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#Grand Rounds

Do Hormonal Contraceptives Protect Against BV and Potential HIV Infection?

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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

METHODS:

  • 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)

RESULTS:

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

CONCLUSION:

  • 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

Learn More – Primary Sources:

Effects of combined oral contraceptives, depot medroxyprogesterone acetate and the levonorgestrel-releasing intrauterine system on the vaginal microbiome

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Related ObG Topics:

Practical info for your gynecology practice
Hormonal Contraception Benefits – Beyond Pregnancy Prevention
Practical info for your gynecology practice
Diagnosing Vaginitis – Why the Office Visit Still Matters
Bacterial Vaginosis – CDC Diagnosis and Treatment Recommendations

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