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  • Title: Oral contraceptive use and the risk of chlamydial and gonococcal infections.
    Author: Louv WC, Austin H, Perlman J, Alexander WJ.
    Journal: Am J Obstet Gynecol; 1989 Feb; 160(2):396-402. PubMed ID: 2916625.
    Abstract:
    Oral contraceptive users were compared with nonusers with respect to the rate of cervical infections by Chlamydia trachomatis and Neisseria gonorrhoeae. The comparison was adjusted for differences in demographic and behavioral characteristics between the two groups. The rates of infection among oral contraceptive users were increased by approximately 70% (statistically significant) for both pathogens. Cervical ectopy was implicated in the increased rate of chlamydia but not gonorrhea. Rates of gonorrheal infection differed significantly among oral contraceptive formulations; rates were higher for formulations containing more androgenic progestins. The rate of cervical infections by Chlamydia trachomatis and Neisseria gonorrhoeae was compared in 617 oral contraceptive (OC) users and 101 controls who were either IUD users or were sterilized. Study subjects were drawn from an Alabama sexually transmitted diseases clinic; 89% were black and the average age was 23 years. OC use was associated with a 73% increase in chlamydial risk and a 70% increase in the risk of gonococcal infection. The number of sexual partners was positively correlated with the rates of both infections, while age was negatively related. 46% of the OC users compared with 19% of nonusers had cervical ectopy. However, the difference of the effect of ectopy on chlamydia and gonorrhea was not statistically significant between OC users and nonusers. The amount of estrogen in the OC was not associated with ectopy, chlamydia, or gonorrhea. In contrast, gonorrhea rates were higher for women taking OCs that contained norethindrone and norgestrel. Formulations containing the less androgenic progestin, norethindrone acetate, were not associated with increased gonococcal risk. These findings suggest that women using OCs, especially OCs that contain norgestrel, should be screened more aggressively than nonusers of OCs for both gonorrhea and chlamydia.
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