Relationship of hormonal contraception and cervical ectopy as measured by computerized planimetry to chlamydial infection in adolescents.
BACKGROUND
Adolescents are at increased risk for chlamydial infection and its sequelae. Hormonal contraception and cervical ectopy were previously suggested risk factors for chlamydia.


OBJECTIVE
To determine if chlamydia is more prevalent in female participants with greater ectopy and in hormonal contraceptive users.


METHODS
Ninety-seven adolescent females aged 11 to 20 years were recruited from two Baltimore inner-city clinics. After administering a reproductive history questionnaire, endocervical specimens were tested for Chlamydia trachomatis by polymerase chain reaction. After acetic acid application to the cervix, cervical photographs were taken, the area of ectopy was quantified by computerized planimetry, and ectopy was categorized as none (0mm2), mild (< 22mm2), and moderate (> 22mm2). The likelihood of chlamydia by ectopy and type of hormonal contraceptive use was determined by logistic regression adjusted for age and sexual partners.


RESULTS
The odds of chlamydial infection was similar in persons with mild ectopy compared with no ectopy (adjusted odds ratio [OR], 0.76; 95% CI, 0.14-4.03), and in persons with moderate ectopy compared with no ectopy (adjusted OR, 1.94; 95% CI, 0.40-9.39). The likelihood of chlamydia was higher in depot-medroxyprogesterone acetate users compared with nonhormone users (adjusted OR, 5.44; 95% CI, 1.25-23.6). Oral contraceptive users did not have an increased likelihood of chlamydia (adjusted OR, 0.92; 95% CI, 0.10-8.78).


CONCLUSIONS
Using a new, reliable, and standardized technique to quantify cervical ectopy, the authors did not find an elevated prevalence of chlamydial infection in adolescents with cervical ectopy. Depot-medroxyprogesterone acetate use may increase the risk of chlamydial infection compared with combined estrogen-progestin oral contraceptives.
Jacobson
D L
DL
Department of Epidemiology, The Johns Hopkins School of Hygiene and Public Health, Baltimore, Maryland, USA.
Peralta
L
L
Farmer
M
M
Graham
N M
NM
Gaydos
C
C
Zenilman
J
J
D000293:Adolescent; D000294:Adolescent Behavior; D000328:Adult; D015142:Baltimore / Q000453:epidemiology; D002584:Cervix Uteri / Q000382:microbiology / Q000473:pathology*; D002648:Child; D002690:Chlamydia Infections / Q000453:epidemiology* / Q000209:etiology; D002692:Chlamydia trachomatis / Q000235:genetics / Q000302:isolation & purification*; D003277:Contraceptives, Oral, Combined; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D017258:Medroxyprogesterone Acetate; D015999:Multivariate Analysis; D015995:Prevalence; D012307:Risk Factors; D011795:Surveys and Questionnaires; D002577:Uterine Cervical Diseases / Q000453:epidemiology* / Q000209:etiology
D003277:Contraceptives, Oral, Combined; D017258:Medroxyprogesterone Acetate