Hormonal contraceptive use and risk of sexually transmitted infections: a systematic review

Previous research has suggested that hormonal contraceptive users, compared with nonusers, may be at increased risk for acquiring sexually transmitted infections (STIs). We searched the MEDLINE and EMBASE databases for all articles from January 1966 through February 2005 for evidence relevant to all hormonal contraceptives and STIs (including cervical chlamydial and gonococcal infection, human papillomavirus, trichomoniasis, herpes and syphilis). We used standard abstract forms and grading systems to summarize and assess the quality of 83 identified studies. Studies of combined oral contraceptive and depot medroxyprogesterone use generally reported positive associations with cervical chlamydial infection, although not all associations were statistically significant. For other STIs, the findings suggested no association between hormonal contraceptive use and STI acquisition, or the results were too limited to draw any conclusions. Evidence was generally limited in both amount and quality, including inadequate adjustment for confounding, lack of appropriate control groups and small sample sizes. The observed positive associations may be due to a true association or to bias, such as differential exposure to STIs by contraceptive use or increased likelihood of STI detection among hormonal contraceptive users.     

未婚青年性病预防和治疗咨询需要和实现状况

全球15~24岁青年性传播疾病(STI)报告率最高[1]。目前各国缺乏未婚性活跃青年STI发病率和流行率的有效数据[2]。国内学者推断中国未婚育龄人群中性病的感染率高于已婚育龄人群[3]。     

Human papillomavirus vaccine-related risk perceptions and subsequent sexual behaviors and sexually transmitted infections among vaccinated adolescent women

ObjectiveTo examine the association between risk perceptions after human papillomavirus (HPV) vaccination and sexual behaviors and sexually transmitted infection (STI) diagnosis over 30 months following vaccination.MethodsParticipants included 112 sexually experienced girls aged 13–21 years who were enrolled at the time of first HPV vaccination and completed ⩾2 of 4 follow-up visits at 2, 6, 18, 30 months and including 30 months. At each visit, participants completed surveys assessing risk perceptions (perceived need for safer sexual behaviors, perceived risk of STIs other than HPV) and sexual behaviors. STI testing was done at 6, 18, and 30 months. Outcomes were condom use at last intercourse with main male partner, number of sexual partners since last study visit, and STI diagnosis. Associations between risk perceptions and sexual behaviors/STIs were examined using generalized linear mixed models.ResultsMean age was 17.9 years; 88% were Black; 49% had a history of STI at baseline. Scale scores for perceived need for safer sexual behaviors did not change significantly over time. Scale scores for perceived risk of STIs other than HPV significantly changed (p = 0.027), indicating that girls perceived themselves to be more at risk of STIs other than HPV over 30 months following vaccination. Multivariable models demonstrated that greater perceived need for safer sexual behaviors following vaccination was associated with condom use (p = 0.002) but not with number of partners or STI diagnosis. Perceived risk of STIs other than HPV was not associated with the three outcomes.ConclusionsThe finding that perceived risk for STIs other than HPV was not associated with subsequent sexual behaviors or STI diagnosis is reassuring. The association between perceived need for safer sexual behaviors and subsequent condom use suggests that the HPV vaccination visit is an important opportunity to reiterate the importance of safer sexual behaviors to sexually experienced girls.     

Contraceptive needs of women seeking care from a publicly funded sexually transmitted infection clinic

Objectives

To determine the contraceptive needs [including emergency contraception (EC)] of women seeking care from a publicly funded sexually transmitted infection (STI) clinic and to better understand women's knowledge of and attitudes towards EC.

Methods

An anonymous survey was administered to 197 women seeking services at one Chicago Department of Public Health STI clinic.

Results

After excluding women unlikely to become pregnant within the next year because of age, sexual orientation, hysterectomy and those who desired pregnancy (n=47), data from 150 women were available for analysis. Thirteen percent were using “very effective” contraception (intrauterine contraception, implant or sterilization) and 26% were using “effective” contraception (contraceptive pill, patch, ring or injectable). Approximately 23% (95% CI 16.5–30.0%) may have benefited from immediate use of EC as they reported at least one act of unprotected intercourse within the past 5 days.

Conclusion

Many women seeking care from public STI clinics are at high risk of unintended pregnancy. A substantial number of women have an immediate need of EC at the time of their clinical visit. Efforts are needed to improve provision of EC as well as effective ongoing contraception for this population.     

Neighborhood drug markets: a risk environment for bacterial sexually transmitted infections among urban youth

We hypothesized that neighborhoods with drug markets, as compared to those without, have a greater concentration of infected sex partners, i.e. core transmitters, and that in these areas, there is an increased risk environment for STIs. This study determined if neighborhood drug markets were associated with a high-risk sex partnership and, separately, with a current bacterial STI (chlamydia and/or gonorrhea) after controlling for individual demographic and sexual risk factors among a household sample of young people in Baltimore City, MD. Analyses also tested whether links were independent of neighborhood socioeconomic status. Data for this study were collected from a household study, systematic social observations and police arrest, public health STI surveillance and U.S. census data. Nonlinear multilevel models showed that living in neighborhoods with household survey-reported drug markets increased the likelihood of having a high-risk sex partnership after controlling for individual-level demographic factors and illicit drug use and neighborhood socioeconomic status. Further, living in neighborhoods with survey-reported drug markets increased the likelihood of having a current bacterial STI after controlling for individual-level demographic and sexual risk factors and neighborhood socioeconomic status. The results suggest that local conditions in neighborhoods with drug markets may play an important role in setting-up risk environments for high-risk sex partnerships and bacterial STIs. Patterns observed appeared dependent on the type of drug market indicator used. Future studies should explore how conditions in areas with local drug markets may alter sexual networks structures and whether specific types of drug markets are particularly important in determining STI risk.     

Incidence of sexually transmitted infections among HIV-infected women using depot medroxyprogesterone acetate contraception

BACKGROUND: Previous studies suggest that depot medroxyprogesterone acetate (DMPA) is associated with an increased risk of sexually transmitted infection (STI) acquisition. The primary aim of this study was to characterize the potential association between DMPA use and risk of STI acquisition among HIV-infected women. STUDY DESIGN: This is a retrospective cohort study among HIV-infected women followed at a university clinic from 1997 to 2005. Medical records were reviewed for demographic data, HIV parameters, self-reported condom use, substance use, duration of follow-up and incident cases of gonorrhea, chlamydial infection and trichomoniasis. RESULTS: Of 304 HIV-infected women identified, 82 received DMPA and 222 did not. Overall incidence rates of trichomoniasis, chlamydial infection and gonorrhea were 8.4, 4.0 and 3.1 cases per 100 person-years, respectively, with no significant differences between the women receiving or not receiving DMPA. CONCLUSIONS: In this HIV-infected cohort, STI rates were higher than the general population, yet DMPA use did not appear to enhance the risk of STI acquisition. This latter finding suggests that the concern for STI acquisition should not be a limiting factor in the use of DMPA in HIV-infected women. The implementation of additional secondary prevention strategies remains an important focus in the HIV epidemic.     

Factors associated with partner referral among patients with sexually transmitted infections in Bangladesh

Understanding the demographic, behavioural and psychosocial factors associated with partner referral for patients with sexually transmitted infections (STIs) is important for designing appropriate intervention strategies. A survey was conducted among STI clients in three government and three non-governmental organization-operated clinics in Dhaka and Chittagong city in Bangladesh. Demographic and psychosocial information was collected using a questionnaire guided by the Attitude-Social Influence-Self Efficacy model. Partner referral data were collected by verification of referral cards when partners appeared at the clinics within one month of interviewing the STI clients. Of the 1339 clients interviewed, 81% accepted partner referral cards but only 32% actually referred their partners; 37% of these referrals were done by clients randomly assigned to a single counselling session vs. 27% by clients not assigned to a counselling session (p < 0.0001). Among psychosocial factors, partner referral intention was best predicted by attitudes and perceived social norms of the STI clients. Actual partner referral was significantly associated with intention to refer partner and attitudes of the index clients. Married clients were significantly more likely to refer their partners, and clients with low income were less likely to refer partners. Intervention programmes must address psychosocial and socio-economic issues to improve partner referral for STIs in Bangladesh.     

The theoretical impact and cost-effectiveness of vaccines that protect against sexually transmitted infections and disease

Sexually transmitted diseases, a source of widespread morbidity and sometimes mortality, are caused by a diverse group of infections with a common route of transmission. Existing vaccines against hepatitis B virus (HBV) and human papilloma virus 16, 18, 6 and 11 are highly efficacious and cost effective. In reviewing the potential role for other vaccines against sexually transmitted infections (STIs) a series of questions needs to be addressed about the burden of disease, the potential characteristics of a new vaccine, and the impact of other interventions. These questions can be viewed in the light of the population dynamics of sexually transmitted infections as a group and how a vaccine can impact these dynamics. Mathematical models show the potential for substantial impact, especially if vaccines are widely used. To better make the case for sexually transmitted infection vaccines we need better data and analyses of the burden of disease, especially severe disease. However, cost effectiveness analyses using a wide range of assumptions show that STI vaccines would be cost effective and their development a worthwhile investment.     

Prevention and control of sexually transmitted infections among adolescents: the importance of a socio-ecological perspective--a commentary

The sexually transmitted infection (STI) epidemic among adolescents in the USA is inextricably tied to individual, psychosocial and cultural phenomena. Reconceptualizing the epidemic within an expanded socio-ecological framework may provide an opportunity to better confront its challenges. In this article, we use a socio-ecological framework to identify determinants of adolescents' sexual risk and protective behaviours as well as antecedents of their STI acquisition. The goal is to provide a synthesis of several discrete categories of research. Subsequently, we propose an integrated strategy that addresses the STI epidemic among adolescents by promoting a socio-ecological perspective in both basic research and intervention design. This approach may expand the knowledge base and facilitate the development of a broader array of intervention strategies, such as community-level interventions, policy initiatives, institutionally based programmes, and macro-level societal changes. Although there are inherent challenges associated with such an approach, the end result may have reciprocal and reinforcing effects designed to enhance the adoption and maintenance of STI-preventive practices among adolescents, and further reduce the rate of STIs.     

504例妊娠妇女性传播感染疾病相关行为调查分析

目的 :为调查妊娠妇女性传播感染疾病患病率 ,阐明妊娠妇女性传播感染疾病的相关行为 ,为性传播疾病预防及控制规划的制定提供基本信息。方法 :首次来到产前门诊的孕周 <2 4周的妇女 ,通过调查其职业、文化程度、经济状况、孕期性生活情况 ,同时对每位妇女进行妇科检查及相关的实验室检查。结果 :5 0 4例妇女年龄范围为 2 0～ 40岁 ,平均 2 6 73岁 ,平均孕周 17 65周。 43 1%的妇女无收入 ,93 8%和 94 2 %的妇女认为孕妇会将性病传染给胎儿 ,以及性交会传播疾病 ,文化程度越低 ,回答正确率越低 (P <0 0 1)。文化程度高者 ,孕期性生活比例越低 (P <0 0 5 )。随着文化程度的提高 ,初次性交年龄 <2 2岁的比例逐渐降低。孕期有性生活者 ,安全套使用率仅为 12 5 % ,不同文化程度间无差异。滴虫培养阳性 15例中 ,除 3例孕期无性生活外 ,安全套使用率仅为 8 3 % ,其配偶职业为个体、司机、无业、饮食服务及供销、个体 8例 ,占 66 7%。结论 :文化程度低且无收入者对性病的认识还很模糊 ,调查人群中普遍存在对使用安全套预防STD认识不足 ,应加强健康教育 ,鼓励男性参与生殖健康 ,有针对性的开展生殖保健服务。     

The global roadmap for advancing development of vaccines against sexually transmitted infections: Update and next steps

In 2014, the World Health Organization, the US National Institutes of Health, and global technical partners published a comprehensive roadmap for development of new vaccines against sexually transmitted infections (STIs). Since its publication, progress has been made in several roadmap activities: obtaining better epidemiologic data to establish the public health rationale for STI vaccines, modeling the theoretical impact of future vaccines, advancing basic science research, defining preferred product characteristics for first-generation vaccines, and encouraging investment in STI vaccine development. This article reviews these overarching roadmap activities, provides updates on research and development of individual vaccines against herpes simplex virus, Chlamydia trachomatis, Neisseria gonorrhoeae, and Treponema pallidum, and discusses important next steps to advance the global roadmap for STI vaccine development.     

Identifying appropriate IUD candidates in areas with high prevalence of sexually transmitted infections

Background

The IUD is a highly effective, safe, inexpensive and long-lasting contraceptive. However, IUDs may increase PID risk during the early postinsertion period when inserted in women with cervical infections. We developed a simple algorithm to identify women at low risk of current sexually transmitted infection (STI) who are appropriate IUD candidates in regions with moderate or high STI prevalence.

Methods

We used data sets from family planning populations in Kenya, Zimbabwe, Jamaica and the United States to develop optimum algorithms. We then validated these algorithms using data sets from family planning populations in Thailand and Uganda.

Results

A simple unweighted algorithm based on age, living with partner, education, bleeding between periods and a behavioral risk score (number of sex partners, condom use) was the most useful. Adding clinical signs did not improve algorithm performance. Women categorized at low risk by this algorithm were at substantially reduced risks of cervical infection. Women identified at high STI risk had at least twice the risk as the overall clinic populations. Women in the moderate-risk group had STI risks similar to the overall clinic populations.

Conclusion

Women categorized as low risk by the algorithm can be referred for IUD insertion while women categorized at high risk should not receive an IUD without further testing or treatment. Women in the moderate-risk group should be triaged based on the STI prevalence of the overall clinic population. A simple checklist has been developed to help providers estimate a client's risk of current STI and to guide appropriate triage.     

育龄妇女性病病原体感染分析

目的了解有生殖道感染症状与体征的已婚育龄妇女中5种性病病原体的感染情况。方法用PCR法对浙江省950例有生殖道感染症状与体征已婚育龄妇女的宫颈分泌物进行人乳头瘤病毒(HPV)16.18、HPV6.11、沙眼衣原体(CT)、解脲支原体(UU)、淋病奈瑟菌(NG)检测。结果该组人群的5种性病病原体总阳性率为69.05%(656/950),其中HPV6.11阳性率最高(45.47%),UU阳性率次之(42.95%),CT阳性率为8.50%,HPV16.18阳性率为2.20%,NG阳性率最低(0.32%),单一病原体感染率42%,混合感染率26.94%,性病病原体感染与受教育程度呈正相关(P<0.05),年龄差异与性病病原体感染无统计学意义(P>0.05)。结论本地区已婚育龄妇女存在不同程度5种性病病原体感染,应高度重视感染的控制问题。     

Norms and stigma around unintended pregnancy in Alabama: Associations with recent contraceptive use and dual method use among young women

The role of unintended pregnancy norms and stigma in contraceptive use among young women is understudied. This study investigated relationships between anticipated reactions from others, perceived stigma, and endorsed stigma concerning unintended pregnancy, with any and dual contraceptive use in this population. From November 2014 to October 2015, young women aged 18–24 years (n = 390) and at risk for unintended pregnancy and sexually transmitted infections participated in a survey at a university and public health clinics in Alabama. Multivariable regression models examined associations of unintended pregnancy norms and stigma with contraceptive use, adjusted for demographic and psychosocial characteristics. Compared to nonusers, more any and dual method users, were White, nulliparous, and from the university and had higher income. In adjusted models, anticipated disapproval of unintended pregnancy by close others was associated with greater contraceptive use (adjusted Odds Ratio [aOR] = 1.54, 95 percent confidence interval [CI] = 1.03–2.30), and endorsement of stigma concerning unintended pregnancy was associated with lower odds of dual method use (aOR = 0.71, 95 percent CI = 0.51–1.00). Unintended pregnancy norms and stigma were associated with contraceptive behavior among young women in Alabama. Findings suggest the potential to promote effective contraceptive use in this population by leveraging close relationships and addressing endorsed stigma.     

Condom use in adolescents and young women following initiation of long- or short-acting contraceptive methods

Objective

The objective was to determine if young women initiating long-acting reversible contraceptives (LARCs) who report new sexual partner(s) would be less likely to report use of a condom than women using short-acting reversible contraceptive (SARC) methods.

The current status of sexually transmitted infections in South Korean children in the last 10 years

ObjectivesThis study aimed to review the status of sexually transmitted infections (STIs) in children in South Korea between 2010 and 2019, as well as to establish guidelines for the prevention and management to reduce the incidence of STIs in children.MethodsData reports from 590 STI surveillance institutions in local health center, hospital-level medical institutions with urology or obstetrics/gynecology departments and public hospitals between 2010 and 2019 in the integrative disease management system of the Korea Disease Control and Prevention Agency as of December 2020 were analyzed.ResultsA total of 172,645 cases of STIs were reported over the 10-year period (2010–2019), of which 2,179 cases (1.26%) represented STIs in children below the age of 18 years. A higher incidence of infections was observed in girls (1,499 cases, 68.79%) than in boys (680 cases, 31.21%). The STIs that had the highest incidence were, in descending order, chlamydial infections (997 cases, 45.75%), gonorrhea (592 cases, 27.17%), condyloma acuminata (338 cases, 15.51%), genital herpes (250 cases, 11.47%), and chancroid (2 cases, 0.09%). In adolescents aged 14 to 17 years, chlamydial infections, genital herpes, and gonorrhea were most frequently reported. Condyloma acuminata, in particular, have been consistently reported in children below the age of 14 years.ConclusionChildren must be protected legally and institutionally from sexual abuse. Specific management protocols for STIs in children must be established by local governments and associated organizations. National human papillomavirus vaccination programs should be expanded to include boys, and anti-STI educational efforts using modern media should be more activated.     

Prevalence of sexually transmitted infections in HIV-1 infected pregnant women in Europe

We investigated prevalence of sexually transmitted infections (STI) in a cohort of HIV-1-infected pregnant women and described factors associated with STI diagnosis, as a nested study within the European Collaborative Study (ECS). The ECS is a cohort study in which HIV-infected pregnant women are enrolled and their children followed from birth, according to standard clinical and laboratory protocols. Information on STIs diagnosed during pregnancy was collected retrospectively from the antenatal records of women enrolling between January 1999 and October 2005; other variables were obtained from the ECS prospective database. A total of 1,050 women were included: 530 in Western Europe and 520 in Ukraine. Syphilis was the most common bacterial STI (2% prevalence, 95% CI 1.2–3.0). Prevalence of HPV-related genital lesions was 8.6% (95%CI 6.9–10.4) and prevalence of Trichomonas vaginalis was 12.1% (95%CI 10.2–14.2). Women in Ukraine (AOR 10.7, 95%CI 3.7–30.5), single women (AOR 3.9, 95%CI 1.2–12.7), sexual partners of injecting drug users (AOR 3.8, 95%CI 1.4–10.4) and women with CD4 counts <200 cells/mm³ (AOR 5.4, 95%CI 1.0–28.1) were at increased risk of diagnosis with Chlamydia trachomatis, syphilis or Trichomonas vaginalis. African origin (AOR 1.9, 95%CI 1.1–3.3) and CD4 count <200 cells/mm³ (AOR 3.4, 95%CI 1.5–7.8) were associated with HSV-2 and/or HPV-related genital lesions. Antenatal screening should be considered an effective tool for diagnosis, treatment and prevention of further transmission of STIs. HIV-infected women should receive adequate screening for STIs during pregnancy together with appropriate counseling and follow-up for treatment and prevention. Electronic Supplementary Material The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

广州地区性病门诊患者生殖支原体感染及致病性分析

目的 探讨广州地区生殖支原体(Mg)的感染情况及其致病性.方法 应用Taqman MGB荧光PCR方法对广东省皮肤性病防治中心2010-2013年性病门诊的2 633例患者宫颈、尿道拭子进行Mg检测,涂片检测念珠菌、阴道毛滴虫和细菌学阴道病,ELISA法检测衣原体,培养法分离淋球菌.结果 2 633例疑似病例经检测Mg阳性209例,总感染率为7.94％,其中男性Mg感染率为8.94％ (175/1 958),女性感染率为5.04％ (34/675),两者比较差异有统计学意义(x2=10.45,P＜0.01).男性感染者主要集中在30～49岁,占77.14％(135/175);女性主要集中在20～39岁,占82.35％(28/34).男性Mg感染者中,30～39岁组占45.14％(79/175),高于其他年龄组,同时也高于女性该年龄组[35.29％ (12/34)],但两者比较差异无统计学意义(x2=1.12,P＞0.05);女性Mg感染者中,20～29岁组占47.06％,高于其他年龄组,同时也高于男性该年龄组[14.29％(25/175)],差异有统计学意义(X2=19.39,P＜0.01).92份男性尿道拭子检出非淋菌性尿道炎(NGU)共33例,其中单纯Mg感染引起的男性NGU占72.73％(24/33).21份宫颈拭子检出宫颈炎17例,其中单纯Mg感染引起的女性宫颈炎占82.35％(14/17).结论 广州地区男性Mg感染率明显高于女性,且不同年龄段男女Mg感染情况并不相同,另外Mg感染可能与男性NGU及女性宫颈炎相关.