Highly effective contraception and acquisition of HIV and other sexually transmitted infections
A key question for clinicians is whether an aetiological association exists between highly effective contraceptive methods and women's risk of acquiring sexually transmitted infections (STIs), including human immunodeficiency virus (HIV). The authors searched the peer-reviewed literature for prospective studies published from January 1966 to August 2008 that assessed contraception and STI/HIV risk. The focus was on combined oral contraceptives (OCs), depot-medroxyprogesterone acetate (DMPA), the T380a copper intra-uterine device (IUD) and the risk of infection with HIV, Chlamydia trachomatis and Neisseria gonorrhoeae. Current data suggest that neither OCs nor DMPA increase HIV risk among women in the general population. Data are equivocal for women in high-risk groups (e.g. sex workers). Current data suggest an increased risk of chlamydial infection associated with OC use, with weaker evidence supporting a harmful effect of DMPA. Reports of OCs and gonococcal infection are inconsistent, and DMPA does not appear to be associated with gonorrhoea acquisition. Data suggest no increased STI/HIV risk among copper IUD users. Prospective data on highly effective contraceptive methods and women's STI/HIV risk are limited, and many studies have important methodological weaknesses. Additional information about the STI/HIV risks associated with these highly effective contraceptive methods is needed.
Available from: Anna-Lise Williamson
- "Another study showed no association between HC use and high-risk HPV infection or on high-grade CIN and disease progression. In this study we did not find an association with HC use and HPV, though genital tract alteration is known to be associated with HC use having greater likelihood of cervical ectopy and thinning of the cervico-vaginal epithelium predisposing to HPV acquisition. Furthermore, HC use is linked to sexual risk behaviours, thus sexual behaviour correlates, together with better measures of HC use, must be taken into account in order to determine the true effect of HC use on HPV acquisition. "
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HPV infection causes cervical cancer, yet information on prevalence and risk factors for HPV in Africa remain sparse. This study describes the prevalence of HPV genotypes and risk factors associated with HPV among young women ≤ 30 years of age in KwaZulu-Natal (KZN), South Africa.
Cervicovaginal lavage samples were tested for HPV genotypes in 224 women enrolled in a prospective cohort study. Clinical, behavioural and demographic data were collected. We measured prevalence of HPV genotypes and using logistic regression, examined for factors associated with HPV.
Median age of participants was 21 years [interquartile range (IQR):18-23]. The overall prevalence of HPV was 76.3% (171/224) with multiple and single genotypes prevalent in 56.3% and 20.1% of women respectively. Proportion of women with high-risk genotypes (16, 18, 31, 33, 35, 39, 45, 51, 52, 56 and 58) was 54.5%. Women not living with their partner [adjusted odds ratio (aOR)] = 3.42 95% CI1.22-9.60; p = 0.019), was significantly associated with HPV infection and high-risk HPV genotype infection.
The high burden of HPV and associated risk behaviours highlight the need to intensify behavioural interventions to prevent HPV acquisition in young women. The large scale delivery of HPV vaccine should be prioritised to prevent HPV acquisition and reduce HPV-related morbidity.
- "The interface between sexually transmitted infection (STI) and contraceptive method is a crucial dimension of women's reproductive and sexual health. Progestin-based contraceptives have been associated with increased risk of STI acquisition and transmission, including Chlamydia trachomatis (CT) (Baeten et al. 2001; Mohllajee et al. 2006; Morrison et al. 2009; Polis et al. 2014) one of the most prevalent STIs in the United States (CDC 2014; Satterwhite et al. 2013). The levonorgestrel-releasing intrauterine system (LNG-IUS) is a highly effective form of intrauterine contraception that is increasing in use among women in the US (Finer et al. 2012; Thonneau and Almont 2008)._ENREF_8 "
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ABSTRACT: Progestin-based contraception may impact women's susceptibility to sexually transmitted infection. We evaluated the effect of the levonorgestrel intrauterine system (LNG-IUS) on cervical persistence of Chlamydia trachomatis (CT) in a baboon model. Female olive baboons (Papio anubis) with or without a LNG-IUS received CT or sham inoculations. CT was detected in cervical epithelium with weekly nucleic acid amplification testing (NAAT) and culture. Presence of the LNG-IUS was associated with prolonged persistence of CT. Median time to post-inoculation clearance of CT as detected by NAAT was 10 weeks (range 7-12) for animals with a LNG-IUS and 3 weeks (range 0-12) for non-LNG-IUS animals (p = 0.06). Similarly, median time to post-inoculation clearance of CT by culture was 9 weeks (range 3-12) for LNG-IUS animals and 1.5 weeks (range 0-10) for non-LNG-IUS animals (p = 0.04). We characterized the community structure of the vaginal microbiota with the presence of the LNG-IUS to determine if alterations in CT colonization dynamics were associated with changes in vaginal commensal bacteria. Vaginal swabs were collected weekly for microbiome analysis. Endocervical CT infection was not correlated with alterations in the vaginal microbiota. Together, these results suggest the LNG-IUS may facilitate CT endocervical persistence through a mechanism distinct from vaginal microbial alterations.
Available from: Benjamin Armbruster
- "risk of failure with perfect use and a 3% risk with typical use . However, some observational studies (the earliest from 1991) link the use of certain contraceptives with an increased risk of HIV acquisition [2,56789101112. Most studies focus on combined oral contraceptives (COCs) and/or POIHC (including DMPA and NET-EN). There is limited data on the potential relationship between HIV risks and other hormonal contraceptive methods such as implants, vaginal rings, or intrauterine devices (IUD). "
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ABSTRACT: A recent study showed that progestogen-only injectable hormonal contraception (POIHC) doubles the risk of HIV transmission. This may affect contraceptive use and HIV-related outcomes, if women switch away from POIHC. A deterministic compartmental model of individuals aged 15-49 distinguishing gender and HIV status was used to simulate various contraceptive use scenarios. We specifically tracked HIV prevalence, new infections, HIV-related deaths, vertical transmission, and births over a 15-year period for five African countries. Stopping POIHC use will result in a large increase in births and vertical transmission. Switching from POIHC to other contraceptives limits these increases while still improving HIV outcomes.
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