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Randomized Controlled Trial
. 2021 Jun;97(4):249-255.
doi: 10.1136/sextrans-2020-054590. Epub 2020 Nov 18.

Sexually transmitted infections among women randomised to depot medroxyprogesterone acetate, a copper intrauterine device or a levonorgestrel implant

Jennifer Deese  1 , Neena Philip  2 , Margaret Lind  3 , Khatija Ahmed  4 , Joanne Batting  5 , Mags Beksinska  6 , Vinodh A Edward  7   8 , Cheryl E Louw  9   10 , Maricianah Onono  11 , Thesla Palanee-Phillips  12 , Jennifer A Smit  6 , Jared M Baeten  13   14 , Deborah Donnell  14 , Timothy D Mastro  15 , Nelly R Mugo  16   17 , Kavita Nanda  18 , Helen Rees  19 , Charles Morrison  20
Affiliations
Randomized Controlled Trial

Sexually transmitted infections among women randomised to depot medroxyprogesterone acetate, a copper intrauterine device or a levonorgestrel implant

Jennifer Deese et al. Sex Transm Infect. 2021 Jun.

Abstract

Objectives: Reproductive aged women are at risk of pregnancy and sexually transmitted infections (STI). Understanding drivers of STI acquisition, including any association with widely used contraceptives, could help us to reduce STI prevalence and comorbidities. We compared the risk of STI among women randomised to three contraceptive methods.

Methods: We conducted a secondary analysis to assess the risk of chlamydia and gonorrhoea in a clinical trial evaluating HIV risk among 7829 women aged 16-35 randomised to intramuscular depot medroxyprogesterone acetate (DMPA-IM), a copper intrauterine device (IUD) or a levonorgestrel (LNG) implant. We estimated chlamydia and gonorrhoea prevalences by contraceptive group and prevalence ratios (PR) using log-binomial regression.

Results: At baseline, chlamydia and gonorrhoea prevalences were 18% and 5%, respectively. Final visit chlamydia prevalence did not differ significantly between DMPA-IM and copper IUD groups or between copper IUD and LNG implant groups. The DMPA-IM group had significantly lower risk of chlamydia compared with the LNG implant group (PR 0.83, 95% CI 0.72 to 0.95). Final visit gonorrhoea prevalence differed significantly only between the DMPA-IM and the copper IUD groups (PR 0.67, 95% CI 0.52 to 0.87).

Conclusions: The findings suggest that chlamydia and gonorrhoea risk may vary with contraceptive method use. Further investigation is warranted to better understand the mechanisms of chlamydia and gonorrhoea susceptibility in the context of contraceptive use.

Keywords: chlamydia trachomatis; clinical trials; contraception; neisseria gonorrhoeae.

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Conflict of interest statement

Competing interests: JMB is an advisor for Gilead Sciences, Merck and Janssen.

Figures

Figure 1
Figure 1
Study profile. DMPA-IM, depot medroxy progesterone acetate; IUD, intrauterine device; LNG, levonorgestrel.
Figure 2
Figure 2
Point prevalence (per 100 persons) of chlamydia and gonorrhoea at baseline and final visit by age category and study site region. Y-axis scale differs for chlamydia and gonorrhoea figures.
Figure 3
Figure 3
Potential reinfection and symptoms among women with chlamydia or gonorrhoea. Data are pooled across the screening and final visits in figures (C) and (D). Symptomatic is defined as presenting with abnormal vaginal discharge and/or abdominal/pelvic pain. Final visit infection is described as potential reinfection because test of cure was not conducted following baseline diagnosis and treatment.
See this image and copyright information in PMC

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