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Prevalence and risk factors associated with STIs among women initiating contraceptive implants in Kingston, Jamaica
  1. Margaret Christine Snead1,
  2. Jeffrey Wiener1,
  3. Sinmisola Ewumi3,
  4. Christi Phillips2,
  5. Lisa Flowers1,
  6. Tina Hylton-Kong4,
  7. Natalie Medley-Singh5,
  8. Jennifer Legardy-Williams6,
  9. Elizabeth Costenbader7,
  10. John Papp2,
  11. Lee Warner1,
  12. Carolyn Black8,
  13. Athena P Kourtis1
  1. 1 Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
  2. 2 Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
  3. 3 Albert Einstein College of Medicine, Bronx, New York, USA
  4. 4 Epidemiology Research and Training Unit, MOH, Kingston, Jamaica
  5. 5 University Hospital of the West Indies, Kingston, Jamaica
  6. 6 Office of Science and Integrated Services, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
  7. 7 Family Health International (FHI 360), Durham, North Carolina, USA
  8. 8 Division of Scientific Resources, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
  1. Correspondence to Dr Margaret Christine Snead. Centers for Disease Control and Prevention, 4770 Buford HWY, MS-F-74, Atlanta, GA 30341, USA; msnead{at}


Background There is limited information on rates of STIs in Jamaica due to syndromic management and limited aetiological surveillance. We examined the prevalence of Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and Trichomonas vaginalis (TV) and characteristics associated with STIs among sexually active women who participated in a randomised trial of a progestin implant initiation in Jamaica (the Sino-Implant Study (SIS)).

Methods SIS was a randomised trial conducted in Kingston, Jamaica, from 2012 to 2014 to evaluate whether initiation of the Sino-Implant (II) led to more unprotected sex among women ages 18–44 years. Data collected included self-reported demographic, sexual behaviour information; and vaginal swabs collected at baseline, 1-month and 3-month follow-up visits for a biomarker of recent semen exposure (prostate-specific antigen (PSA)) and for STIs. We examined associations between STIs and PSA, demographics, sexual behaviour and insertion of an implant, with a repeated-measures analysis using generalised estimating equations (SAS Institute, V.9.3).

Results Remnant vaginal swabs from 254 of 414 study participants were tested for STIs. At baseline, 29% of participants tested for STIs (n=247) had laboratory-confirmed CT, 5% NG, 23% TV and 45% any STI. In a repeated-measures analysis adjusted for study arm (immediate vs delayed implant insertion), those with PSA detected did not have an increased prevalence of any STI (prevalence ratio (PR)=1.04 (95% CI 0.89 to 1.21)), whereas prevalence decreased for each 1-year increase in age (PR=0.98 (95% CI 0.97 to 0.99)). Immediate implant insertion was not associated with increases in any STI in subsequent visits (PR=1.09 (95% CI 0.94 to 1.27)).

Conclusions Although the prevalence of laboratory-confirmed STIs was high, the immediate initiation of a contraceptive implant was not associated with higher STI prevalence rates over 3 months.

Trial registration number NCT01684358.


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  • Handling editor Jackie A Cassell

  • Contributors All authors participated in the interpretation of the study and drafting of the manuscript. All authors have seen and approved the final version. MCS, JW, LF, SE and APK participated in the design and analysis for the manuscript. TH-K, NM, LW, JL-W and BC contributed to the overall study design and concept. CB, JP, CP and MCS participated in acquisition of data and oversight of lab analyses. JW performed the statistical analysis.

  • Funding Supported by the Centers for Disease Control and Prevention, United States Agency for International Development, Family Health International (FHI 360) cooperative agreement, CA/GPO-A-00-05-00022.

  • Disclaimer The findings and conclusions in this report are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Use of trade names is for identification only and does not imply endorsement by the U.S. Department of Health and Human Services.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval The study protocol was approved by the Jamaican Ministry of Health, the CDC and the University of West Indies ethical review boards and was registered with (NCT01684358). Ethics committee number: 6136.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement For data sharing enquiries, please contact