Perceived stress and incident sexually transmitted infections in a prospective cohort

Abstract

Purpose: Psychosocial stress has been associated with susceptibility to many infectious pathogens. We evaluated the association between perceived stress and incident sexually transmitted infections (STIs, Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis genital infections) in a prospective study of women. Stress may increase vulnerability to STIs by suppressing immune function and altering the protective vaginal microbiota.Methods: Utilizing the 1999 Longitudinal Study of Vaginal Flora (n=2,439), a primarily African-American cohort of women, we fitted Cox proportional hazards models to examine the association between perceived stress and incident STIs. We tested bacterial vaginosis (measured by Nugent Score) and sexual behaviors (condom use, number of partners, partner concurrence) as mediators using Vanderweele's difference method with bootstrapping.Results: Baseline perceived stress was associated with incident STIs both in the unadjusted model (HR=1.019; 95% CI 1.009-1.029) and after adjusting for confounders (aHR=1.015; 95% CI 1.005-1.026). Nugent score and sexual behaviors significantly mediated 21 % and 65% of this adjusted association respectively, and 78% when included together in the adjusted model. Conclusions:This study advances understanding of the relationship between perceived stress and STIs and identifies high-risk sexual behaviors and development of BV-both known risk factors for STIs-as potential mechanisms underlying this association.

Intimate Partner Violence, Depression, and Anxiety Are Associated With Higher Perceived Stress Among Both Young Men and Women in Soweto and Durban, South Africa

“…While there is evidence that short-term stress can be protective (5), long-term stress response activation is linked to immune system dysregulation and changes in the pathological inflammatory response (5,6), as well as modification of gene expression (7), playing an important role in predicting lowered health outcomes (7)(8)(9)(10)(11)(12). Chronic stress has been linked to mental health conditions such as depression and anxiety (1,13), cardiovascular disease, systemic inflammation, upper respiratory infections, and obesity (14), as well as poor sexual and reproductive health outcomes (15).…”

DataSheet_5.pdf

“…According to previous reports, factors including age, BMI, hygiene habits, diet, exercise intensity, smoking, and perceived stress can affect the vaginal microbiome (ESHRE Guideline Group on RPL et al, 2018;He et al, 2019;Khalife et al, 2019;Turpin et al, 2019;Song et al, 2020). In this study, all factors except for age were similar among the experimental groups (Table 1).…”

Characterization of Vaginal Microbiota in Women With Recurrent Spontaneous Abortion That Can Be Modified by Drug Treatment

“…According to previous reports, factors including age, BMI, hygiene habits, diet, exercise intensity, smoking, and perceived stress can affect the vaginal microbiome ( ESHRE Guideline Group on RPL et al., 2018 ; He et al., 2019 ; Khalife et al., 2019 ; Turpin et al., 2019 ; Song et al., 2020 ). In this study, all factors except for age were similar among the experimental groups ( Table 1 ).…”

“…After delivery, the microbiota revert to be similar to those in non-pregnant women ( Neuman and Koren, 2017 ). Vaginal microbiota composition is also affected by exogenous factors including hygienic practices, contraceptive method, sexual behavior, stress, diet, exercise, drugs, and rectal colonization ( Muzny and Schwebke, 2016 ; Abdelmaksoud et al., 2017 ; Achilles et al., 2018 ; Turpin et al., 2019 ; Song et al., 2020 ). According to existing literature reports, imbalanced vaginal microflora is related to the following diseases, including but not limited to, bacterial vaginosis, sexually transmitted infections, preterm birth (PTB), gynecological cancers, preterm pre-labor rupture of the fetal membranes, recurrent implantation failure, and polycystic ovary syndrome (PCOS) ( Brotman, 2011 ; Muzny and Schwebke, 2016 ; Champer et al., 2017 ; Freitas et al., 2018 ; Brown et al., 2018 ; Elovitz et al., 2019 ; Fu et al., 2020 ; Hong et al., 2020 ).…”