You are here

  • Home
  • Archive
  • Volume 97, Issue 4
  • Sexually transmitted infections among women randomised to depot medroxyprogesterone acetate, a copper intrauterine device or a levonorgestrel implant

Article Text

Article menu
XML
Clinical
Original research
Sexually transmitted infections among women randomised to depot medroxyprogesterone acetate, a copper intrauterine device or a levonorgestrel implant
  1. Jennifer Deese1,
  2. Neena Philip2,
  3. Margaret Lind3,
  4. Khatija Ahmed4,
  5. Joanne Batting5,
  6. Mags Beksinska6,
  7. Vinodh A Edward7,8,
  8. Cheryl E Louw9,10,
  9. Maricianah Onono11,
  10. Thesla Palanee-Phillips12,
  11. Jennifer A Smit6,
  12. Jared M Baeten13,14,
  13. Deborah Donnell14,
  14. Timothy D Mastro15,
  15. Nelly R Mugo16,17,
  16. Kavita Nanda18,
  17. Helen Rees19,
  18. Charles Morrison20
  1. 1Global Public Health Impact Center, RTI International, Research Triangle Park, North Carolina, USA
  2. 2Mailman School of Public Health, Columbia University, New York, New York, USA
  3. 3Department of Global Health, International Clinical Research Center, University of Washington, Seattle, Washington, USA
  4. 4Setshaba Research Centre, Pretoria, South Africa
  5. 5Effective Care Research Unit, University of the Witwatersrand, East London, South Africa
  6. 6MatCH Research Unit, Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
  7. 7The Aurum Institute, Johannesburg, South Africa
  8. 8School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
  9. 9Madibeng Centre for Research, Brits, South Africa
  10. 10Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
  11. 11Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
  12. 12Faculty of Health Sciences, Wits Reproductive Health and HIV Institute, Johannesburg, South Africa
  13. 13Global Health, Medicine, and Epidemiology, University of Washington, Seattle, Washington, USA
  14. 14Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
  15. 15FHI 360, Durham, North Carolina, USA
  16. 16Department of Global Health, University of Washington, Seattle, Washington, USA
  17. 17Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
  18. 18Product Development and Introduction, FHI 360, Durham, North Carolina, USA
  19. 19Wits Reproductive Health & HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
  20. 20Behavioral, Epidemiological and Clinical Sciences, FHI 360, Durham, North Carolina, USA
  1. Correspondence to Dr Jennifer Deese, Global Public Health Impact Center, RTI International, Research Triangle Park, NC, USA; jdeese{at}rti.org

Abstract

Objectives Reproductive aged women are at risk of pregnancy and sexually transmitted infections (STI). Understanding drivers of STI acquisition, including any association with widely used contraceptives, could help us to reduce STI prevalence and comorbidities. We compared the risk of STI among women randomised to three contraceptive methods.

Methods We conducted a secondary analysis to assess the risk of chlamydia and gonorrhoea in a clinical trial evaluating HIV risk among 7829 women aged 16–35 randomised to intramuscular depot medroxyprogesterone acetate (DMPA-IM), a copper intrauterine device (IUD) or a levonorgestrel (LNG) implant. We estimated chlamydia and gonorrhoea prevalences by contraceptive group and prevalence ratios (PR) using log-binomial regression.

Results At baseline, chlamydia and gonorrhoea prevalences were 18% and 5%, respectively. Final visit chlamydia prevalence did not differ significantly between DMPA-IM and copper IUD groups or between copper IUD and LNG implant groups. The DMPA-IM group had significantly lower risk of chlamydia compared with the LNG implant group (PR 0.83, 95% CI 0.72 to 0.95). Final visit gonorrhoea prevalence differed significantly only between the DMPA-IM and the copper IUD groups (PR 0.67, 95% CI 0.52 to 0.87).

Conclusions The findings suggest that chlamydia and gonorrhoea risk may vary with contraceptive method use. Further investigation is warranted to better understand the mechanisms of chlamydia and gonorrhoea susceptibility in the context of contraceptive use.

  • contraception
  • clinical trials
  • chlamydia trachomatis
  • neisseria gonorrhoeae

Data availability statement

Data are available on reasonable request. As of the time of publication, data access applications are in process with the governing IRBs of the ECHO trial to make de-identified publicly available.

https://creativecommons.org/licenses/by/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

https://doi.org/10.1136/sextrans-2020-054590

Statistics from Altmetric.com

    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.

    Data availability statement

    Data are available on reasonable request. As of the time of publication, data access applications are in process with the governing IRBs of the ECHO trial to make de-identified publicly available.

    View Full Text

    Supplementary materials

    • Supplementary Data

      This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

    • Supplementary Data

      This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

    Footnotes

    • JD and NP are joint first authors.

    • Handling editor Catherine H Mercer

    • Twitter @DrTimMastro

    • Funding This work and The Evidence for Contraceptive Options and HIV Outcomes (ECHO) Trial was supported by the combined support of the Bill & Melinda Gates Foundation (grant OPP1032115); the American people through the United States Agency for International Development (grant AID-OAA-A-15–00045); the Swedish International Development Cooperation Agency (grant 2017/762965–0); the South Africa Medical Research Council; and the United Nations Population Fund. Contraceptive supplies were donated by the Government of South Africa and US Agency for International Development.

    • Disclaimer The contents of this paper are solely the responsibility of the authors and do not necessarily reflect the views, decisions or policies of the institutions with which they are affiliated, the ECHO trial funders or the supporting governments.

    • Competing interests JMB is an advisor for Gilead Sciences, Merck and Janssen.

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

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.