The impact of hormonal contraception and pregnancy on sexually transmitted infections and on cervicovaginal microbiota in african sex workers
article
Background The observed association between Depo-Provera injectable use and increased HIV acquisition may be caused by hormone-induced increased susceptibility to other sexually transmitted infections (STIs) or changes in the cervicovaginal microbiota (VMB), accompanied by genital immune activation and/or mucosal remodeling. Methods Rwandan female sex workers (n = 800) were interviewed about contraceptive use and sexual behavior and were tested for STIs, bacterial vaginosis by Nugent score and pregnancy, at baseline. A subset of 397 HIV-negative, nonpregnant women were interviewed and tested again at regular intervals for 2 years. The VMB of a subset of 174 women was characterized by phylogenetic microarray. Outcomes of STI and VMB were compared between women with hormonal exposures (reporting oral contraceptive or injectable use, or testing positive for pregnancy) and controls (not reporting hormonal contraception and not pregnant). Results Oral contraceptive use was associated with increased human papillomavirus prevalence (adjusted odds ratio [aOR], 3.10; 1.21-7.94) and Chlamydia trachomatis incidence (aOR, 6.13; 1.58-23.80), injectable use with increased herpes simplex virus-2 prevalence (aOR, 2.13; 1.26-3.59) and pregnancy with lower HIV prevalence (aOR, 0.45; 0.22-0.92) but higher candidiasis incidence (aOR, 2.14; 1.12-4.09). Hormonal status was not associated with Nugent score category or phylogenetic VMB clustering, but oral contraceptive users had lower semiquantitative vaginal abundance of Prevotella, Sneathia/Leptotrichia amnionii, and Mycoplasma species. Conclusions Oral contraceptive and injectable use were associated with several STIs but not with VMB composition. The increased herpes simplex virus-2 prevalence among injectable users might explain the potentially higher HIV risk in these women, but more research is needed to confirm these results and elucidate biological mechanisms. © 2015 by the American Sexually Transmitted Diseases Association. Chemicals / CAS Contraceptive Agents, Female; Contraceptives, Oral, Hormonal
Topics
injectable contraceptive agentoral contraceptive agentcontraceptive agentoral contraceptive agentadultArticleChlamydia trachomatiscontraceptive behaviorcontrolled studydisease associationfemalegenital system disease assessmentHerpes simplex virus 2high risk populationhormonal contraceptionhumanHuman immunodeficiency virus prevalenceincidenceLeptotrichiaLeptotrichia amnioniimajor clinical studymicroarray analysisMycoplasmanugent scoreoral contraceptive useoutcome assessmentphylogenypregnancypregnancy outcomepregnancy testpregnant womanPrevotellaprostitutionRwandansecondary analysisseroprevalencesexual behaviorsexually transmitted diseasevagina candidiasisvagina floraWart viruscondomimmunologymicrobiologypregnancyprevalenceprospective studyprostitutionrisk factorRwandaSexually Transmitted Diseasesstatistics and numerical datauterine cervixutilizationvaginaAdultCervix UteriCondomsContraceptive Agents, FemaleContraceptives, Oral, HormonalFemaleHumansIncidenceMicroarray AnalysisPhylogenyPregnancyPrevalenceProspective StudiesRisk FactorsRwandaSex WorkersSexual BehaviorSexually Transmitted DiseasesVagina
TNO Identifier
954693
ISSN
01485717
Source
Sexually Transmitted Diseases, 42(3), pp. 143-152.
Pages
143-152
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