Effects of contraceptive method on the vaginal microbial flora: a prospective evaluation.
A prospective evaluation of 331 university women who were initiating use of oral contraceptive pills (OCPs), a cervical cap, diaphragm-spermicide, or other spermicidal methods was done to assess the effects of commonly used contraceptive methods on the vaginal flora. Vaginal introital cultures were performed at baseline and then weekly for 1 month. The prevalence of Escherichia coli vaginal colonization and of abnormal vaginal Gram stain scores (Nugent criteria) increased significantly among women using a cervical cap or diaphragm-spermicide but not among women using OCPs. Women with E. coli colonization were significantly more likely to have an abnormal Nugent score and an absence of lactobacilli. In a multivariate model, use of spermicidal contraception in the preceding week was associated with an abnormal Nugent score and with colonization with E. coli, Enterococcus species, and anaerobic gram-negative rods. Thus, spermicidal methods of contraception are associated with alterations of the vaginal microflora that consequently may predispose women to genitourinary infections.
Gupta
K
K
Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA 98195. kalg@u.washington.edu. kalg@u.washington.edu
Hillier
S L
SL
Hooton
T M
TM
Roberts
P L
PL
Stamm
W E
WE
D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D003271:Contraceptive Agents, Female; D003274:Contraceptive Devices, Female; D003470:Culture Media; D016983:Enterococcus / Q000254:growth & development; D004926:Escherichia coli / Q000254:growth & development; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D007778:Lactobacillus / Q000254:growth & development; D011446:Prospective Studies; D014621:Vagina / Q000382:microbiology*
D003271:Contraceptive Agents, Female; D003470:Culture Media