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

doi:10.1136/sextrans-2020-054590

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 Deese¹, Neena Philip², Margaret Lind³, Khatija Ahmed⁴, Joanne Batting⁵, Mags Beksinska⁶, Vinodh A Edward^{7

8}, Cheryl E Louw^{9

10}, Maricianah Onono¹¹, Thesla Palanee-Phillips¹², Jennifer A Smit⁶, Jared M Baeten^{13

14}, Deborah Donnell¹⁴, Timothy D Mastro¹⁵, Nelly R Mugo^{16

17}, Kavita Nanda¹⁸, Helen Rees¹⁹, Charles Morrison²⁰

Affiliations

¹ Global Public Health Impact Center, RTI International, Research Triangle Park, North Carolina, USA (formerly with FHI 360) jdeese@rti.org.
² Mailman School of Public Health, Columbia University, New York, New York, USA.
³ Department of Global Health, International Clinical Research Center, University of Washington, Seattle, Washington, USA.
⁴ Setshaba Research Centre, Pretoria, South Africa.
⁵ Effective Care Research Unit, University of the Witwatersrand, East London, South Africa.
⁶ MatCH Research Unit, Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa.
⁷ The Aurum Institute, Johannesburg, South Africa.
⁸ School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
⁹ Madibeng Centre for Research, Brits, South Africa.
¹⁰ Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
¹¹ Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya.
¹² Faculty of Health Sciences, Wits Reproductive Health and HIV Institute, Johannesburg, South Africa.
¹³ Global Health, Medicine, and Epidemiology, University of Washington, Seattle, Washington, USA.
¹⁴ Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.
¹⁵ FHI 360, Durham, North Carolina, USA.
¹⁶ Department of Global Health, University of Washington, Seattle, Washington, USA.
¹⁷ Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya.
¹⁸ Product Development and Introduction, FHI 360, Durham, North Carolina, USA.
¹⁹ Wits Reproductive Health & HIV Institute, University of the Witwatersrand, Johannesburg, South Africa.
²⁰ Behavioral, Epidemiological and Clinical Sciences, FHI 360, Durham, North Carolina, USA.

PMID: 33208512
PMCID: PMC8165154
DOI: 10.1136/sextrans-2020-054590

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.

. 2021 Jun;97(4):249-255.

doi: 10.1136/sextrans-2020-054590. Epub 2020 Nov 18.

Authors

Affiliations

¹ Global Public Health Impact Center, RTI International, Research Triangle Park, North Carolina, USA (formerly with FHI 360) jdeese@rti.org.
² Mailman School of Public Health, Columbia University, New York, New York, USA.
³ Department of Global Health, International Clinical Research Center, University of Washington, Seattle, Washington, USA.
⁴ Setshaba Research Centre, Pretoria, South Africa.
⁵ Effective Care Research Unit, University of the Witwatersrand, East London, South Africa.
⁶ MatCH Research Unit, Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa.
⁷ The Aurum Institute, Johannesburg, South Africa.
⁸ School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
⁹ Madibeng Centre for Research, Brits, South Africa.
¹⁰ Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
¹¹ Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya.
¹² Faculty of Health Sciences, Wits Reproductive Health and HIV Institute, Johannesburg, South Africa.
¹³ Global Health, Medicine, and Epidemiology, University of Washington, Seattle, Washington, USA.
¹⁴ Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.
¹⁵ FHI 360, Durham, North Carolina, USA.
¹⁶ Department of Global Health, University of Washington, Seattle, Washington, USA.
¹⁷ Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya.
¹⁸ Product Development and Introduction, FHI 360, Durham, North Carolina, USA.
¹⁹ Wits Reproductive Health & HIV Institute, University of the Witwatersrand, Johannesburg, South Africa.
²⁰ Behavioral, Epidemiological and Clinical Sciences, FHI 360, Durham, North Carolina, USA.

PMID: 33208512
PMCID: PMC8165154
DOI: 10.1136/sextrans-2020-054590

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**
Study profile. DMPA-IM, depot medroxy progesterone acetate; IUD, intrauterine device; LNG, levonorgestrel.

**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**
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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References

1. South Africa National Department of Health . South Africa demographic and health survey, 2016. Available: https://dhsprogram.com/pubs/pdf/FR337/FR337.pdf [Accessed 01 Mar 2020].
1. Family planning.org . Family planning, 2020. Available: http://www.familyplanning2020.org/microsite/about-us [Accessed 01 Mar 2020].
1. Torrone EA, Morrison CS, Chen P-L, et al. . Correction: prevalence of sexually transmitted infections and bacterial vaginosis among women in sub-Saharan Africa: an individual participant data meta-analysis of 18 HIV prevention studies. PLoS Med 2018;15:e1002608. 10.1371/journal.pmed.1002608 - DOI - PMC - PubMed
1. Rowley J, Vander Hoorn S, Korenromp E, et al. . Chlamydia, gonorrhoea, trichomoniasis and syphilis: global prevalence and incidence estimates, 2016. Bull World Health Organ 2019;97:548–62. 10.2471/BLT.18.228486 - DOI - PMC - PubMed
1. World Health Organization . Global health sector strategy on sexually transmitted infections, 2016-2021. Available: https://www.who.int/reproductivehealth/publications/rtis/ghss-stis/en/ [Accessed 01 Mar 2020].

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[1] South Africa National Department of Health . South Africa demographic and health survey, 2016. Available: https://dhsprogram.com/pubs/pdf/FR337/FR337.pdf [Accessed 01 Mar 2020].

[2] South Africa National Department of Health . South Africa demographic and health survey, 2016. Available: https://dhsprogram.com/pubs/pdf/FR337/FR337.pdf [Accessed 01 Mar 2020].

[3] Family planning.org . Family planning, 2020. Available: http://www.familyplanning2020.org/microsite/about-us [Accessed 01 Mar 2020].

[4] Family planning.org . Family planning, 2020. Available: http://www.familyplanning2020.org/microsite/about-us [Accessed 01 Mar 2020].

[5] Torrone EA, Morrison CS, Chen P-L, et al. . Correction: prevalence of sexually transmitted infections and bacterial vaginosis among women in sub-Saharan Africa: an individual participant data meta-analysis of 18 HIV prevention studies. PLoS Med 2018;15:e1002608. 10.1371/journal.pmed.1002608 - DOI - PMC - PubMed

[6] Torrone EA, Morrison CS, Chen P-L, et al. . Correction: prevalence of sexually transmitted infections and bacterial vaginosis among women in sub-Saharan Africa: an individual participant data meta-analysis of 18 HIV prevention studies. PLoS Med 2018;15:e1002608. 10.1371/journal.pmed.1002608 - DOI - PMC - PubMed

[7] Rowley J, Vander Hoorn S, Korenromp E, et al. . Chlamydia, gonorrhoea, trichomoniasis and syphilis: global prevalence and incidence estimates, 2016. Bull World Health Organ 2019;97:548–62. 10.2471/BLT.18.228486 - DOI - PMC - PubMed

[8] Rowley J, Vander Hoorn S, Korenromp E, et al. . Chlamydia, gonorrhoea, trichomoniasis and syphilis: global prevalence and incidence estimates, 2016. Bull World Health Organ 2019;97:548–62. 10.2471/BLT.18.228486 - DOI - PMC - PubMed

[9] World Health Organization . Global health sector strategy on sexually transmitted infections, 2016-2021. Available: https://www.who.int/reproductivehealth/publications/rtis/ghss-stis/en/ [Accessed 01 Mar 2020].

[10] World Health Organization . Global health sector strategy on sexually transmitted infections, 2016-2021. Available: https://www.who.int/reproductivehealth/publications/rtis/ghss-stis/en/ [Accessed 01 Mar 2020].

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

Affiliations

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

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