Condom use and incident sexually transmitted infection after initiation of long-acting reversible contraception

Abstract

Background: Use of more effective contraception may lead to less condom use and increased incidence of sexually transmitted infection. Objective: The objective of this study was to compare changes in condom use and incidence of sexually transmitted infection acquisition among new initiators of long-acting reversible contraceptives to those initiating non-long acting reversible contraceptive methods. Study Design: This is a secondary analysis of the Contraceptive CHOICE Project. We included two sample populations of 12-month continuous contraceptive users. The first included users with complete condom data (baseline, 3, 6, and 12 months) (long-acting reversible contraceptive users: n=2371; other methods: n=575). The second included users with 12-month sexually transmitted infection data (long-acting reversible contraceptive users: n=2102; other methods: n=592). Self-reported condom use was assessed at baseline and at 3, 6, and 12 months following enrollment. Changes in condom use and incident sexually transmitted infection rates were compared using chi-square tests. Risk factors for sexually transmitted infection acquisition were identified using multivariable logistic regression. Results: Few participants in either group reported consistent condom use across all survey time points and with all partners (long-acting reversible contraceptive users: 5.2%; other methods: 11.3%, P<0.001). There was no difference in change of condom use at 3, 6 and 12 months compared to baseline condom use regardless of method type (p=0.65). A total of 94 incident sexually transmitted infections were documented, with long-acting reversible contraceptive users accounting for a higher proportion (3.9% vs. 2.0%; P=0.03). Initiation of a long-acting reversible contraceptive method was associated with increased sexually transmitted infection incidence (OR 2.0, 95% CI: 1.07, 3.72). Conclusions: Long-acting reversible contraceptive initiators reported lower rates of consistent condom use, but did not demonstrate a change in condom use when compared to pre-initiation behaviors. Long-acting reversible contraceptive users were more likely to acquire a sexually transmitted infection in the 12 months following initiation.

Young Women's Complex Patterns of Contraceptive Use: Findings from an Australian Cohort Study

“…32 While condoms are the best way to prevent STD transmission, these are often not used in longer term relationships. 9,33 Australian guidelines recommend that sexually active people younger than 30 be screened for STDs regularly (and more often if an individual is engaging in sexual activities that increase transmission risk); 34 heightened efforts to encourage men and women to visit their general practitioner for regular sexual health checkups are needed.…”

“…In a study of Australian clinic users aged 16-24, fewer than one-third of hormonal contraceptive users reported consistent use of condoms, and dual method use decreased as relationship length increased. 9 Using condoms by themselves or as a supplementary method in new or casual relationships (and a decline in condom use as relationship length increases) has also been found in the United States. 9,10 The use of condoms in combination with another method by Australian women is an important area of research, particularly given the country' s increasing STD rates among women.…”

“…9 Using condoms by themselves or as a supplementary method in new or casual relationships (and a decline in condom use as relationship length increases) has also been found in the United States. 9,10 The use of condoms in combination with another method by Australian women is an important area of research, particularly given the country' s increasing STD rates among women. 11 Few studies have examined the wide range of contraceptive combinations women could be using.…”

Dual method use among long-acting reversible contraceptive users

“…Another analysis of a cohort of CHOICE participants revealed that women using LARC were less likely to use a condom every time with every partner (5.2% vs. 11.3% in non-LARC users), but that the condom use patterns did not change over the year after initiating a LARC method. [15] Similarly, a recent randomized controlled trial evaluating the effect of initiation a contraceptive implant on condom use did not find any difference in condom use before compared to after implant insertion, or when comparing women who received immediate vs. delayed implant insertion. [16] These findings suggest that it may not be initiation of the LARC method itself that impacts condom use, but that other factors related to LARC use may also impact condom use.…”

“…Another analysis of a cohort of CHOICE participants revealed that LARC users did have higher rates of STI (3.9% vs. 2.0% in non-LARC users), but this was not attributable to a decrease in condom use after LARC initiation. [15] One previous study suggested that lower condom use among implant users compared to pill users did not confer a greater risk of STIs due to more stable sexual relationships among implant users. [20] Conversely, another study evaluating high school adolescents found that LARC users were 60% less likely to use condoms, and also more likely to have a greater number of sexual partners, putting them at increased risk for STIs.…”