Department of Epidemiology, School of Public Health, University of North Carolina, Chapel Hill, NC 27599-7435, USA.
Contraception. 2009 Dec;80(6):555-60. doi: 10.1016/j.contraception.2009.06.007. Epub 2009 Jul 16.
This study was conducted to determine the association between the use of injectable progestin contraception (IPC) and the risk of infection with Neisseria gonorrhoeae (GC), Chlamydia trachomatis (CT), bacterial vaginosis (BV) and Trichomonas vaginalis (TV) among women in South Africa.
From August 1999 through May 2001, 643 HIV-1-negative women were recruited from family planning clinics in Orange Farm, South Africa. IPC [norethisterone enanthate (NET-EN) and depot medroxyprogesterone acetate (DMPA)] users and nonhormonal contraception users were recruited in approximately equal numbers. Eligible participants were seen at enrolment and on four follow-up visits over a 12-month period; 567 returned for at least one follow-up visit. Multivariable Poisson regression models with generalized estimating equations were used to compute the incidence rate ratios (IRRs) for infections with GC, CT, BV and TV by use of NET-EN or DMPA relative to nonuse during follow-up.
In multivariable models, the use of DMPA slightly increased the risk of infection with CT [IRR=1.24; 95% confidence interval (95% CI)=0.80-1.94] and GC (IRR=1.30; 95% CI=0.58-2.98), although these associations were not statistically significant. In contrast, DMPA appeared to be protective for TV (IRR=0.35; 95% CI=0.12-1.01), although this estimate was very imprecise. The use of both DMPA and NET-EN was associated with a decreased risk of BV.
The use of DMPA among women in this study population was associated with an increased - but not statistically significant - risk of cervical infection with chlamydia and gonorrhea, and a decreased risk of TV and BV. Given the inconsistencies and limitations of the data describing an increased risk of CT and GC with IPC use, the potential risk of sexually transmitted infections (STIs) must be balanced against the risk of unintended pregnancy and its health consequences, especially in developing countries. Women opting to use IPC should be counseled to use condoms to protect against STIs and HIV.
本研究旨在确定在南非妇女中，使用注射用孕激素避孕药（IPC）与感染淋病奈瑟菌（GC）、沙眼衣原体（CT）、细菌性阴道病（BV）和阴道毛滴虫（TV）之间的关系。
1999 年 8 月至 2001 年 5 月，从南非奥兰治农场的计划生育诊所招募了 643 名 HIV-1 阴性妇女。IPC [左炔诺孕酮酯（NET-EN）和醋酸甲羟孕酮酯（DMPA）]使用者和非激素避孕使用者的招募人数大致相等。符合条件的参与者在入组时和 12 个月期间的 4 次随访中接受了检查；567 人至少进行了一次随访。使用广义估计方程的多变量泊松回归模型计算了在随访期间使用 NET-EN 或 DMPA 相对于不使用者的 GC、CT、BV 和 TV 感染的发病率比（IRR）。
在多变量模型中，DMPA 的使用略微增加了 CT [IRR=1.24；95%置信区间（95%CI）=0.80-1.94]和 GC（IRR=1.30；95%CI=0.58-2.98）感染的风险，尽管这些关联没有统计学意义。相比之下，DMPA 似乎对 TV（IRR=0.35；95%CI=0.12-1.01）有保护作用，尽管这个估计值非常不准确。同时使用 DMPA 和 NET-EN 与 BV 风险降低相关。
在本研究人群中，DMPA 的使用与宫颈衣原体和淋病感染的风险增加（但无统计学意义）相关，与 TV 和 BV 的风险降低相关。鉴于描述 IPC 使用增加 CT 和 GC 风险的数据存在不一致和局限性，必须权衡性传播感染（STI）的潜在风险与意外怀孕及其健康后果的风险，尤其是在发展中国家。选择使用 IPC 的妇女应被告知使用避孕套以预防 STI 和 HIV。
