Analysis of Progestin-Based Injectable Contraception and the Risk of Curable Sexually Transmitted Infections in a Prospective Cohort of Adolescent Girls and Young Women in Johannesburg, South Africa

Abstract

Introduction: Several studies have shown an increased risk for sexually transmitted infections (STIs) in women using hormonal contraception. We explored this association in a cohort of adolescent girls and young women (AGYW) in Johannesburg, South Africa. Methods: CHOICES was a prospective observational study that investigated the association between progestin-based injectable contraception (IC) and Neisseria gonorrhoea (GC), Chlamydia trachomatis (CT), Mycoplasma genitalium (MG), and Trichomonas vaginalis (TV) in Human-Immuno-Deficiency Virus (HIV) uninfected AGYW aged 16-24 years. We used logistic regression to explore the associations between IC compared to non-HC use for each STI. Results: Of 736 AGYW screened, 611(83%) were eligible, and 577 included in this analysis. Median age was 21 years (IQR 19-22 years). Overall, 183/577 (32%) had a curable STI, with 130/577 (23%) having CT, 37/577 (6%) MG, 24/577(4%) NG and 19/577 (3%) TV at baseline. In both bivariate and after adjusting for sexual behavioural factors, there were no statistically significant associations between IC use and having an STI. Conclusion: Although there was a trend, there was no statistically significant association between IC and any STIs were observed in this cohort with a high STI burden.