Gonorrhoea, chlamydia high in women on family planning

Women on long-acting contraceptives suffer higher rates of sexually transmitted infections, compared to the general population, a new study suggests.

Most affected are young girls aged 16 to 24 years.

The analysis shows Gonorrhea and chlamydia are the leading STIs in women who practice modern family planning. 

The evidence emerged after further analysis of data from the Evidence for Contraceptive Options and HIV Outcomes (ECHO) trial, which last month confirmed hormonal contraceptives do not increase women’s risk of becoming infected with HIV.

The trial was conducted over three years in Kenya, eSwatini, Zambia and South Africa and results released last month. 

Experts did not indict the contraceptive methods used but recommended STI testing should now be offered at family planning clinics.

"Women seeking family planning had high rates of gonorrhea an Chlamydia. Chlamydia infection was 18 per cent at baseline (start of the study) and 15 per cent at last visit. Overall gonorrhea was five percent," said Jen Dees, an epidemiologist with FHI 360, who presented the results at the ongoing International Aids Society HIV Science conference in Mexico.

According to the 2008 World Health Organisation, estimates for STIs, women in Africa had 2.3 per cent prevalence of gonorrhea and 2.6 per cent Chlamydia, which can make it difficult or impossible for a woman to get pregnant later on.

Dr James Kiarie, coordinator of WHO's human reproduction team, said this is a wake-up call.

"STIs have been forgotten. These were women participating in a clinical trial and had access to treatment, yet STI prevalence was still high," he said.

"We must be careful we don't turn family planning solely into HIV prevention services. WHO is looking at the evidence and synthesising it and on July 29 we will come with guidelines on the use of contraceptives for women with a high risk of HIV," he said.

He also called for an integrated family planning approach.

"People who benefit from services get tired of the silo approach and want integrated services. There's push from advocates and service providers to provide an integrated approach," he added.

The ECHO Study began in December 2015, enrolling and following 7,829 sexually active, HIV-negative women ages 16 to 35 years across 12 clinical trial sites in the four countries.

In Kenya, 900 women in Kisumu took part in the study, locally coordinated by the Kenya Medical Research Institute.

It was meant to establish whether the use of hormonal contraception, particularly Depo, may increase women’s risk of HIV acquisition.

“Few studies had examined whether hormonal implants or IUDs affected users’ risk of HIV acquisition,” Nelly Mugo, head of the sexual, reproductive, adolescent and child health research programme at Kemri said yesterday.