Long-Acting Reversible Contraception Effect on Condom Use, STI Acquisition

Varying risk perception, partner discordance in condom preference, and intermittent or partner-specific condom use make accurate assessment of condom use difficult.

Although condom use was shown to be lower among women who initiated long-acting reversible contraceptives, it did not differ from preinitiation behavior. Nonetheless, long-acting reversible contraception use was associated with increased acquisition of sexually transmitted infection within the first 12 months, according to research published in American Journal of Obstetrics & Gynecology.

In this secondary analysis of the contraceptive CHOICE project, 2 independent sample populations of 12-month continuous contraceptive users were evaluated for condom use (long-acting reversible contraceptives, n = 2371; other methods, n = 575) or sexually transmitted infection (STI) acquisition (long-acting reversible contraceptives, n = 2102; other methods, n = 592). Self-reported information on condom use and STI testing occurred at baseline and 3, 6, and 12 months.

Compared with users of other types of contraception, long-acting reversible contraceptive users were less likely to consistently use condoms (11.3% vs 5.2%; P <.001). Regardless of contraceptive method choice, condom use did not significantly change at any point compared with baseline.

Users of long-acting reversible contraceptives had a higher rate of STIs after initiation compared with other methods (3.9% vs 2.0%; P =.03). After adjustment, long-acting reversible contraceptives were associated with an increased incidence of STIs within the first 12 months (odds ratio [OR], 2.0; 95% CI, 1.07-3.72).

Other risk factors associated with an increased risk for STI included age <25 years (adjusted OR, 2.94; 95% CI, 1.74-4.97), black race (adjusted OR, 3.18; 95% CI, 1.91-5.31), nonnmarried women not living with partners (adjusted OR, 3.17; 95% CI, 1.21-8.26), and new sexual partners (adjusted OR, 2.16; 95% CI, 1.40-3.33).

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The authors concluded that the results “reaffirm that consistent condom use and dual contraceptive method use are low regardless of which additional contraceptive method is being used…[adding] to the growing body of literature that provides reassurance that [long-acting reversible contraceptive] use does not change condom use behavior.” Nonetheless, the researchers emphasize the importance of dual-method patient education because of the increased risk for STIs.


McNicholas CP, Klugman JB, Zhao Q, Peipert JF. Condom use and incident sexually transmitted infection after initiation of long-acting reversible contraception [published online September 14, 2017]. Am J Obstet Gynecol. doi: 10.1016/j.ajog.2017.09.009