Grand Rounds

Do Hormonal Contraceptives Protect Against BV and Potential HIV Infection?

BACKGROUND AND PURPOSE:

Studies have shown that the composition of the vaginal microbiome may also impact predisposition to STDs and BV
- There is an association between BV and HIV susceptibility
Research also indicates that hormonal contraception may impact STDs and BV
- Use of estrogen-containing contraceptives appears to decreases BV
- Effect of progesterone inconclusive
This study by Brooks et al. (Contraception, 2017) aimed to explore the effects of hormonal contraceptives on the vaginal microbiome
- Researchers also sought ascertained amount of H2O2-producing Lactobacillus abundance as a decrease in Lactobacillus and replacement by bacteria can result in BV

Retrospective Study
16s rRNA genes from vaginal bacteria were sequenced and identified
- Gene survey data was taken from the Human Vaginal Microbiome Project
682 women who used a single form of birth control were included
- Types of birth control were: condoms, combined oral contraceptives (COCs), depot medroxyprogesterone acetate (DMPA), or IUD, specifically the levonorgestrel-releasing intrauterine system (LNG-IUS)

Compared to women using condoms,

COC (adjusted odds ratio 0.29, 95% CI 0.13-0.64) and DMPA (adjusted odds ratio 0.34, 95% CI 0.13-0.89) are both less likely to have BV-associated bacteria
- Women who used COCs (adjusted odds ratio 1.94, 95% CI 1.25-3.02) had increased Lactobacillus species
- Neither LNG-IUS nor DMPA was associated with Lactobacillus abundance

Use of COCs significantly increased the odds of vaginal colonization by healthy lactobacilli
This study provides supporting data that COCs increase healthy, protective vaginal flora

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