Prevalence and Incidence of Sexually Transmitted Infection in Injectable Progestin Contraception Users in South Africa.

Autor: Noguchi LM; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States., Marrazzo JM; Division of Infectious Diseases, School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, United States., Richardson B; Department of Biostatistics, University of Washington, Seattle, WA, United States., Hillier SL; Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh and the Magee-Womens Research Institute, Pittsburgh, PA, United States., Balkus JE; Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, United States., Palanee-Phillips T; Wits Reproductive Health & HIV Institute, University of the Witwatersrand, Johannesburg, South Africa., Nair G; CAPRISA, Durban, South Africa., Panchia R; Perinatal HIV Research Unit, Johannesburg, South Africa., Piper J; Division of AIDS, NIAID, U.S. National Institutes of Health, Bethesda, MD, United States., Gomez K; FHI 360, Durham, NC, United States., Ramjee G; South African Medical Research Council, Durban, South Africa., Chirenje ZM; University of Zimbabwe Clinical Trials Research Centre, Department of Obstetrics and Gynaecology, Harare, Zimbabwe.
Jazyk: angličtina
Zdroj: Frontiers in reproductive health [Front Reprod Health] 2021 Jul; Vol. 3. Date of Electronic Publication: 2021 Jul 16.
DOI: 10.3389/frph.2021.668685
Abstrakt: Introduction: Whether intramuscular depot medroxyprogesterone acetate (DMPA-IM) and norethisterone enanthate (NET-EN) have a differential impact on the incidence of sexually transmitted infection (STI) remains unclear. In the Vaginal and Oral Interventions to Control the Epidemic (VOICE) trial, HIV-1 acquisition was higher for DMPA-IM users vs. NET-EN users. We compared DMPA-IM and NET-EN users with regard to chlamydia, gonorrhea, trichomoniasis, syphilis, and herpes simplex virus type 2 (HSV-2) infection.
Materials and Methods: Prospective data were analyzed from VOICE, a randomized trial of HIV-1 chemoprophylaxis. Participants were evaluated annually and as indicated for chlamydia, gonorrhea, trichomoniasis, and syphilis. Stored specimens were tested for HSV-2. Proportional hazards models compared the risk of STI between DMPA-IM and NET-EN users.
Results: Among 2,911 injectable contraception users in South Africa, 1,800 (61.8%) used DMPA-IM and 1,111 used NET-EN (38.2%). DMPA-IM and NET-EN users did not differ in baseline chlamydia: 15.1 vs. 14.3%, p = 0.54; gonorrhea: 3.4 vs. 3.7%, p = 0.70; trichomoniasis: 5.7 vs.5.0%, p = 0.40; or syphilis: 1.5 vs. 0.7%, p = 0.08; but differed for baseline HSV-2: (51.3 vs. 38.6%, p < 0.001). Four hundred forty-eight incident chlamydia, 103 gonorrhea, 150 trichomonas, 17 syphilis, and 48 HSV-2 infections were detected over 2,742, 2,742, 2,783, 2,945, and 756 person-years (py), respectively (chlamydia 16.3/100 py; gonorrhea 3.8/100 py; trichomoniasis 5.4/100 py; syphilis 0.6/100 py; HSV-2 6.4/100 py). Comparing DMPA-IM with NET-EN users, no difference was noted in the incidence of chlamydia, gonorrhea, trichomoniasis, syphilis, or HSV2 infections, including when adjusted for confounders [chlamydia (aHR 1.03, 95% CI 0.85-1.25), gonorrhea (aHR 0.88, 95% CI 0.60-1.31), trichomoniasis (aHR 1.07, 95% CI 0.74-1.54), syphilis (aHR 0.41, 95% CI 0.15-1.10), and HSV-2 (aHR 0.83, 95% CI 0.45-1.54, p = 0.56)].
Discussion: Among South African participants enrolled in VOICE, DMPA-IM and NETEN users differed in prevalence of HSV-2 at baseline but did not differ in the incidence of chlamydia, gonorrhea, trichomoniasis, syphilis, or HSV-2 infection. Differential HIV-1 acquisition, previously demonstrated in this cohort, does not appear to be explained by differential STI acquisition. However, the high incidence of multiple STIs reinforces the need to accelerate access to comprehensive sexual and reproductive health services.
Competing Interests: Conflict of Interest: TP-P is the co-editor of the ‘Integration of HIV Prevention with Sexual and Reproductive Health Services’ special issue to which this manuscript is submitted. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Databáze: MEDLINE