title: The impact of hormonal contraception and pregnancy on sexually transmitted infections and on cervicovaginal microbiota in african sex workers.
abstract: BACKGROUND
  The observed association between Depo-Provera injectable use and increased HIV acquisition may be caused by hormone-induced increased susceptibility to other sexually transmitted infections (STIs) or changes in the cervicovaginal microbiota (VMB), accompanied by genital immune activation and/or mucosal remodeling.
  
  
  METHODS
  Rwandan female sex workers (n = 800) were interviewed about contraceptive use and sexual behavior and were tested for STIs, bacterial vaginosis by Nugent score and pregnancy, at baseline. A subset of 397 HIV-negative, nonpregnant women were interviewed and tested again at regular intervals for 2 years. The VMB of a subset of 174 women was characterized by phylogenetic microarray. Outcomes of STI and VMB were compared between women with hormonal exposures (reporting oral contraceptive or injectable use, or testing positive for pregnancy) and controls (not reporting hormonal contraception and not pregnant).
  
  
  RESULTS
  Oral contraceptive use was associated with increased human papillomavirus prevalence (adjusted odds ratio [aOR], 3.10; 1.21-7.94) and Chlamydia trachomatis incidence (aOR, 6.13; 1.58-23.80), injectable use with increased herpes simplex virus-2 prevalence (aOR, 2.13; 1.26-3.59) and pregnancy with lower HIV prevalence (aOR, 0.45; 0.22-0.92) but higher candidiasis incidence (aOR, 2.14; 1.12-4.09). Hormonal status was not associated with Nugent score category or phylogenetic VMB clustering, but oral contraceptive users had lower semiquantitative vaginal abundance of Prevotella, Sneathia/Leptotrichia amnionii, and Mycoplasma species.
  
  
  CONCLUSIONS
  Oral contraceptive and injectable use were associated with several STIs but not with VMB composition. The increased herpes simplex virus-2 prevalence among injectable users might explain the potentially higher HIV risk in these women, but more research is needed to confirm these results and elucidate biological mechanisms.
authors: From the *Amsterdam Institute for Global Health and Development and Department of Global Health, Academic Medical Center, Amsterdam, the Netherlands; †Institute of Infection and Global Health, University of Liverpool, Liverpool, UK; ‡TNO Microbiology & Systems Biology, Zeist, the Netherlands; §Rinda Ubuzima, Kigali, Rwanda; and ¶International Center for Reproductive Health, Ghent University, Ghent, Belgium.
authors: Hanneke
authors: H
authors: Borgdorff
authors: Marijn C
authors: MC
authors: Verwijs
authors: Ferdinand W N M
authors: FW
authors: Wit
authors: Evgeni
authors: E
authors: Tsivtsivadze
authors: Gilles F
authors: GF
authors: Ndayisaba
authors: Rita
authors: R
authors: Verhelst
authors: Frank H
authors: FH
authors: Schuren
authors: Janneke H H M
authors: JH
authors: van de Wijgert
mesh_terms: D000328:Adult; D002584:Cervix Uteri / Q000276:immunology / Q000382:microbiology*; D017280:Condoms / Q000706:statistics & numerical data*; D003271:Contraceptive Agents, Female; D003278:Contraceptives, Oral, Hormonal; D005260:Female; D006801:Humans; D015994:Incidence; D046228:Microarray Analysis; D010802:Phylogeny; D011247:Pregnancy; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D012432:Rwanda / Q000453:epidemiology; D060386:Sex Workers / Q000706:statistics & numerical data*; D012725:Sexual Behavior; D012749:Sexually Transmitted Diseases / Q000453:epidemiology / Q000276:immunology* / Q000517:prevention & control; D014621:Vagina / Q000276:immunology / Q000382:microbiology*
chemical_list: D003271:Contraceptive Agents, Female; D003278:Contraceptives, Oral, Hormonal