Hum Reprod Update. 2014 Nov-Dec;20(6):952-63. doi: 10.1093/humupd/dmu030. Epub 2014 Jun 16.
Unintended pregnancy and sexually transmitted infections (STIs) are the major negative consequences of unsafe sex. Both are common and have long-term social and health consequences. Barrier methods of contraception can prevent both, but unfortunately they are much less effective than the more modern methods at pregnancy prevention. Modern effective contraceptives, however, do not protect against STIs and some may increase the risk of acquisition of infection. This comprehensive review discusses the magnitude of burden of reproductive ill-health, focussing on data from the European region, and explores the relationship between contraceptive use and STIs.
Searches were performed by using Medline, Popline, EMBASE, Cochrane Library and the Social Sciences Citation Index databases for relevant English language publications from 1995 to 2012. Summaries were discussed by the European Society of Human Reproduction and Embryology (ESHRE) Workshop Group.
An understanding of patterns of sexual behaviour helps to understand the epidemiology of unintended pregnancy and STIs and gives pointers towards their prevention, but survey methodologies differ and results are hard to compare. Contraceptive prevalence and method mix vary widely between countries, and the use of the dual method of protection is very infrequent. Abortion rates have fallen in many European countries, particularly Eastern Europe, and contraceptive prevalence increased but unsafe abortion still accounts for 11% of maternal mortality in Eastern Europe. STIs are common but reporting systems are often rudimentary or non-existent and robust data are scarce. Providers still worry about the effect of intrauterine contraception on reproductive tract infections despite reassuring evidence to the contrary. New data on HIV acquisition and hormonal contraception are causing concern in settings where HIV infection is common. New developments in multipurpose technologies aimed at producing a single device/drug, which prevents infection and pregnancy simultaneously, are in early stages. While the benefits of national screening programmes for STIs remain uncertain, human papilloma virus (HPV) vaccination is clearly reducing HPV infection rates and gives hope for the public health benefits of other STI vaccines.
The consequences of unsafe sex-unintended pregnancy and STI-continue to present major public health problems worldwide even in countries where the prevalence of use of modern contraception is high. Robust systems for routine data collection are sorely needed in most countries and systematic attempts to compare patterns of sexual behaviour across men and women of all ages would be welcome.
意外怀孕和性传播感染（STIs）是不安全性行为的主要负面影响。这两者都很常见，且会带来长期的社会和健康后果。避孕的屏障方法可以预防这两种情况，但不幸的是，它们在预防怀孕方面的效果远不如更现代的方法。然而，现代有效的避孕药具并不能预防 STIs，有些可能会增加感染的风险。本综述全面探讨了生殖健康不良的负担问题，重点关注欧洲地区的数据，并探讨了避孕方法与 STIs 之间的关系。
使用 Medline、Popline、EMBASE、Cochrane 图书馆和社会科学引文索引数据库，检索了 1995 年至 2012 年期间的相关英文文献，并对欧洲人类生殖与胚胎学会（ESHRE）工作组的总结进行了讨论。
了解性行为模式有助于理解意外怀孕和 STIs 的流行病学，并为其预防提供线索，但调查方法不同，结果难以比较。避孕方法的普及程度和种类在国家之间差异很大，双重保护方法的使用非常罕见。许多欧洲国家，特别是东欧的堕胎率已经下降，避孕方法的普及率有所提高，但不安全堕胎仍占东欧孕产妇死亡率的 11%。STIs 很常见，但报告系统往往很基础或不存在，可靠的数据也很少。尽管有相反的证据，但提供者仍然担心宫内节育器对生殖道感染的影响。在 HIV 感染较为普遍的地区，关于 HIV 感染和激素避孕的新数据令人担忧。旨在生产一种既能预防感染又能预防怀孕的单一设备/药物的多用途技术的新发展尚处于早期阶段。虽然国家 STI 筛查计划的好处仍不确定，但人乳头瘤病毒（HPV）疫苗的接种显然降低了 HPV 感染率，并为其他 STI 疫苗的公共卫生效益带来了希望。
即使在现代避孕方法普及率较高的国家，不安全性行为的后果——意外怀孕和 STIs——仍然是全球重大的公共卫生问题。大多数国家都非常需要健全的常规数据收集系统，人们还希望系统地尝试比较不同年龄段男性和女性的性行为模式。
