Hormonal Contraception and Vaginal Infections Among Couples Who Are Human Immunodeficiency Virus Serodiscordant in Lusaka, Zambia

Abstract

To examine the relationship between hormonal contraception and vaginal infections with bacterial vaginosis, vaginal candidiasis, or trichomoniasis. METHODS:Couples who were human immunodeficiency virus (HIV) serodiscordant in Zambia were enrolled in a longitudinal cohort study. From 1994 to 2002, both partners were seen quarterly and received physical exams including genital examinations. Separate rates for three outcome infections of interest (bacterial vaginosis, vaginal candidiasis, and trichomoniasis) were calculated. Bivariate associations between baseline and time-varying covariates and outcome infections of interest were evaluated using unadjusted Anderson-Gill survival models. Adjusted hazard ratios (aHRs) were generated using multivariable Anderson-Gill survival models that included demographic and clinical factors associated with both hormonal contraceptive use and each infection of interest.RESULTS: There were 1,558 cases of bacterial vaginosis, 1,529 cases of vaginal candidiasis, and 574 cases of trichomoniasis over 2,143 person-years of observation. Depot medroxyprogesterone acetate (DMPA) users had significantly lower rates of trichomoniasis and bacterial vaginosis. In adjusted models, DMPA was protective for bacterial vaginosis (aHR50.72; 95% CI 0.54-0.95), candidiasis (aHR 0.75, 95% CI 0.57-1.00) and trichomoniasis (aHR50.43, 95% CI 0.25-0.74). Oral contraceptive pills were protective for candidiasis (aHR50.79, 95% CI 0.65-0.97). CONCLUSION:We confirm that DMPA use was associated with reduced rates of the three most common causes of vaginitis, and oral contraceptive pill use was associated with reduced rates of candidiasis among women in couples who were HIV discordant.

Clinical research on traditional Chinese medicine treatment for bacterial vaginosis

“…By utilizing the abundant glycogen, lactobacilli can produce enough lactic acid to create an acidic vaginal microenvironment, and thus protecting women from BV infection (Kalia et al, 2020; Wessels et al, 2018). Based on a meta‐analysis, Vodstrcil et al (2013) found that the use of hormonal contraceptives was highly relevant to a decreased incidence of prevalent BV, which is in accordance with the experimental result reported by Haddad et al (2019). Moreover, it was also reported that progesterone and estrogen act as modulators to regulate the human immune mechanisms in the genital tract, such as controlling the level of immunoglobulins and defensins (Faught & Reyes, 2019).…”

An updated review on the effects of depot medroxyprogesterone acetate on the mucosal biology of the female genital tract

“…Studies which reported increased vaginal microbial diversity or lower levels of Lactobacillus in women using DMPA compared to other contraceptive groups were confounded by small sample sizes or were cross‐sectional in nature. The longitudinal studies and larger cross‐sectional studies by Dabee and Noel‐Romas et al indicate that differences in the vaginal microbiome with DMPA are mild and associated with a reduction in BV‐associated bacteria, as reported in previous meta‐analyses 8,38 . An important observation, discussed in the Noel‐Romas et al paper, is the influence of the microbiome in the context of examining DMPA‐associated inflammation making it an important consideration.…”

“…For example, a meta‐analysis by Vodstrcil et al which focused on studies published before January 2013 reported a decreased incidence of BV, defined by Nugent or Amsel scores, with the use of both progestin‐based contraceptives and combined hormonal contraceptives 8 . A more recent review by Haddad et al noted similar observations 38 . Recently, six publications evaluated the vaginal microbiome with DMPA use.…”

“… 8 A more recent review by Haddad et al noted similar observations. 38 Recently, six publications evaluated the vaginal microbiome with DMPA use.…”

“…The longitudinal studies and larger cross‐sectional studies by Dabee and Noel‐Romas et al indicate that differences in the vaginal microbiome with DMPA are mild and associated with a reduction in BV‐associated bacteria, as reported in previous meta‐analyses. 8 , 38 An important observation, discussed in the Noel‐Romas et al paper, is the influence of the microbiome in the context of examining DMPA‐associated inflammation making it an important consideration.…”