The risk of acquiring a sexually transmitted infection (STI) is not higher among adolescents using long-acting reversible contraceptives compared with other forms of contraception, according to a study recently published in the American Journal of Preventive Medicine.
The United States has one of the highest birth rate for adolescent girls among industrialized countries. The most effective forms of contraception are long-acting, reversible contraceptives, such as intrauterine devices and subdermal hormonal implants. This form of contraception has a failure rate of <1%, vs other forms (oral contraception pills, hormone patches and vaginal rings), which have failure rates between 6% and 9%.
Though long-acting, reversible contraceptives have been approved and recommended for adolescent use, uptake has been low; this is may be due to perceived risks for side effects, including risks of developing STIs. Previous literature demonstrated a significantly increased incidence of STIs among women who used long-acting, reversible contraceptives (odds ratio [OR], 2.0; 95% CI, 1.07-3.72). However, data on this possible association among an adolescent population is scant.
Therefore, researchers conducted an archival data analysis study that included Medicaid claims from 62,550 adolescent girls (58.1% white; 29.4% black; 12.5% other race) aged 14 to 19 years who were given a prescription for a contraceptive between 2011 and 2015, completed a 1-year follow-up, and had no prior STI diagnosis. The researchers examined the incidence of STI diagnoses after receipt of contraceptive prescription. Hazard ratios (HRs) were calculated using a Cox proportional hazards regression model with 95% confidence intervals.
The rate of STI diagnosis at 1-year follow-up was 10.9%. Combining all STIs, adolescents who switched contraceptive methods had the highest STI diagnosis rate (13.2%; HR, 1.51; 95% CI, 1.43-1.60; P <.001) compared with those who remained consistently on a contraceptive pill. Compared with the pill method of contraception, those using hormonal implant had the lowest STI diagnosis rate (8.3%; HR, 0.81; 95% CI, 0.70-0.93; P =.004), while hormone injection was associated with increased risk (HR 1.08; 95% CI, 1.00-1.16; P =.040).
Limitations to this study included a lack of data on the use of dual protection, which could have affected STI rates, lack of data on relationship status, not accounting for factors like unreported STIs, not having data on actual prescription use, and a significant number of participants without 1-year follow-up data.
The study researchers concluded that “the clinical risk for STI acquisition is the same or perhaps lower for [long-acting reversible contraceptives] than for other forms of contraception.” Although these findings “support [long-acting reversible contraceptives] use in female adolescents” in light of the fact that “77% of births to teenagers in the [United States] were unintended,” the high STI rate supports “the need for promoting other STI prevention strategies, including condoms, for dual protection.”
Derefinko KJ, Ashby S, Hayes T, et al. Sexually transmitted infections and contraceptive use in adolescents [published February 17, 2020]. Am J Prev Med. doi:10.1016/j.amepre.2019.11.012