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

• Published in: Journal of the International AIDS Society Vol. 22; no. 2; pp. e25257 - n/a
• Main Authors: Kiweewa, Flavia Matovu, Brown, Elizabeth, Mishra, Anu, Nair, Gonasagrie, Palanee‐Phillips, Thesla, Mgodi, Nyaradzo, Nakabiito, Clemensia, Chakhtoura, Nahida, Hillier, Sharon L, Baeten, Jared M, Soto‐Torres, Lydia, Schwartz, Katie, Makanani, Bonus, Martinson, Francis, Bekker, Linda‐Gail, Govender, Vaneshree, Mhlanga, Felix
• Format: Journal Article
• Language: English
• Published: Switzerland International AIDS Society 01.02.2019; John Wiley & Sons, Inc; John Wiley and Sons Inc
• Subjects: Acquired immune deficiency syndrome; Adolescent; Adult; Age; AIDS; Analysis; Birth control; Chlamydia; Condoms; Confidence intervals; Contraception; Contraceptive Devices, Female; Contraceptives; Copper; Disease susceptibility; Family planning; Female; gonorrhoea; HIV; HIV infections; HIV Infections - epidemiology; HIV Infections - prevention & control; hormonal contraception; Human immunodeficiency virus; Humans; Incidence; Infections; Malawi - epidemiology; Medical research; Methods; Middle Aged; Participation; Patient outcomes; Pregnancy; Prospective Studies; Risk factors; Sexual behavior; Sexually transmitted diseases; Sexually Transmitted Diseases - epidemiology; Sexually Transmitted Diseases - prevention & control; South Africa - epidemiology; Studies; Transplants & implants; trichomoniasis; Uganda - epidemiology; Women - psychology; Womens health; Young Adult; Zimbabwe - epidemiology; South Africa; Uganda; Zimbabwe; Malawi; hormonal contraception; gonorrhoea; sexually transmitted diseases; chlamydia; trichomoniasis
• ISSN: 1758-2652; 1758-2652
• DOI: 10.1002/jia2.25257

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.