长效可逆避孕措施、避孕套使用与性传播感染：系统评价和荟萃分析。

Long-Acting Reversible Contraception, Condom Use, and Sexually Transmitted Infections: A Systematic Review and Meta-analysis.

机构信息

Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia.

Oak Ridge Institute for Science and Education, Atlanta, Georgia.

出版信息

Am J Prev Med. 2021 Nov;61(5):750-760. doi: 10.1016/j.amepre.2021.04.032. Epub 2021 Sep 16.

DOI:10.1016/j.amepre.2021.04.032

PMID:34686301

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9125421/

Abstract

INTRODUCTION

Given mixed findings regarding the relationship between long-acting reversible contraception and condom use, this systematic review and meta-analysis synthesizes studies comparing sexually transmitted infection‒related outcomes between users of long-acting reversible contraception (intrauterine devices, implants) and users of moderately effective contraceptive methods (oral contraceptives, injectables, patches, rings).

METHODS

MEDLINE, Embase, PsycINFO, Global Health, CINAHL, Cochrane Library, and Scopus were searched for articles published between January 1990 and July 2018. Eligible studies included those that (1) were published in the English language, (2) were published in a peer-reviewed journal, (3) reported empirical, quantitative analyses, and (4) compared at least 1 outcome of interest (condom use, sexual behaviors other than condom use, sexually transmitted infection‒related service receipt, or sexually transmitted infections/HIV) between users of long-acting reversible contraception and users of moderately effective methods. In 2020, pooled ORs were calculated for condom use, chlamydia/gonorrhea infection, and trichomoniasis infection; findings for other outcomes were synthesized qualitatively. The protocol is registered on the International Prospective Register of Systematic Reviews (CRD42018109489).

RESULTS

A total of 33 studies were included. Long-acting reversible contraception users had decreased odds of using condoms compared with oral contraceptive users (OR=0.43, 95% CI=0.30, 0.63) and injectable, patch, or ring users (OR=0.58, 95% CI=0.48, 0.71); this association remained when limited to adolescents and young adults only. Findings related to multiple sex partners were mixed, and only 2 studies examined sexually transmitted infection testing, reporting mainly null findings. Pooled estimates for chlamydia and/or gonorrhea were null, but long-acting reversible contraception users had increased odds of trichomoniasis infection compared with oral contraceptive users (OR=2.01, 95% CI=1.11, 3.62).

DISCUSSION

Promoting condom use specifically for sexually transmitted infection prevention may be particularly important among long-acting reversible contraception users at risk for sexually transmitted infections, including adolescents and young adults.

摘要

简介

鉴于长效可逆避孕措施与 condom 使用之间的关系存在混杂结果，本系统综述和荟萃分析综合了比较使用长效可逆避孕措施（宫内节育器、植入物）和使用中度有效避孕方法（口服避孕药、注射剂、贴剂、环）的患者在性传播感染相关结局方面的研究。

方法

检索了 1990 年 1 月至 2018 年 7 月期间发表的 MEDLINE、Embase、PsycINFO、全球卫生、CINAHL、 Cochrane 图书馆和 Scopus 中的文章。纳入的研究符合以下标准：（1）用英文发表；（2）发表在同行评议的期刊上；（3）报告实证、定量分析；（4）比较了长效可逆避孕措施使用者和中度有效方法使用者之间至少 1 个感兴趣的结局（ condom 使用、 condom 以外的性行为、性传播感染相关服务的使用、性传播感染/艾滋病毒）。2020 年，计算了 condom 使用、衣原体/淋病感染和滴虫病感染的合并 OR；其他结局的结果采用定性方法综合。该方案已在国际前瞻性系统评价注册库（CRD42018109489）中注册。

结果

共纳入 33 项研究。与口服避孕药使用者相比，长效可逆避孕措施使用者 condom 使用的可能性降低（OR=0.43，95%CI=0.30，0.63），与注射剂、贴剂或环使用者相比（OR=0.58，95%CI=0.48，0.71）；仅在青少年和年轻人中进行限制时，这种关联仍然存在。与多个性伴侣相关的发现混杂，只有 2 项研究检查了性传播感染检测，主要报告了阴性结果。衣原体和/或淋病的合并估计值为阴性，但与口服避孕药使用者相比，长效可逆避孕措施使用者患滴虫病的可能性增加（OR=2.01，95%CI=1.11，3.62）。