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July 12, 1985, Vol 254, No. 2 >
ARTICLE | July 12, 1985

Association Between Diaphragm Use and Urinary Tract Infection FREE

Stephan D. Fihn, MD, MPH; Robert H. Latham, MD; Pacita Roberts, MS; Katherine Running, WHCS; Walter E. Stamm, MD
[+] Author Affiliations

Reprint requests to the Medical Comprehensive Care Unit, Seattle VA Medical Center, 1660 S Columbian Way, Seattle, WA 98108 (Dr Fihn).


JAMA. 1985;254(2):240-245. doi:10.1001/jama.1985.03360020072027
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References

We conducted independent case-control and retrospective cohort investigations to assess the relationship between diaphragm use and urinary tract infection (UTI). In the former, we compared diaphragm use and vaginal flora among 114 women with acute UTI and 85 women with acute urinary tract symptoms and no UTI. In the latter study, we ascertained the incidence of UTI in 192 diaphragm users and 182 women taking oral contraceptives during a mean follow-up of 9.4 months. Both studies demonstrated a significantly increased risk of UTI in diaphragm users: relative odds were 2.0 in the case-control study and the relative risk was 2.5 in the retrospective cohort study. Vaginal colonization with Escherichia coli was significantly greater in diaphragm users. The incidence of UTI in the cohort study was 26.6 per 1,000 patient-months for diaphragm users and 8.9 per 1,000 patient-months for women taking oral contraceptives. The increased risk of UTI in diaphragm users could not be attributed to differences in age, parity, sexual activity, or previous UTI.

(JAMA 1985;254:240-245)

REFERENCES

1 +
Vessey M, Doll R, Peto R, et al:  A long-term follow-up study of women using different methods of contraception: An interim report . J Biosoc Sci 1976;;8:373-427.
2 +
Elster AB, Lach PA, Roghmann KF, et al:  Relationship between frequency of sexual inter course and urinary tract infection . South Med J 1981;;74:704-708.
3 +
Gillespie L:  The diaphragm: An accomplice in recurrent urinary tract infections . Urology 1984;;24:25-30.
4 +
Wall EM, Baldwin-Johnson C:  Urinary tract infections among diaphragm users . J Fam Pract 1984;;5:707-711.
5 +
Stamm WE, Wagner KF, Amsel R, et al:  Causes of the acute urethral syndrome in women . N Engl J Med 1980;;303:409-415.
6 +
Counts GW, Stamm WE, McKevitt M, et al:  Treatment of cystitis in women with a single dose of trimethoprim-sulfisoxazole . Rev Infect Dis 1982;;4:484-490.
7 +
Yoder BL, Stamm WE, Koester CM:  Microtest procedure for isolation of Chlamydia trachomatis . J Clin Microbiol 1981;;304:956-958.
8 +
Stamm WE, Counts GW, Running KR, et al:  Diagnosis of coliform infection in acutely dysuric women . N Engl J Med 1982;;307:463-468.
9 +
Latham RH, Running K, Stamm WE:  Urinary tract infection in young adult women caused by Staphylococcus saprophyticus . JAMA 1983;;250:3063-3066.
10 +
Berg AO, Heidrich FE, Fihn SD, et al:  Establishing the cause of genitourinary symptoms in women in a family practice: Comparison of clinical examination of comprehensive microbiology . JAMA 1984;;251:620-625.
11 +
Spiegel CA, Amsel R, Eschenbach DA, et al:  Anaerobic bacteria in nonspecific vaginitis . N Engl J Med 1980;;303:601-607.
12 +
Cochran W:  Some methods for strengthening the common χ2 test . Biometrics 1954;;10:417-441.
13 +
Fleiss JL: Statistical Methods for Rates and Proportions , ed 2. New York, John Wiley & Sons Inc, 1981;.
14 +
Cox DR: Analysis of Binary Data . London, Chapman & Hall, 1970;.
15 +
Peto R, Pike MC, Armitage P, et al:  Design and analysis of randomized trials requiring prolonged observation of each patient: I. Introduction and design . Br J Cancer 1976;;34:585-612.
16 +
Mantel N:  Evaluation of survival data and two new rank order statistics arising in its consideration . Cancer Chemother Rep 1966;; 50:163-170.
17 +
Takahashi M, Loveland DB:  Bacteriuria and oral contraceptives: Routine health examinations of 12,076 middle-class women . JAMA 1974;;227:762-765.
18 +
Evans DA, Hennekens CH, Miao L, et al:  Oral-contraceptive use and bacteriuria in a community-based study . N Engl J Med 1978;; 299:536-537.
19 +
Cole P:  The evolving case-control study . J Chronic Dis 1979;;32:15-27.
20 +
Austin H, Louv WC, Alexander J:  A casecontrol study of spermicides and gonorrhea . JAMA 1984;;241:2822-2824.
21 +
McCormack WM, Rosner B, McComb DE, et al:  Infection with Chlamydia trachomatis in female college students . Am J Epidemiol 1985;; 121:107-115.
22 +
Bachrach CA, Mosher WD: Use of contraception in the United States, 1982 . National Center for Health Statistics advance data No. 102. Dept of Health and Human Services, (December) 1984;.
23 +
Fihn SD, Running K, Pinkstaff C, et al:  Diaphragms cause urinary obstruction in women with prior urinary tract infection , abstracted. Clin Res 1985;;33:720A.
24 +
Stamey TA, Sexton CS:  The role of vaginal colonization with enterobacteriaceae in recurrent urinary infections . J Urol 1975;;113:214-219.
25 +
Marsh FR, Murray M, Panchamia P:  The relationship between bacterial cultures of the vaginal introitus and urinary infection , in Urinary Tract Infection . Oxford, England, Oxford University Press, 1973;.
26 +
Watt B, Goldacre MJ, Loudon N, et al:  Prevalence of bacteria in the vagina of normal young women . Br J Obstet Gynaecol 1981;;88:588-595.
27 +
Percival-Smith R, Bartlett KH, Chow AW:  Vaginal colonization of Escherichia coli and its relation to contraceptive methods . Contraception 1983;;27:497-504.
28 +
Peddie BA, Bishop V, Bailey RR, et al:  Relationship between contraceptive method and vaginal flora . Aust NZ J Obstet Gynaecol 1984;; 24:217-218.
29 +
Thurner J, Poitschek C, Kopp C:  Der einfluss von spermiziden auf die physiologische und pathologene genitalflora . Wien Med Wochenschr 1983;;133:265-268.
30 +
Jick H, Hannan MT, Stergachis A, et al:  Vaginal spermicides and gonorrhea . JAMA 1982;; 248:1619-1621.
31 +
Kelaghan J, Rubin GL, Ory H, et al:  Barrier-method contraceptives and pelvic inflammatory disease . JAMA 1982;;248:184-187.

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1 +
Vessey M, Doll R, Peto R, et al:  A long-term follow-up study of women using different methods of contraception: An interim report . J Biosoc Sci 1976;;8:373-427.
2 +
Elster AB, Lach PA, Roghmann KF, et al:  Relationship between frequency of sexual inter course and urinary tract infection . South Med J 1981;;74:704-708.
3 +
Gillespie L:  The diaphragm: An accomplice in recurrent urinary tract infections . Urology 1984;;24:25-30.
4 +
Wall EM, Baldwin-Johnson C:  Urinary tract infections among diaphragm users . J Fam Pract 1984;;5:707-711.
5 +
Stamm WE, Wagner KF, Amsel R, et al:  Causes of the acute urethral syndrome in women . N Engl J Med 1980;;303:409-415.
6 +
Counts GW, Stamm WE, McKevitt M, et al:  Treatment of cystitis in women with a single dose of trimethoprim-sulfisoxazole . Rev Infect Dis 1982;;4:484-490.
7 +
Yoder BL, Stamm WE, Koester CM:  Microtest procedure for isolation of Chlamydia trachomatis . J Clin Microbiol 1981;;304:956-958.
8 +
Stamm WE, Counts GW, Running KR, et al:  Diagnosis of coliform infection in acutely dysuric women . N Engl J Med 1982;;307:463-468.
9 +
Latham RH, Running K, Stamm WE:  Urinary tract infection in young adult women caused by Staphylococcus saprophyticus . JAMA 1983;;250:3063-3066.
10 +
Berg AO, Heidrich FE, Fihn SD, et al:  Establishing the cause of genitourinary symptoms in women in a family practice: Comparison of clinical examination of comprehensive microbiology . JAMA 1984;;251:620-625.
11 +
Spiegel CA, Amsel R, Eschenbach DA, et al:  Anaerobic bacteria in nonspecific vaginitis . N Engl J Med 1980;;303:601-607.
12 +
Cochran W:  Some methods for strengthening the common χ2 test . Biometrics 1954;;10:417-441.
13 +
Fleiss JL: Statistical Methods for Rates and Proportions , ed 2. New York, John Wiley & Sons Inc, 1981;.
14 +
Cox DR: Analysis of Binary Data . London, Chapman & Hall, 1970;.
15 +
Peto R, Pike MC, Armitage P, et al:  Design and analysis of randomized trials requiring prolonged observation of each patient: I. Introduction and design . Br J Cancer 1976;;34:585-612.
16 +
Mantel N:  Evaluation of survival data and two new rank order statistics arising in its consideration . Cancer Chemother Rep 1966;; 50:163-170.
17 +
Takahashi M, Loveland DB:  Bacteriuria and oral contraceptives: Routine health examinations of 12,076 middle-class women . JAMA 1974;;227:762-765.
18 +
Evans DA, Hennekens CH, Miao L, et al:  Oral-contraceptive use and bacteriuria in a community-based study . N Engl J Med 1978;; 299:536-537.
19 +
Cole P:  The evolving case-control study . J Chronic Dis 1979;;32:15-27.
20 +
Austin H, Louv WC, Alexander J:  A casecontrol study of spermicides and gonorrhea . JAMA 1984;;241:2822-2824.
21 +
McCormack WM, Rosner B, McComb DE, et al:  Infection with Chlamydia trachomatis in female college students . Am J Epidemiol 1985;; 121:107-115.
22 +
Bachrach CA, Mosher WD: Use of contraception in the United States, 1982 . National Center for Health Statistics advance data No. 102. Dept of Health and Human Services, (December) 1984;.
23 +
Fihn SD, Running K, Pinkstaff C, et al:  Diaphragms cause urinary obstruction in women with prior urinary tract infection , abstracted. Clin Res 1985;;33:720A.
24 +
Stamey TA, Sexton CS:  The role of vaginal colonization with enterobacteriaceae in recurrent urinary infections . J Urol 1975;;113:214-219.
25 +
Marsh FR, Murray M, Panchamia P:  The relationship between bacterial cultures of the vaginal introitus and urinary infection , in Urinary Tract Infection . Oxford, England, Oxford University Press, 1973;.
26 +
Watt B, Goldacre MJ, Loudon N, et al:  Prevalence of bacteria in the vagina of normal young women . Br J Obstet Gynaecol 1981;;88:588-595.
27 +
Percival-Smith R, Bartlett KH, Chow AW:  Vaginal colonization of Escherichia coli and its relation to contraceptive methods . Contraception 1983;;27:497-504.
28 +
Peddie BA, Bishop V, Bailey RR, et al:  Relationship between contraceptive method and vaginal flora . Aust NZ J Obstet Gynaecol 1984;; 24:217-218.
29 +
Thurner J, Poitschek C, Kopp C:  Der einfluss von spermiziden auf die physiologische und pathologene genitalflora . Wien Med Wochenschr 1983;;133:265-268.
30 +
Jick H, Hannan MT, Stergachis A, et al:  Vaginal spermicides and gonorrhea . JAMA 1982;; 248:1619-1621.
31 +
Kelaghan J, Rubin GL, Ory H, et al:  Barrier-method contraceptives and pelvic inflammatory disease . JAMA 1982;;248:184-187.

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