title: The levonorgestrel-releasing intrauterine system is associated with delayed endocervical clearance of Chlamydia trachomatis without alterations in vaginal microbiota.
abstract: Progestin-based contraception may impact women's susceptibility to sexually transmitted infection. We evaluated the effect of the levonorgestrel intrauterine system (LNG-IUS) on cervical persistence of Chlamydia trachomatis (CT) in a baboon model. Female olive baboons (Papio anubis) with or without an LNG-IUS received CT or sham inoculations. CT was detected in cervical epithelium with weekly nucleic acid amplification testing (NAAT) and culture. Presence of the LNG-IUS was associated with prolonged persistence of CT. Median time to post-inoculation clearance of CT as detected by NAAT was 10 weeks (range 7-12) for animals with an LNG-IUS and 3 weeks (range 0-12) for non-LNG-IUS animals (P = 0.06). Similarly, median time to post-inoculation clearance of CT by culture was 9 weeks (range 3-12) for LNG-IUS animals and 1.5 weeks (range 0-10) for non-LNG-IUS animals (P = 0.04). We characterized the community structure of the vaginal microbiota with the presence of the LNG-IUS to determine if alterations in CT colonization dynamics were associated with changes in vaginal commensal bacteria. Vaginal swabs were collected weekly for microbiome analysis. Endocervical CT infection was not correlated with alterations in the vaginal microbiota. Together, these results suggest that LNG-IUS may facilitate CT endocervical persistence through a mechanism distinct from vaginal microbial alterations.
authors.affiliation: Unit for Laboratory Animal Medicine, University of Michigan, 1150 W. Medical Center Drive, Ann Arbor, MI 48109, USA.
authors.forename: Emma R
authors.initials: ER
authors.lastname: Liechty
authors.affiliation: Unit for Laboratory Animal Medicine, University of Michigan, 1150 W. Medical Center Drive, Ann Arbor, MI 48109, USA.
authors.forename: Ingrid L
authors.initials: IL
authors.lastname: Bergin
authors.affiliation: Department of Internal Medicine Division of Infectious Diseases, University of Michigan, Ann Arbor, MI 48109, USA.
authors.forename: Christine M
authors.initials: CM
authors.lastname: Bassis
authors.affiliation: Institute for Primate Research, Nairobi, Kenya.
authors.forename: Daniel
authors.initials: D
authors.lastname: Chai
authors.affiliation: Department of Pathology, University of Michigan, Ann Arbor, MI 48109, USA.
authors.forename: William
authors.initials: W
authors.lastname: LeBar
authors.affiliation: Department of Internal Medicine Division of Infectious Diseases, University of Michigan, Ann Arbor, MI 48109, USA Department of Microbiology and Immunology, University of Michigan, Ann Arbor, MI 48109, USA.
authors.forename: Vincent B
authors.initials: VB
authors.lastname: Young
authors.affiliation: Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI 48109, USA jasonbel@med.umich.edu.
authors.forename: Jason D
authors.initials: JD
authors.lastname: Bell
mesh_terms: D000282:Administration, Intravaginal; D000818:Animals; D001431:Bacteriological Techniques; D002690:Chlamydia Infections / Q000382:microbiology*; D002692:Chlamydia trachomatis / Q000302:isolation & purification*; D003271:Contraceptive Agents, Female / Q000494:pharmacology*; D004195:Disease Models, Animal; D016503:Drug Delivery Systems; D004717:Endometrium / Q000382:microbiology*; D005260:Female; D016912:Levonorgestrel / Q000494:pharmacology*; D064307:Microbiota; D025202:Molecular Diagnostic Techniques; D021141:Nucleic Acid Amplification Techniques; D010215:Papio; D013997:Time Factors; D014621:Vagina / Q000382:microbiology*
chemical_list: D003271:Contraceptive Agents, Female; D016912:Levonorgestrel
keywords: contraception; sexually transmitted infection; vaginal microbiome