Readers of this Website will have been alerted by the piece “LemonAIDS comes of age” which described the presentation we made to the International AIDS Society Conference in Sydney, July 22-25, 2007.

We are delighted to report that a full scientific paper entitled “Prevalence of HIV and other sexually transmissible infections in relation to lemon or lime juice douching among female sex workers in Jos, Nigeria” has just been published on-line in the journal Sexual Health (2008) Vol 5, pages 55-60. This can be accessed on the journal’s Website http://www.publish.csiro.au/journals/sh , and will be available in print in a few weeks for those who subscribe to the journal, or have access to a medical library.

The study was carried out by a group of our Nigerian colleagues, led by Godwin Imade who had studied under Prof David de Kretser and Prof Roger Short at Monash University, and it was directed by Prof Atiene Sagay, the Professor of Obstetrics and Gynaecology at the University of Jos. Prof Viola Onwuliri from the Department of Biochemistry provided that essential female touch in planning, design and recruitment, and we had invaluable medical, technical and statistical support from Daniel Egah in the Department of Medical Microbiology, Christopher Egbodo in the Department of Obstetrics and Gynaecology, and Tom Thatcher in the Department of Family Medicine.

A Final Year Medical Student from the University of Melbourne, Matthew Grigg, generously volunteered to defer his Finals for a year to go and help with the project; he has now qualified! Prof Malcolm Potts at the University of California, Berkeley, who knows Nigeria well, helped with the planning and data analysis, and Prof Roger Short was involved in fundraising through the Mary Magdalene Project appeal, planning, and helping to write up the results for publication. We are indebted to many Doctors and others throughout Australia and New Zealand and beyond who generously contributed to the Mary Magdalene Project, and made the study possible.

So what did we discover? Much to our disappointment, at the end of the day we could find no evidence to suggest that douching the vagina either before or after sexual intercourse with neat or dilute lemon or lime juice afforded any protection to the sex workers against infection with either HIV, Syphilis, Gonorrhoea, Candida or Trichomoniasis. The study was a cross-sectional one, and compared the prevalence of these sexually transmitted infections in 86 sex workers who douched with citrus juice against a control group of 312 who did not douche. As far as HIV was concerned, the prevalence of infection was 48.8% in those who douched, compared to 48.0% in those who did not, clearly a non-significant difference The only good news was that there was no evidence that the douching increased the susceptibility of the sex workers to any of these infections.

Eighty four percent of the sex workers preferred to douche with lime juice, and 67% believed that the douching prevented them from becoming infected with a sexually transmitted disease and/or from becoming pregnant. The majority said that the procedure was painless, or caused only mild discomfort, but 15% admitted that it was painful.

Clearly a cross-sectional study is not nearly as powerful as a longitudinal study, which would have been much more costly, time-consuming and difficult to carry out. But despite these limitations, we are forced to conclude that douching the vagina with lemon or lime juice before or after sex is unlikely to offer any protection against infection with HIV or other common sexually transmitted diseases.

On a more positive note, at least 398 Nigerian sex workers now know their HIV status, have received appropriate post-test counseling, and have been referred to a specialist HIV/AIDS facility in Jos for antiretroviral therapy, care and support.