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

https://doi.org/10.1067/mob.2001.115862Get rights and content

Abstract

Objectives: To examine the relationship between use of oral contraceptive pills or depot medroxyprogesterone acetate and sexually transmitted disease acquisition. Study Design: Prospective cohort included 948 Kenyan prostitutes. Multivariate Andersen-Gill proportional hazards models were constructed, adjusting for sexual behavioral and demographic variables. Results: 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. Conclusions: 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. (Am J Obstet Gynecol 2001;185:380-85)

Section snippets

Study procedures

In February 1993, an open cohort of female sex workers was established as part of the Preparation for AIDS Vaccine Evaluation/HIV Network for Prevention Trials initiative of the US National Institutes of Health. The study protocol was approved by the institutional review boards of the University of Washington and the University of Nairobi. Participants provided informed consent.

Clinical and laboratory procedures have been described previously.9 Briefly, registered prostitutes were offered

Study population characteristics

Between February 1993 and August 1999, 4528 women were screened for antibodies to HIV-1, and 2413 (53%) were seropositive. Among the 2115 seronegative women, 1202 (57%) were enrolled in the cohort. Nine hundred and ninety-four women (83% of those enrolled) returned for at least one follow-up visit, and 948 (95% of those with follow-up) met the inclusion criteria for this analysis. The median length of follow-up time was 421 days (range, 15-2366 days), and the median number of follow-up visits

Discussion

In this population of Kenyan prostitutes, oral contraceptive pill and DMPA use were both associated with significantly elevated risk of cervical chlamydial infection and significantly decreased risk of bacterial vaginosis, after controlling for sexual behavior and demographic factors. In addition, oral contraceptive use was associated with significantly increased risk of vaginal candidiasis, and DMPA use was associated with significantly decreased risk of trichomoniasis and PID. To our

Acknowledgements

We would like to acknowledge the dedication of the clinic and laboratory staff and the support of the Municipal Council of Mombasa and the administration of Coast Provincial General Hospital for use of their facilities. We are grateful to the women of Ganjoni Clinic, whose participation made this study possible.

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    Deceased.

    ☆☆

    Supported in part by US National Institutes of Health grants AI33873, D43-TW00007, and T22-TW00001 and by Family Health International (subcontract NO1-A1-35173-119).

    Reprint requests: Jared M. Baeten, University of Washington, 325 Ninth Avenue, Box 359909, Seattle, WA 98104-2499. E-mail: [email protected].

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