Acquisition of Sexually Transmitted Infections among Women Using a Variety of Contraceptive Options: A prospective Study among High-risk African Women
Acquisition of Sexually Transmitted Infections among Women Using a Variety of Contraceptive Options: A prospective Study among High-risk African Women
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DOI：
10.1002/jia2.25257
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发表时间：
2019-02-01
影响因子：
6
通讯作者：
Mhlanga, Felix
中科院分区：
文献类型：
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作者：
Kiweewa, Flavia Matovu;Brown, Elizabeth;Mhlanga, Felix
在许多非洲环境中，妇女同时面临人类免疫缺陷病毒1型（HIV-1）感染、性传播感染和意外怀孕的重大风险。很少有研究评估激素植入物和铜质宫内节育器（iud）使用者的性传播感染风险，尽管这些长效可逆避孕方法因其益处而得到广泛推广。在一项针对HIV-1感染风险女性的前瞻性研究中，我们比较了使用不同避孕方法的女性感染沙眼衣原体、淋病奈瑟菌和阴道毛滴虫的风险。smn -020/ASPIRE是一项来自马拉维、南非、乌干达和津巴布韦的2629名年龄在18 - 45岁的妇女的随机试验，其中2264名妇女在随访期间使用了铜宫内节育器或基于黄体酮的注射或植入物。上述性传播感染的筛查每半年进行一次。结果在3440人-年的随访中，检出沙眼衣原体408例（发病率11.86/100人-年）、淋病奈索菌196例（发病率5.70/100人-年）、阴道滴虫213例（发病率6.19/100人-年）。沙眼衣原体和淋病奈瑟菌的发病率在不同避孕方法间无显著差异。铜宫内节育器使用者阴道生殖道炎的发生率明显高于醋酸甲孕酮（DMPA）、植入物和烯酸去甲睾酮使用者。结论在非洲HIV-1高危妇女中，性传播感染较为常见。宫颈感染的风险在不同的避孕方法中没有差异。与使用铜宫内节育器的患者相比，使用黄体酮的患者阴道生殖道绦虫的发生率明显更高。总的来说，这些发现要求对性传播感染进行更密集的常规筛查，并支持目前世界卫生组织的指导，即妇女应该有广泛的避孕选择。
IntroductionIn 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.MethodsMTN-020/ASPIRE was a randomized trial of the dapivirine vaginal ring for HIV-1 prevention among 2629 women aged 18 to 45years 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.ResultsOver 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.ConclusionAmong 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.