Department of Gynecology and Obstetrics, Emory University, School of Medicine, the Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health, Emory University, and the Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia; the Department of Epidemiology, Ryals School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama; and the Department of Gynecology and Obstetrics, School of Medicine, University of Zambia, and the Ministry of Community Development, Mother and Child Health, Lusaka, Zambia.
Obstet Gynecol. 2019 Sep;134(3):573-580. doi: 10.1097/AOG.0000000000003404.
To examine the relationship between hormonal contraception and vaginal infections with bacterial vaginosis, vaginal candidiasis, or trichomoniasis.
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.
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 (aHR=0.72; 95% CI 0.54-0.95), candidiasis (aHR 0.75, 95% CI 0.57-1.00) and trichomoniasis (aHR=0.43, 95% CI 0.25-0.74). Oral contraceptive pills were protective for candidiasis (aHR=0.79, 95% CI 0.65-0.97).
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.
研究激素避孕与细菌性阴道病、阴道假丝酵母菌病或滴虫性阴道炎之间的关系。
赞比亚的 HIV 血清学不一致的夫妇被纳入一项纵向队列研究。1994 年至 2002 年期间，每季度对夫妇双方进行随访，包括体格检查和生殖器检查。分别计算三种感兴趣的感染结局（细菌性阴道病、阴道假丝酵母菌病和滴虫性阴道炎）的发生率。采用未调整的 Anderson-Gill 生存模型评估基线和时变协变量与感兴趣的感染结局之间的双变量关系。使用包含与激素避孕和每种感染均相关的人口统计学和临床因素的多变量 Anderson-Gill 生存模型生成调整后的危险比（aHR）。
在 2143 人年的观察期间，共发生 1558 例细菌性阴道病、1529 例阴道假丝酵母菌病和 574 例滴虫病。DMPA 使用者的滴虫病和细菌性阴道病发生率显著降低。在调整后的模型中，DMPA 对细菌性阴道病（aHR=0.72；95%CI 0.54-0.95）、阴道假丝酵母菌病（aHR 0.75，95%CI 0.57-1.00）和滴虫病（aHR=0.43，95%CI 0.25-0.74）具有保护作用。口服避孕药对阴道假丝酵母菌病具有保护作用（aHR=0.79，95%CI 0.65-0.97）。
我们证实，DMPA 使用与三种最常见阴道炎病因的发生率降低有关，而口服避孕药的使用与 HIV 血清学不一致的夫妇中阴道假丝酵母菌病的发生率降低有关。
