Acquisition of sexually transmitted infections among women using a variety of contraceptive options: a prospective study among high-risk African women.
Open accessAbstract
INTRODUCTION: In many African settings, women concurrently face substantial risk of human immunodeficiency virus type 1 (HIV-1) infection, sexually transmitted infections (STIs) and unintended pregnancies. Few studies have evaluated STI risk among users of hormonal implants and copper intrauterine devices (IUDs) 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 IUDs or progestin-based injectables or implants during follow-up. Screening for the above STIs 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, STIs 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 STIs, and they support current World Health Organization guidance that women should have a wide range of contraceptive options.
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Whether hormonal contraception alters a woman's risk for other STIs is uncertain.
“Whether hormonal contraception alters a woman’s risk for other STIs is uncertain (56,57).”
From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [56]
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Sexually Transmitted Infections Treatment Guidelines, 2021
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- Authors
- Kiweewa, F. M., Brown, E., Mishra, A., Nair, G., Palanee‐Phillips, T., Mgodi, N., Nakabiito, C., Chakhtoura, N., Hillier, S. L., Baeten, J. M., & the MTN‐020/ASPIRE Study Team
- Affiliations
- MUJHU Research Collaboration (UG)
- University of Washington (US)
- Emavundleni Research Centre CapeTown Republic of South Africa
- University of the Witwatersrand (ZA)
- University of Zimbabwe (ZW)
- National Institutes of Health (US)
- University of Pittsburgh (US)
- Corresponding author
- Kiweewa, Flavia Matovu
- ORCID
- Venue
- Journal of the International AIDS Society
- Publisher
- Wiley
- Published
- 2019-02
- Volume
- 22
- Issue
- 2
- Pages
- e25257-e25257
- ISSN
- 1758-2652 (ISSN-L)
- PMC
- PMC6393855
- OpenAlex
- W2920025628
- Cited by
- 19
- References
- 38
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 2 · 2023: 2 · 2022: 2 · 2021: 6 · 2020: 2 · 2019: 2
- FWCI
- 2.20
- Type
- journal article
- Language
- en
- Update notices
- erratum (2019-04-15)
- Open access
- gold
- doi.org
- Licence
- Locations
- Journal of the International AIDS Society (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Greater South Information System
- Funders
- National Institute of Allergy and Infectious Diseases (UM1AI068633, UM1AI068615, UM1AI106707)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development
- National Institute of Mental Health
- National Institutes of Health (NCT01617096)
- Topics
- Life Sciences › Immunology and Microbiology › Microbiology › Reproductive tract infections research
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
- Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
- Keywords
- sexually transmitted infections, Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, copper intrauterine device, depot medroxyprogesterone acetate, norethisterone enanthate, HIV-1 prevention, dapivirine vaginal ring, African women, STI screening, cervical infection
- MeSH terms
- Adolescent, Adult, Contraception, Contraceptive Devices, Female, Female, Humans, Malawi, Middle Aged, Pregnancy, Prospective Studies, Sexually Transmitted Diseases, South Africa, Uganda, Women, Zimbabwe, HIV Infections, Incidence, Young Adult
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