Family Planning, Sexually Transmitted Diseases and Contraceptive Choice: A Literature Update--Part I

Abstract

Couples who use contraceptives not only protect themselves against unwanted pregnancies, but also may reduce their risk of becoming infected with a sexually transmitted disease (STD). No currently available method, however, is highly effective in protecting simultaneously against pregnancy and infection. Thus, couples who place high priority on minimizing both risks may have to use two methods. The need for contraceptive methods that provide effective protection against both pregnancy and STDs has been intensified by the HIV epidemic, but progress has been slowed by the lack of integration between the STD and family planning fields. The first part of this two-part article discusses the similarities and differences between the two fields, examines the impact of STDs on contraceptive use and services, and reviews the scientific literature dealing with the effects of condoms, spermicides and barrier-and-spermicide methods on the risk of STD transmission. Part II (which will appear in the next issue) examines what is known about the effects of oral contraceptives, the IUD, tubal sterilization and abortion on reproductive tract infections. The second part also includes a discussion of the trade-offs involved in choosing a contraceptive and presents estimates of the first-year rates of unplanned pregnancy and gonorrhea infection (given an infected partner) that would occur among women using various contraceptive methods.

Prevalence and determinants of human papillomavirus genital infection in men

“…Although a condom confers substantial protection against several STDs (e.g., gonorrhoea, human immunodeficiency virus, etc.) (Cates and Stone, 1992), a favourable effect against HPV infection in women or men has not been shown so far (Syrjanen et al, 1984). Behavioural (e.g., the difficulty of using a condom consistently in stable relationships) or biological (e.g., extension of HPV infection beyond the anatomical area covered by a condom) factors may account for this finding.…”

Condom Use by Adolescents

“…Protection rates of one half to three quarters (ie, relative risk ratios of one half to two thirds) have been found in several studies of Neisseria gonorrhoeae and Ureaplasma urealyticum transmission, with 2 studies demonstrating 100% protection with short-term, consistent use. 49 Less clear is the demonstration of protection against Chlamydia trachomatis and Treponema pallidum in males, and there are no definitive studies to date on protection against herpes simplex and human papillomavirus, 2 organisms that can be transmitted by skin-to-skin contact for which the condom may offer less protection. 49 -55 2.…”

“…Studies of gonorrhea and Trichomonas infection demonstrate protection rates with condom use of only one third to one eighth (ie, relative risk ratios of 0.66 -0.87). 49 Although some studies show no protection, others demonstrate some protection for women against infection with human papillomavirus and C trachomatis and bacterial vaginosis and decreased rates of infertility and hospitalizations for pelvic inflammatory disease among those who use condoms for contraception compared with those who use no protection. 49 …”

“…The fact that any single act of intercourse is more likely to result in transmission of disease from an infected partner than in pregnancy may partially account for this difference. 49 From a public health perspective, condoms, especially if used consistently and correctly, can be expected to decrease the rates of unintended pregnancy and STD and HIV acquisition among those who are sexually active, including adolescents. For the individual, however, condom use, even if consistent and correct, does not ensure prevention of unintended pregnancy or acquisition of an STD or HIV.…”

Under one roof? A population-based survey of patient use and preference for sexual health services

“…One recommendation is integrating services for contraception and services for the management of sexually transmitted infections (STIs), which historically developed independently despite these health concerns being closely and commonly related (Cates and Stone, 1992;Ward et al, 1995;Kane and Wellings, 1999). 'One-stop shops' -where all services are provided on a single site or 'under one roof' -is one suggested model of integration, which is thought to provide a number of benefits, including being more responsive to patients' needs, and being more efficient in terms of both health outcomes and cost (Hardee and Yount, 1995;Bloxham et al, 1999;Schierhout and Hardon, 1999;Dawson et al, 2000).…”