atiene Sagay A , Daniel Egah B , Viola Onwuliri C , Matthew Grigg E , Christopher Egbodo A , Tom Thacher D , Malcolm Potts F and Roger Short E
+ Author Affiliations
- Author Affiliations

A Departments of Obstetrics and Gynaecology, University of Jos, Jos, Plateau State, Nigeria.

B Medical Microbiology, University of Jos, Jos, Plateau State, Nigeria.

C Biochemistry, Faculty of Medical Sciences, University of Jos, Jos, Plateau State, Nigeria.

D Department of Family Medicine, Jos University Teaching Hospital, Jos, Nigeria.

E Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia.

F School of Public Health, University of California, Berkeley, USA.

G Corresponding author. Email:

Sexual Health 5(1) 55-60
Submitted: 27 June 2007  Accepted: 19 December 2007   Published: 22 February 2008


Background: The rates of sexually transmissible infections (STI), including HIV, are high among female sex workers (FSW) in Nigeria and the use of various local vaginal cleansing agents to prevent infection is a common practice. The present study was aimed at determining whether any association exists between current lime or lemon douching and the prevalence of STI and HIV infections among FSW in Jos, Nigeria. Methods: Consenting FSW who were users of lemon or lime (UL) or non-users (NUL) were recruited for the study between May and September 2006. A structured questionnaire was administered by trained counsellors. Pre-HIV test counselling was done. Participant’s blood samples were tested for HIV and syphilis. Genital examination was done and high vaginal and endocervical samples were collected. The samples obtained were processed for STI using standard laboratory procedures. FSW found with treatable STI received free drugs. HIV results were disclosed after post-test counselling and positive FSW were referred to a HIV/AIDS facility for care, support and antiretroviral therapy. Results: A total of 398 FSW (86 UL and 312 NUL) participated in the study. Their mean age was 27.6 ± 7.0 years (range 16–63 years). HIV prevalence was high for both UL and NUL: 48.8 and 48.2%, respectively (odds ratio 1.0; 95% confidence interval 0.6–1.2, P = 0.9427). The rates of bacterial vaginosis were not significantly higher in UL (UL 55.8%, NUL 44.0%, odds ratio 1.59, 95% confidence interval 0.96–2.65, P = 0.06). There were no associations between the use of citrus douching and other STI. Conclusion: There were no significant associations between the prevalence of STI and HIV and lime or lemon juice usage.


We are grateful to the women who participated in this study, and the research staff involved in the field work, counselling and testing of biological samples. We are thankful to the Chief Medical Director and staff of Solat Women’s Hospital, Jos for their cooperation. The strong support and encouragement received from Brian Haill are much appreciated. This study was supported by public donations to the Mary Magdalene project (


[1] Steen R,  Dallabetta G. Sexually transmitted infection control with sex workers: regular screening and presumptive treatment augment efforts to reduce risk and vulnerability. Reprod Health Matters 2003; 11 74–90.
CrossRef | PubMed |

[2] UNAIDS/WHO. AIDS epidemic update. Geneva: UNAIDS/WHO; 2007. Available at: [verified 4 January 2008].

[3] Morison L,  Weiss HA,  Buve A,  Carael M,  Abega SC,  Kaona F, et al. Commercial sex and the spread of HIV in four cites in sub-Sahara Africa (The multicentre study of factors determining the different prevalence of HIV in sub-Saharan Africa). AIDS 2001; 15 S61–9.
CrossRef | PubMed |

[4] Esu-Williams E,  Mulanga-Kabeya C,  Tekena H,  Zwandor A,  Aminu K, et al. Seroprevalence of HIV-1, HIV-2, and HIV-I group in Nigeria: evidence of a growing increase of HIV infection. J Acquir Immune Defic Syndr Hum Retrovirol 1997; 16 204–10.
PubMed |

[5] Alary M,  Mukenge-Tshibaka L,  Bernier F,  Geraldo N,  Lowndes C,  Meda H, et al. Decline in the prevalence of HIV and sexually transmitted diseases among female sex workers in Cotonou, Benin, 1993–1999. AIDS 2002; 16 463–70.
CrossRef | PubMed |

[6] Ghys PD,  Diallo MO,  Ettiegne-Traore V,  Kale K,  Tawil O,  Carael M, et al. Increase in condom use and decline in HIV and transmitted diseases among female sex workers in Abidjan, Cote d’Ivoire, 1991–1998. AIDS 2002; 16 251–8.
CrossRef | PubMed |

[7] Mamadou S,  Laouel Kader A,  Rabiou S,  Aboubacar A,  Soumana O,  Garba A, et al. Prevalence of HIV infection and five other sexually transmitted infection among sex workers in Niamey, Niger. Bull Soc Pathol Exot 2006; 99 19–22.
CrossRef | PubMed |

[8] Low N,  Broutet N,  Adu-Sarkodie Y,  Barton P,  Hossain M,  Howkes S. Global control of sexually transmitted infections. Lancet 2006; 368 2001–16.
CrossRef | PubMed |

[9] Lowndes CM,  Alary M,  Meda H,  Gnintoungbe CAB,  Mukenge-Tshibaka L,  Adjovi C, et al. Role of core and bridging groups in the transmission dynamics of HIV and STIs in Contonou, Benin, West Africa. Sex Transm Infect 2002; 78 69–77.

[10] Potts M,  Short RV. Using microbicides to fight the spread of HIV. Science 2003; 300 431.
CrossRef | PubMed |

[11] Himes NE . Medical history of contraception. New York: Gamut Press; 1963.

[12] Imade GE,  Sagay AS,  Onwuliri VA,  Egah DZ,  Potts M,  Short RV. Use of lemon or lime douches in women in Jos, Nigeria. Sex Health 2005; 2 237–9.
CrossRef | PubMed |

[13] Reed BD,  Ford K,  Wirawan DN. The Bali STD/AIDS study: association between vaginal hygiene practices and STDs among sex workers. Sex Transm Infect 2001; 77 46–52.
CrossRef | PubMed |

[14] McClelland SR,  Lavreys L,  Hassan WM,  Mandaliya K,  Ndinya-Achola JO,  Baetan JM. Vaginal washing and increase risk of HIV-1 acquisition among African women: a 10 year prospective study. AIDS 2006; 20 269–73.
PubMed |

[15] Van de Wijgert JHHM,  Chirenje ZM,  Iliff V,  Mbizvo MT,  Mason PR,  Gwanzura L, et al. Effect of intravaginal practices on the vaginal and cervical mucosa of Zimbabwe women. J Acquir Immune Defic Syndr 2000; 24 62–7.
PubMed |

[16] Mayer L,  Denny L,  de Souza M,  Wright TC,  Kuhn L. Distinguishing the temporal association between women’s intravaginal practices and risk of human immunodeficiency virus infection: a prospective study of South African women. Am J Epidemiol 2006; 10 1–9.

[17] Clarke GN,  McCoombe SG,  Short RV. Sperm immobilizing properties of lemon juice. Fertil Steril 2006; 85 1529–30.
CrossRef | PubMed |

[18] Short RV. The HIV/AIDS pandemic: new ways of preventing infection in men. Reprod Fertil Dev 2004; 16 555–9.
CrossRef | PubMed |

[19] Short RV.. New ways of preventing HIV infection: thinking simply, simply thinking. Phil Trans Roy Soc B 2005; 361 811–20.
CrossRef |

[20] Joint Publication of Global Campaign for Microbicide, Nigeria HIV Vaccine and Microbicide Advocacy Group and African Microbicides Advocacy Group. Why women should not use lemon or lime juice as a microbicide; 2006. Available at: [verified 4 January 2008].

[21] Holmes W. Investigating widely available substances as vaginal microbicide. Sex Health 2004; 1 73–9.
CrossRef | PubMed |

[22] WHO/CDC. Rapid HIV tests: guidelines for use in HIV testing and counseling services in resource-constrained setting. Geneva: World Health Organization; 2004. Available online at: [verified 4 January 2008].

[23] Amsel R,  Totten PA,  Spiegel CA,  Chen KC,  Eschenbach D,  Holmes KK. Non-specific vaginitis: diagnostic criteria and microbial and epidemiological associations. Am J Med 1983; 74 14–22.
CrossRef | PubMed |

[24] CDC Recommendations and Reports. Sexually transmitted diseases treatment guidelines. Bacterial vaginosis. MMWR 2006; 55 50–1.

[25] Hoffman IF,  Taha TE,  Padian NS,  Kelly CW,  Welch JD,  Maritinson FE, et al. Nonoxynol-9 100 mg gel: multi-site safety study from sub-Sahara Africa. AIDS 2004; 18 2191–5.
CrossRef | PubMed |

Rent Article (via Deepdyve) Export Citation Cited By (10)