No association was found between hormonal contraceptive use and HIV acquisition overall. This is reassuring for women needing effective contraception in settings of high HIV prevalence. However, hormonal contraceptive users who were HSV-2 seronegative had an increased risk of HIV acquisition. Additional research is needed to confirm and explain this finding.

Objective To assess the protective effect of depot‐medroxyprogesterone acetate (DMPA) on uterine leiomyomas. DMPA has been widely used in Thailand for many years; uterine leiomyomas is the most common female tumour. Design A multicentre hospital‐based case‐control study. Setting University and regional hospitals. Patients Cases were all newly diagnosed patients with pathologically proven diagnosis of uterine leiomyomas, who were admitted to eight hospitals in three regions of Thailand from January 1991; to June 1993;. Three controls matched with cases by sex, age within five years and date of admission within three months were recruited. Main outcome measures Information on socio‐demographic factors, personal and family history, current disease, reproductive and contraceptive history was collected from cases and controls by interview. Results There were 910 cases and 2709; controls. After univariate and unconditional multiple logistic regression analysis, risk factors associated positively with uterine leiomyomas are tubal ligation, family history of uterine leiomyomas, higher education, obesity and abortion. In contrast, DMPA, use of oral contraceptives, higher parity and smoking are associated with a lower relative risk suggesting that they have a protective effect against uterine leiomyomas. This causative relation is further strengthened by the strong duration‐response relation between DMPA and uterine leiomyomas. This protection may persist for more than 10 years after the last dose. Conclusion We have demonstrated a strong, duration dependent protective effect of DMPA against uterine leiomyomas.

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Characterization of persons highly exposed to human immunodeficiency virus (HIV)-1 who remain uninfected may help define protective immunity. Seventeen HIV-1-seronegative Thai female sex workers (CSWs) with epidemiologic evidence of exposure to HIV-1 were studied for humoral immune responses and phenotypic and genotypic analyses of HLA class I and CCR5 allelic profiles. Infected CSWs and low-risk HIV-1-seronegative Thai women were controls. Highly exposed, persistently seronegative (HEPS) CSWs did not differ from HIV-infected CSWs in HIV risks, condom use, or sexually transmitted diseases. Significant differences were seen in humoral immune responses: gp160-specific IgA responses were detected in cervicovaginal lavage fluids in 6 of 13 HEPS CSWs but 0 of 21 seronegative subjects. All women had wild-type CCR5. HEPS CSWs were more likely to have the HLA-B18 phenotype and genotype than were matched controls (corrected P=.018). Epidemiologic exposure to HIV-1 without apparent infection, an unusual distribution of HLA class I alleles, and HIV-1 gp160-specific IgA responses suggest a biologic basis for this phenomenon.

Results are available from 34 sex establishments (249 women) in the male/female condom group, and 37 sex establishments (255 women) in the male condom group. Condom use was very high in both groups (97.9 and 97.3 % of all sexual acts, respectively, P > 0.05). Male condom use was lower in the male/female condom group when compared with the male condom group (88.2 and 97.5%, respectively, P < 0.001). However, this reduction in male condom use was counterbalanced by the use of female condoms in 12.0% of all sexual acts in the male/female condom group, contributing to a 17% reduction in the proportion of unprotected sexual acts in this group when compared to the male condom group (5.9 versus 7.1%, respectively, P = 0.16). Female condom use was sustained over the entire study period. There was also a 24% reduction in the weighted geometric mean incidence rate of STDs in the sex establishments of the male/female condom group compared to the male condom group (2.81 versus 3.69 per 100 person-weeks, P = 0.18).

HSV-2 plays an important role in the acquisition of HIV among women. Efforts to implement known HSV-2 control measures, as well as identify additional measures to control HSV-2, are urgently needed to curb the spread of HIV.

BackgroundCervical cancer is the most common cancer among women of reproductive age in Thailand. However, information on the prevalence and correlates of anogenital HPV infection in Thailand is sparse.MethodsHPV genotype information, reproductive factors, sexual behavior, other STI and clinical information, and cervical cytology and histology were assessed at enrollment among one thousand two hundred and fifty-six (n = 1,256) HIV negative women aged 20–37 from Thailand enrolled in a prospective study of the natural history of HPV. The type-specific prevalence of HPV was estimated using cervical swab specimens from healthy women and women with a diagnosis of CIN 2/3 at baseline. Prevalence ratios (95% CI) were estimated using Poisson regression to quantify the association of demographic, behavioral, and clinical correlates with prevalent HPV infection.ResultsOverall, 307 (24.6%) and 175 (14.0%) of women were positive for any HPV type and any HR-HPV type, respectively; the most common types were 72, 52, 62, and 16. Among women diagnosed with CIN 2/3 at enrollment (n = 11), the most prevalent HPV types were 52 and 16. In multivariate analysis, HPV prevalence at enrollment was higher among women with: long-term combined oral contraceptive use, a higher number of lifetime sexual partners, a prior Chlamydia infection, and a current diagnosis of Bacterial Vaginosis.ConclusionThe study findings provide important information that can be used in the evaluation of primary and secondary interventions designed to reduce the burden of cervical cancer in Thailand.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-015-0886-z) contains supplementary material, which is available to authorized users.

Women diagnosed with cervical cancer report longer duration and more recent use of combined oral contraceptives (COCs). It is unclear whether COC use is associated with upstream events of human papillomavirus (HPV) infection prior to development of clinical disease. The objective of our study was to assess the association of contraceptive use on the risk for prevalent HPV infection in a cohort of long-term hormonal contraceptive (HC) users. One thousand and seventy (n 5 1,070) HIV-negative women aged 20-37 from Thailand enrolled in a prospective study of the natural history of HPV. Baseline HPV genotype information, recency and duration of HC use, sexual behavior, other sexually transmitted infection (STI) information and cervical cytology and histology were assessed. At enrollment, 19.8% and 11.5% of women were infected with any HPV or any high-risk (HR)-HPV, respectively. After adjustment for age, current and past sexual risk behaviors, STI history and cytology, the use of COCs for >6 years was found to be associated with an increased risk of infection with any HPV [prevalence ratio (PR): 1.88 (1.21, 2.90)] and any HR-HPV [PR: 2.68 (1.47, 4.88)] as compared to never users. Recent, long-term COC use was associated with an increased risk for prevalent HPV infection independent of sexual behavior and cervical abnormalities. No similar association was observed for recent or long duration use of progestin-only contraceptives (i.e., depomedroxyprogesterone acetate). These data suggest that COC use may impact early upstream events in the natural history of HPV infection.Cervical cancer is the second most common cancer among women worldwide and a leading cause of cancer-related mortality in the developing world.1 Genital human papillomavirus (HPV) infections have been identified as a necessary cause of cervical cancer.2-4 More than 35 different types of HPVs infect the genital tract, with $18 types considered oncogenic or potentially oncogenic. 5,6 Roughly 291 million women worldwide are currently infected with one of these anogenital HPVs, and approximately 80% of women will be exposed at some point in their lifetime, making HPV the most common sexually transmitted infection (STI).7 However, a majority of HPV infections spontaneously resolve within 1-2 years postdetection. Therefore, other environmental, host and viral cofactors are likely required for the development of cervical cancer. Long-term use of combined oral contraceptives (COCs) has been shown in several case-control studies to be associated with cervical cancer diagnosis among HPV-positive women.9-12 However, it is unclear whether this association is driven by COCs' effect on carcinogenesis or on upstream subclinical endpoints of the natural history such as HPV acquisition and persistence as prospective studies assessing these relationships are inconsistent.