ECTOPY, HORMONAL CONTRACEPTION AND STD'S IN ADOLESCENTS

青少年患性传播疾病的风险很高，这可能对他们未来的健康和生育造成严重后果，并可能增加他们感染艾滋病毒的脆弱性。宫颈异位和口服避孕药（OC）在青少年中都很常见，是衣原体感染的危险因素，衣原体是最常见的炎症性性传播疾病。异位对使用卵巢囊肿的独立风险分级研究尚不充分。在青少年中广泛使用的避孕药具醋酸甲孕酮（DMPA）与宫外孕和性病感染之间的关系尚未见报道。本研究的目的是前瞻性研究：1)性活跃青少年宫颈异位的自然历史和转化区（T区）；2)DMPA和联合雌激素-孕激素（OC）对宫颈异位/T区的影响；3)异位/T区面积大小与性病感染的关系，包括衣原体、淋病、滴虫和HPV；4)按宫颈异位/T区程度分层的OC使用者与DMPA使用者的性病风险比较。设计：这是一项为期5年的前瞻性研究，研究对象为500名12-18岁的市中心性活跃的未生育女性，其中一些人将开始DMPA或OC。他们将从巴尔的摩马里兰大学的青少年、儿科和社区妇产科诊所连续招募，研究将在那里进行。参与者将每6个月接受一次医疗/性史检查，全面体检和盆腔检查，以及性病标本采集。宫颈造影将用于确定异位和T区，由计算机平面测量测量。这是一种创新、可靠、灵敏和标准化的测量方法。行为数据将通过音频辅助计算机访谈（A-CASI）匿名收集。中期随访（每3个月一次）将包括ACASI的行为风险、病史和尿液筛查的性传播疾病发病率以及城市性病登记处的数据。总结。该提案将1)在使用激素避孕药之前和期间使用一种标准化的未生育青少年宫外孕测量方法；2)明确性传播疾病与卵巢囊肿的关系，特别是含有新孕激素的卵巢囊肿；3)是少数研究青少年DMPA、性病与宫外孕关系的研究之一；4)招募性传播疾病（尤其是衣原体感染）发病率最高的人群。该研究团队在性传播疾病、青少年健康和宫颈解剖方面拥有专业知识。他们合作进行了初步研究，并在规划、实施和管理成功的高风险青年纵向研究方面具有经验。

Adolescents are at high risk for sexually transmitted diseases (STDs), which can have serious consequences for their future health and fertility, and which can increase their vulnerability to HIV infection. Cervical ectopy and use of oral contraceptives (OC), both common in adolescence, are risk factors for chlamydia, the most common inflammatory STD. Standardized, reliable measurements of ectopy have not been employed across studies. The independent risk of OC use stratified by ectopy has not been well studied. The association among Depot Medroxy Progesterone Acetate (DMPA), a contraceptive widely used among adolescents, ectopy and STD acquisition has not been reported. The aims of this proposal are to study prospectively: 1) the natural history of cervical ectopy and the transformation zone (T zone) in sexually active adolescents, 2) the impact of DMPA and a combined estrogen-progestins (OC) over time on cervical ectopy/T zone; 3) the relation between the size of the area of ectopy/T zone and STD acquisition, including chlamydia, gonorrhea, trichomonas and HPV; and 4) the risk of STDs in OC users compared to DMPA users stratified by the extent of cervical ectopy/T zone. Design: This is a 5 year prospective study on 500 inner-city sexually active nonparous females aged 12-18, some of whom will initiate DMPA or OC. They will be recruited consecutively from the Adolescent, Pediatric and community-based OB/Gyn Clinics of the University of Maryland, Baltimore, where the study will be conducted. Participants will be seen every 6 months for medical/sexual history, complete physical and pelvic examinations, and specimen collection of STDs. Cervicography will be used to determine the areas of ectopy and T zone, measured by computerized planimetry. This is an innovative reliable, sensitive and standardized method of measurement. Behavioral data will be collected anonymously by audio assisted computer interview (A-CASI). Interim follow up visits (every 3 months) will include behavioral risk by ACASI, medical history and incidence of STDs by urine screening and from the City STD registry. Summary. This proposal will 1) use a standardized measure of ectopy in young nonparous adolescents before and during hormonal contraceptive use; 2) address the relation between STDs and OCs, especially those OCs containing new progestins; 3) be one of the few studies to examine the association among DMPA, STDs and ectopy in adolescents; 4) recruit a difficult cohort with one of the highest rates of STDs, especially chlamydia infection. The team of researchers has expertise on STDs, adolescent health, and cervical anatomy. They have collaborated on the preliminary study and have experience in planning, implementing and managing successful longitudinal studies on high-risk youth.