title: Biological and hormonal markers of chlamydia, human papillomavirus, and bacterial vaginosis among adolescents attending genitourinary medicine clinics.
abstract: OBJECTIVE
  To assess maturity indices, menstrual patterns, hormonal factors, and risk of adolescent genital tract infections.
  
  
  METHODS
  Cross sectional study in three genitourinary medicine clinics. Females 17 years or less, within 5 years of menarche, or reporting oligo-amenorrhoea were screened for genital tract infections and menstrual cycle characteristics determined. The outcome measures were risk factors associated with chlamydia, human papillomavirus (HPV DNA) and bacterial vaginosis (BV), separately and pooled. Correlations between estrone-3-glucuronide (E3G) and pregnanediol-3alpha-glucuronide (P3G) hormone concentrations and chlamydia, HPV, and BV.
  
  
  RESULTS
  Among 127 adolescents, HPV was present in 64.4% (95% CI: 54.5 to 74.3), BV in 33.9% (19.1 to 34.5), and chlamydia in 26.8% (19.1 to 34.5). Breast maturity, oligomenorrhoea, and older gynaecological age were associated with lower risk of all infections. After adjustment for calendar age, race, and behavioural factors, gynaecological age remained significant (OR = 0.7, 0.6-0.9; p = 0.008). Behavioural risk factors differed by infection. Smoking was protective for HPV (OR = 0.1, 0.0 to 0.9; p = 0.007), and a recent new partner for chlamydia (OR = 0.3, 0.1 to 0.9; p = 0.024). Sex during menses was associated with increased BV risk (OR = 3.3, 1.5 to 7.2; p = 0.003). Chlamydia was higher among adolescents who used emergency contraception (2.5; 1.1 to 5.9, p = 0.029) and lower among those using condoms at last sex (OR = 0.3, 0.1 to 0.9; p = 0.015). Among 25 adolescents not using hormonal contraceptives, 15 had disturbed or anovulatory cycles. Chlamydia risk was inversely associated with P3G concentrations (Mann-Whitney; p = 0.05).
  
  
  CONCLUSIONS
  Adolescents engaging in high risk behaviour at a young gynaecological age are susceptible to multiple infections. Adolescent clinical assessment should include gynaecological age.
authors.affiliation: Academic Unit of Obstetrics and Gynaecology and Reproductive Health Care, Research Floor, St Mary's Hospital, Whitworth Park, Manchester M13 0JH, UK. loretta.brabin@manchester.ac.uk
authors.forename: L
authors.initials: L
authors.lastname: Brabin
authors.forename: E
authors.initials: E
authors.lastname: Fairbrother
authors.forename: D
authors.initials: D
authors.lastname: Mandal
authors.forename: S A
authors.initials: SA
authors.lastname: Roberts
authors.forename: S P
authors.initials: SP
authors.lastname: Higgins
authors.forename: S
authors.initials: S
authors.lastname: Chandiok
authors.forename: P
authors.initials: P
authors.lastname: Wood
authors.forename: G
authors.initials: G
authors.lastname: Barnard
authors.forename: H C
authors.initials: HC
authors.lastname: Kitchener
mesh_terms: D000293:Adolescent; D015415:Biomarkers / Q000097:blood; D002690:Chlamydia Infections / Q000097:blood / Q000209:etiology*; D002692:Chlamydia trachomatis; D003430:Cross-Sectional Studies; D004970:Estrone / Q000031:analogs & derivatives* / Q000097:blood; D005260:Female; D006801:Humans; D008597:Menstrual Cycle / Q000502:physiology; D009344:Neisseria gonorrhoeae; D030361:Papillomavirus Infections / Q000097:blood / Q000209:etiology*; D011276:Pregnanediol / Q000031:analogs & derivatives* / Q000097:blood; D018570:Risk Assessment; D012307:Risk Factors; D012725:Sexual Behavior; D013223:Statistics as Topic; D016585:Vaginosis, Bacterial / Q000097:blood / Q000209:etiology*
chemical_list: D015415:Biomarkers; C022270:pregnanediol-3 alpha-glucuronide; C015856:estrone-3-glucuronide; D004970:Estrone; D011276:Pregnanediol