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Review
. 2021 Nov;61(5):750-760.
doi: 10.1016/j.amepre.2021.04.032. Epub 2021 Sep 16.

Long-Acting Reversible Contraception, Condom Use, and Sexually Transmitted Infections: A Systematic Review and Meta-analysis

Riley J Steiner  1 , Sanjana Pampati  2 , Katherine M Kortsmit  3 , Nicole Liddon  4 , Andrea Swartzendruber  5 , Karen Pazol  6
Affiliations
Review

Long-Acting Reversible Contraception, Condom Use, and Sexually Transmitted Infections: A Systematic Review and Meta-analysis

Riley J Steiner et al. Am J Prev Med. 2021 Nov.

Abstract

Introduction: Given mixed findings regarding the relationship between long-acting reversible contraception and condom use, this systematic review and meta-analysis synthesizes studies comparing sexually transmitted infection‒related outcomes between users of long-acting reversible contraception (intrauterine devices, implants) and users of moderately effective contraceptive methods (oral contraceptives, injectables, patches, rings).

Methods: MEDLINE, Embase, PsycINFO, Global Health, CINAHL, Cochrane Library, and Scopus were searched for articles published between January 1990 and July 2018. Eligible studies included those that (1) were published in the English language, (2) were published in a peer-reviewed journal, (3) reported empirical, quantitative analyses, and (4) compared at least 1 outcome of interest (condom use, sexual behaviors other than condom use, sexually transmitted infection‒related service receipt, or sexually transmitted infections/HIV) between users of long-acting reversible contraception and users of moderately effective methods. In 2020, pooled ORs were calculated for condom use, chlamydia/gonorrhea infection, and trichomoniasis infection; findings for other outcomes were synthesized qualitatively. The protocol is registered on the International Prospective Register of Systematic Reviews (CRD42018109489).

Results: A total of 33 studies were included. Long-acting reversible contraception users had decreased odds of using condoms compared with oral contraceptive users (OR=0.43, 95% CI=0.30, 0.63) and injectable, patch, or ring users (OR=0.58, 95% CI=0.48, 0.71); this association remained when limited to adolescents and young adults only. Findings related to multiple sex partners were mixed, and only 2 studies examined sexually transmitted infection testing, reporting mainly null findings. Pooled estimates for chlamydia and/or gonorrhea were null, but long-acting reversible contraception users had increased odds of trichomoniasis infection compared with oral contraceptive users (OR=2.01, 95% CI=1.11, 3.62).

Discussion: Promoting condom use specifically for sexually transmitted infection prevention may be particularly important among long-acting reversible contraception users at risk for sexually transmitted infections, including adolescents and young adults.

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Figures

Figure 1.
Figure 1.
Conceptual model of behavioral relationships between highly and moderately effective contraception and STI-related outcomes. Solid lines indicate empirically established. Dashed lines indicate not empirically established. STI, sexually transmitted infection; LARC, long-acting reversible contraception.
Figure 2.
Figure 2.
Flow chart of literature search and article selection process. aForty-one distinct studies were identified, but 1 study noted substantial overlap with the sample of another study published by the same first author, and thus these 2 studies are treated as 1. bSix studies that reported only on HIV infection are not included. In addition, 1 study reported on STIs other than chlamydia, gonorrhea, or trichomoniasis (and did not compare other STI-related outcomes between LARC users and moderately effective method users). STI, sexually transmitted infection; LARC, long-acting reversible contraception.
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