Hormonal contraception and risk of sexually transmitted disease acquisition: Results from a prospective study

Department of Epidemiology, University of Washington, Seattle, WA 98104-2499, USA.
American Journal of Obstetrics and Gynecology (Impact Factor: 4.7). 09/2001; 185(2):380-5. DOI: 10.1067/mob.2001.115862
Source: PubMed


To examine the relationship between use of oral contraceptive pills or depot medroxyprogesterone acetate and sexually transmitted disease acquisition.
Prospective cohort included 948 Kenyan prostitutes. Multivariate Andersen-Gill proportional hazards models were constructed, adjusting for sexual behavioral and demographic variables.
When compared with women who were using no contraception, users of oral contraceptive pills were at increased risk for acquisition of chlamydia (hazard ratio, 1.8; 95% confidence interval, 1.1-2.9) and vaginal candidiasis (hazard ratio, 1.5; 95% confidence interval, 1.2-1.9) and at decreased risk for bacterial vaginosis (hazard ratio, 0.8; 95% confidence interval, 0.7-1.0). Women using depot medroxyprogesterone acetate had significantly increased risk of chlamydia infection (hazard ratio, 1.6; 95% confidence interval, 1.1-2.4) and significantly decreased risk of bacterial vaginosis (hazard ratio, 0.7; 95% confidence interval, 0.5-0.8), trichomoniasis (hazard ratio, 0.6; 95% confidence interval, 0.4-1.0), and pelvic inflammatory disease (hazard ratio, 0.4; 95% confidence interval, 0.2-0.7). Consistent condom use was associated with significantly decreased risk of gonorrhea, chlamydia, genital ulcer disease, bacterial vaginosis, and pelvic inflammatory disease.
The use of oral or injectable hormonal contraception altered susceptibility to sexually transmitted diseases, which may in turn influence transmission of human immunodeficiency virus type 1. Consistent condom use was protective with regards to sexually transmitted disease and should be encouraged for the prevention of sexually transmitted disease and human immunodeficiency virus type 1 among women who use hormonal contraception.

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Available from: Ludo Lavreys, Oct 07, 2015
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    • "Cervical ectopy is common in adolescents, pregnant women and in women using oral contraceptives (Critchlow et al. 1995). Many studies have reported associations between cervical ectopy and various infections, including chlamydia (Baeten et al. 2001; Collier et al. 1995; Morrison et al. 2004), human papillomavirus (HPV), human immunodeficiency virus (HIV) and cytomegalovirus (CMV) (Morrison et al. 2001; Morrison et al. 2004; Plourde et al. 1994). Cervical erosion may be categorized as either physiologic or pathologic. "
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    ABSTRACT: This study aimed to explore the therapeutic effect of focused ultrasound (FU) therapy in patients with symptomatic cervical ectopy. 4677 patients with symptomatic cervical ectopy were enrolled and treated with FU. Three months after treatment, we analyzed the therapeutic effects and the adverse reactions in 4014 cases with complete records. All influential factors were also analyzed with logistic regression analysis. For the treatment of symptomatic cervical ectopy, the effective rate of FU was 99.8%, and the cure rate was 72.52%. Bleeding that either reached or exceeded normal menstrual volume occurred in 12 cases. Logistic regression analysis showed that the degree of illness, vaginal cleanliness, economic level, occupation, age and artificial abortion frequency were all influential factors. Focused ultrasound is a promising new therapeutic option for the treatment of symptomatic cervical ectopy. Additionally, it can be widely used for a variety of patients.
    Ultrasound in medicine & biology 04/2013; 39(4):604-10. DOI:10.1016/j.ultrasmedbio.2012.11.012 · 2.21 Impact Factor
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    • "This association has been evident in a number of published studies. Hormonal contraceptives, mainly combined methods, have been reported to be protective against prevalent [18], [19], [20], incident [6], [35] and recurrent [17], [19], [21] BV. While there are a number of confounding factors that may explain this association it is consistently evident in the literature, and many analyses including our own, have adjusted for known confounders such as numbers of sexual partners and educational level. "
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    ABSTRACT: To determine prevalence and incidence of bacterial vaginosis (BV) and risk factors in young sexually-active Australian women. 1093 women aged 16-25 years were recruited from primary-care clinics. Participants completed 3-monthly questionnaires and self-collected vaginal smears 6-monthly for 12-months. The primary endpoint was a Nugent Score = 7-10 (BV) and the secondary endpoint was a NS = 4-10 (abnormal flora [AF]). BV and AF prevalence estimates and 95% confidence intervals (95%CI) were derived, and adjusted odds ratios (AOR) calculated to explore epidemiological associations with prevalent BV and AF. Proportional-hazards regression models were used to examine factors associated with incident BV and AF. At baseline 129 women had BV [11.8% (95%CI: 9.4-14.2)] and 188 AF (17.2%; 15.1-19.5). Prevalent BV was associated with having a recent female partner [AOR = 2.1; 1.0-4.4] and lack of tertiary-education [AOR = 1.9; 1.2-3.0]; use of an oestrogen-containing contraceptive (OCC) was associated with reduced risk [AOR = 0.6; 0.4-0.9]. Prevalent AF was associated with the same factors, and additionally with >5 male partners (MSP) in 12-months [AOR = 1.8; 1.2-2.5)], and detection of or [AOR = 2.1; 1.0-4.5]. There were 82 cases of incident BV (9.4%;7.7-11.7/100 person-years) and 129 with incident AF (14.8%; 12.5-17.6/100 person-years). Incident BV and AF were associated with a new MSP [adjusted rate ratio (ARR) = 1.5; 1.1-2.2 and ARR = 1.5; 1.1-2.0], respectively. OCC-use was associated with reduced risk of incident AF [ARR = 0.7; 0.5-1.0]. This paper presents BV and AF prevalence and incidence estimates from a large prospective cohort of young Australian women predominantly recruited from primary-care clinics. These data support the concept that sexual activity is strongly associated with the development of BV and AF and that use of an OCC is associated with reduced risk.
    PLoS ONE 03/2013; 8(3):e57688. DOI:10.1371/journal.pone.0057688 · 3.23 Impact Factor
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    • "In an in vitro model of infection of HeLa cells with C. trachomatis, estradiol pre-exposed of cells enhanced both the adherence of chlamydial elementary bodies to the cells as well as the development of chlamydial inclusions [9]. Oral contraceptive use also increases the risk of contracting chlamydial infections compared to women not using contraception [10]. Collectively, these data show that the outcome of chlamydial infection is determined in part by the hormonal status of the epithelium at the time of exposure. "
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