norethindrone-enanthate and Sexually-Transmitted-Diseases--Bacterial

Genital inflammatory changes may be a mechanism of increased HIV risk among injectable progestin-only contraception (IPC) users.. We conducted a cross-sectional analysis of 376 Kenyan and South African women. Genital cytokines and secretory leukocyte peptidase inhibitor concentrations in a reference population were compared to IPC users and women with reproductive tract infections.. No significant variability in marker concentrations was observed by age or site. Depot medroxyprogesterone acetate (DMPA) users had significantly higher MIP-1α, MIP-1β, IL-6, IL-8, IP-10, and RANTES concentrations. Norethisterone oenanthate users had significantly higher IL-6, IL-8, and RANTES concentrations. Women with sexually transmitted infections had variable inflammation, and women with bacterial vaginosis exhibited a mixed profile of up and downregulation.. The finding of substantial mucosal inflammation among DMPA users provides evidence which, combined with the results of prior studies, suggests that DMPA may create an immune environment conducive to HIV target cell recruitment and inhibitory for antiviral activity.

Topics: Adolescent; Adult; Contraception; Contraceptive Agents, Female; Cross-Sectional Studies; Cytokines; Female; Genitalia, Female; HIV Infections; Humans; Inflammation; Kenya; Medroxyprogesterone Acetate; Norethindrone; Pregnancy; Progestins; Sexually Transmitted Diseases, Bacterial; South Africa; Vaginosis, Bacterial; Young Adult

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.

Topics: Adolescent; Adult; Condoms; Female; Humans; Medroxyprogesterone Acetate; Multivariate Analysis; Norethindrone; Patient Selection; Pregnancy; Regression Analysis; Risk Factors; Sexually Transmitted Diseases, Bacterial; South Africa; Vaginitis