The Impact of Hormonal Contraception and Pregnancy on Sexually Transmitted Infections and on Cervicovaginal Microbiota in African Sex Workers

Borgdorff, Hanneke; Verwijs, Marijn C.; Wit, Ferdinand W. N. M.; Tsivtsivadze, Evgeni; Ndayisaba, Gilles; Verhelst, Rita; Schuren, Frank; Wijgert, Janneke van de

doi:10.1097/olq.0000000000000245

Cited by 49 publications

(75 citation statements)

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“…Although the association between HIV‐1 acquisition and the use of hormonal contraception has been extensively studied , with the bulk of studies suggesting modestly elevated HIV‐1 risk for DMPA users, relatively fewer studies have examined STI acquisition among different groups of contraceptive users. Prior prospective studies examining the association between use of certain hormonal contraceptives and the risk of STIs have reported mixed findings , with some reporting a statistically significantly higher incidence of certain STIs among users of specific contraceptive methods while others found no association . Several of these studies had important methodological shortcomings, including insensitive STI diagnostics, wide variability in exposure definitions, and limited control for potential confounding factors particularly sexual behaviour which is closely linked to contraceptive choice.…”

Section: Introductionmentioning

confidence: 99%

Acquisition of Sexually Transmitted Infections among Women Using a Variety of Contraceptive Options: A prospective Study among High‐risk African Women

et al. 2019

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Introduction In many African settings, women concurrently face substantial risk of human immunodeficiency virus type 1 ( HIV ‐1) infection, sexually transmitted infections ( STI s) and unintended pregnancies. Few studies have evaluated STI risk among users of hormonal implants and copper intrauterine devices ( IUD s) although these long‐acting reversible contraceptive methods are being promoted widely because of their benefits. Within a prospective study of women at risk for HIV ‐1, we compared the risk of acquisition of Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis among women using different contraceptive methods. Methods MTN ‐020/ ASPIRE was a randomized trial of the dapivirine vaginal ring for HIV ‐1 prevention among 2629 women aged 18 to 45 years from Malawi, South Africa, Uganda and Zimbabwe, of whom 2264 used copper IUD s or progestin‐based injectables or implants during follow‐up. Screening for the above STI s occurred semi‐annually. Results Over 3440 person‐years of follow‐up, 408 cases of C. trachomatis (incidence 11.86/100 person‐years), 196 of N. gonorrhoeae (5.70/100 person‐years) and 213 cases of T. vaginalis (6.19/100 person‐years) were detected. C. trachomatis and N. gonorrhoeae incidence were not significantly different across contraceptive methods. T. vaginalis incidence was significantly higher for copper IUD users compared to depot medroxyprogesterone acetate ( DMPA ), implant and norethisterone enanthate users. Conclusion Among African women at high HIV ‐1 risk, STI s were common. Risk of cervical infections did not differ across contraceptive methods. Significantly higher rates of T. vaginalis were observed among progestin‐based methods compared to copper IUD users. Overall, these findings call for more intensive routine screening for STI s, and they support current World Health Organization guidance that women should have a wide range of contraceptive options.

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Section: Introductionmentioning

confidence: 99%

Acquisition of Sexually Transmitted Infections among Women Using a Variety of Contraceptive Options: A prospective Study among High‐risk African Women

et al. 2019

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“…In South Africa (where both DMPA and NET-EN injectables are used), studies suggest that women perceive DMPA and NET-EN differently, and providers may preferentially prescribe different injectable types to specific subpopulations, which could result in confounding specific to injectable type [30,65,66]. Although beyond the scope of this review, emerging evidence related to DMPA and HSV-2 acquisition must also be considered [67,68]. …”

Section: Discussionmentioning

confidence: 99%

An updated systematic review of epidemiological evidence on hormonal contraceptive methods and HIV acquisition in women

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Curtis

Hannaford

et al. 2016

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Objective and design:Some studies suggest that specific hormonal contraceptive methods [particularly depot medroxyprogesterone acetate (DMPA)] may increase women's HIV acquisition risk. We updated a systematic review to incorporate recent epidemiological data.Methods:We searched for articles published between 15 January 2014 and 15 January 2016 and hand-searched reference lists. We identified longitudinal studies comparing users of a specific hormonal contraceptive method against either nonusers of hormonal contraception or users of another specific hormonal contraceptive method. We added newly identified studies to those in the previous review, assessed study quality, created forest plots to display results, and conducted a meta-analysis for data on DMPA versus non-use of hormonal contraception.Results:We identified 10 new reports of which five were considered ‘unlikely to inform the primary question’. We focus on the other five reports, along with nine from the previous review, which were considered ‘informative but with important limitations’. The preponderance of data for oral contraceptive pills, injectable norethisterone enanthate, and levonorgestrel implants do not suggest an association with HIV acquisition, though data for implants are limited. The new, higher quality studies on DMPA (or nondisaggregated injectables), which had mixed results in terms of statistical significance, had hazard ratios between 1.2 and 1.7, consistent with our meta-analytic estimate for all higher quality studies of hazard ratio 1.4.Conclusion:Although confounding in these observational data cannot be excluded, new information increases concerns about DMPA and HIV acquisition risk in women. If the association is causal, the magnitude of effect is likely hazard ratio 1.5 or less. Data for other hormonal contraceptive methods, including norethisterone enanthate, are largely reassuring.

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“…Differences in age and hormonal status have a wide variety of physiological implications and have been correlated with specific phenotypic features of the vaginal microbiota (e.g. presence or amounts of various bacteria) [326, 327]. These factors could therefore be important confounders that may contribute to the differences observed between the cases and controls.…”

Section: “Uncultivated” Bacterial Inhabitants Of the Urinary Tractmentioning

confidence: 99%

Gram-Positive Uropathogens, Polymicrobial Urinary Tract Infection, and the Emerging Microbiota of the Urinary Tract

2016

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Gram-positive bacteria are a common cause of urinary tract infection (UTI), particularly among individuals who are elderly, pregnant, or who have other risk factors for UTI. Here we review the epidemiology, virulence mechanisms, and host response to the most frequently isolated Gram-positive uropathogens: Staphylococcus saprophyticus, Enterococcus faecalis, and Streptococcus agalactiae. We also review several emerging, rare, misclassified, and otherwise underreported Gram-positive pathogens of the urinary tract including Aerococcus, Corynebacterium, Actinobaculum, and Gardnerella. The literature strongly suggests that urologic diseases involving Gram-positive bacteria may be easily overlooked due to limited culture-based assays typically utilized for urine in hospital microbiology laboratories. Some UTIs are polymicrobial in nature, often involving one or more Gram-positive bacteria. We herein review the risk factors and recent evidence for mechanisms of bacterial synergy in experimental models of polymicrobial UTI. Recent experimental data has demonstrated that, despite being cleared quickly from the bladder, some Gram-positive bacteria can impact pathogenic outcomes of co-infecting organisms. When taken together, the available evidence argues that Gram-positive bacteria are important uropathogens in their own right, but that some can be easily overlooked because they are missed by routine diagnostic methods. Finally, a growing body of evidence demonstrates that a surprising variety of fastidious Gram-positive bacteria may either reside in or be regularly exposed to the urinary tract and further suggests that their presence is widespread among women, as well as men. Experimental studies in this area are needed; however, there is a growing appreciation that the composition of bacteria found in the bladder could be a potentially important determinant in urologic disease, including susceptibility to UTI.

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The Impact of Hormonal Contraception and Pregnancy on Sexually Transmitted Infections and on Cervicovaginal Microbiota in African Sex Workers

Cited by 49 publications

References 30 publications

Acquisition of Sexually Transmitted Infections among Women Using a Variety of Contraceptive Options: A prospective Study among High‐risk African Women

Acquisition of Sexually Transmitted Infections among Women Using a Variety of Contraceptive Options: A prospective Study among High‐risk African Women

An updated systematic review of epidemiological evidence on hormonal contraceptive methods and HIV acquisition in women

Gram-Positive Uropathogens, Polymicrobial Urinary Tract Infection, and the Emerging Microbiota of the Urinary Tract

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