ECTOPY, HORMONAL CONTRACEPTION AND STD'S IN ADOLESCENTS

青少年罹患性传播疾病的风险很高，这可能会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风险。宫颈异位和口服避孕药(OC)的使用都是青春期常见的，是衣原体感染的危险因素，衣原体是最常见的炎症性性病。标准化的、可靠的异位测量方法尚未在所有研究中使用。根据异位分层使用OC的独立风险还没有得到很好的研究。代孕酮(DMPA)是一种在青少年中广泛使用的避孕药，其异位与性病感染之间的关系尚未见报道。这项建议的目的是前瞻性地研究：1)性行为活跃的青少年宫颈异位和变形区(T区)的自然病史；2)DMPA和联合雌激素-孕激素(OC)随时间对宫颈异位/T区的影响；3)异位/T区面积的大小与STD感染的关系，包括衣原体、淋病、滴虫和HPV；以及4)按宫颈异位/T区的程度分层，OC使用者和DMPA使用者患STD的风险。设计：这是一项为期5年的前瞻性研究，对象为500名12-18岁的内城区性行为活跃的绝产女性，其中一些人将启动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，该研究将在那里进行。参与者将每6个月接受一次病史/性史检查，全面的身体和盆腔检查，以及性传播疾病样本采集。子宫颈造影术将被用来确定异位和T区的面积，通过计算机平面测量来测量。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)将包括ACASI的行为风险、病史和通过尿液筛查和市STD登记的STD发病率。总结。这项建议将1)在使用激素避孕药之前和期间在年轻的未生育青少年中使用标准化的异位测量方法；2)解决性传播疾病和OCS之间的关系，特别是那些含有新孕激素的OCS；3)是为数不多的检查DMPA、STD和青少年异位之间关系的研究之一；4)招募一个STD发病率最高的困难队列，特别是衣原体感染。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。他们在初步研究方面进行了合作，并在规划、实施和管理成功的关于高危青少年的纵向研究方面拥有经验。

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.