Article Text

Download PDFPDF
Biological and hormonal markers of chlamydia, human papillomavirus, and bacterial vaginosis among adolescents attending genitourinary medicine clinics
  1. L Brabin1,
  2. E Fairbrother1,
  3. D Mandal2,
  4. S A Roberts3,
  5. S P Higgins4,
  6. S Chandiok5,
  7. P Wood6,
  8. G Barnard7,
  9. H C Kitchener1
  1. 1Academic Unit of Obstetrics and Gynaecology and Reproductive Health Care, University of Manchester, UK
  2. 2Manchester Centre for Sexual Health, Manchester Royal Infirmary, UK
  3. 3Biostatistics Group, School of Epidemiology and Health Sciences, University of Manchester, UK
  4. 4Department of Genitourinary Medicine, North Manchester General Hospital, UK
  5. 5Sexual Health Clinic, Withington Hospital, Manchester, UK
  6. 6Regional Endocrine Unit, University of Southampton, UK
  7. 7Centre for Veterinary Science, Department of Clinical Veterinary Medicine, University of Cambridge, UK
  1. Correspondence to:
 Dr L Brabin
 Academic Unit of Obstetrics and Gynaecology and Reproductive Health Care, Research Floor, St Mary’s Hospital, Whitworth Park, Manchester M13 0JH, UK;


Objective: To assess maturity indices, menstrual patterns, hormonal factors, and risk of adolescent genital tract infections.

Methods: Cross sectional study in three genitourinary medicine clinics. Females 17 years or less, within 5 years of menarche, or reporting oligo-amenorrhoea were screened for genital tract infections and menstrual cycle characteristics determined. The outcome measures were risk factors associated with chlamydia, human papillomavirus (HPV DNA) and bacterial vaginosis (BV), separately and pooled. Correlations between estrone-3-glucuronide (E3G) and pregnanediol-3α-glucuronide (P3G) hormone concentrations and chlamydia, HPV, and BV.

Results: Among 127 adolescents, HPV was present in 64.4% (95% CI: 54.5 to 74.3), BV in 33.9% (19.1 to 34.5), and chlamydia in 26.8% (19.1 to 34.5). Breast maturity, oligomenorrhoea, and older gynaecological age were associated with lower risk of all infections. After adjustment for calendar age, race, and behavioural factors, gynaecological age remained significant (OR = 0.7, 0.6–0.9; p = 0.008). Behavioural risk factors differed by infection. Smoking was protective for HPV (OR = 0.1, 0.0 to 0.9; p = 0.007), and a recent new partner for chlamydia (OR = 0.3, 0.1 to 0.9; p = 0.024). Sex during menses was associated with increased BV risk (OR = 3.3, 1.5 to 7.2; p = 0.003). Chlamydia was higher among adolescents who used emergency contraception (2.5; 1.1 to 5.9, p = 0.029) and lower among those using condoms at last sex (OR = 0.3, 0.1 to 0.9; p = 0.015). Among 25 adolescents not using hormonal contraceptives, 15 had disturbed or anovulatory cycles. Chlamydia risk was inversely associated with P3G concentrations (Mann-Whitney; p = 0.05).

Conclusions: Adolescents engaging in high risk behaviour at a young gynaecological age are susceptible to multiple infections. Adolescent clinical assessment should include gynaecological age.

  • BV, bacterial vaginosis
  • E3G, estrone-3-glucuronide
  • GUM, genitourinary medicine
  • HPV, human papillomavirus
  • P3G, pregnanediol-3α-glucuronide
  • PCR, polymerase chain reaction
  • adolescents
  • genital tract infections
  • risk factors

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.