TP 63 Hormonal Contraceptive Use and Risk of Chlamydia Trachomatis (CT) Infection in USPHS Region X Family Planning (FP) Female Clients

Tuesday, June 10, 2014
Exhibit Hall
Wendy Nakatsukasa-Ono, MPH1, Robyn Neblett Fanfair, MD, MPH2, Sarah Salomon, MPH1, David Fine, PhD1 and Lauri Markowitz, MD3, 1Cardea Services, Seattle, WA, 2DHHS/CDC/OID/NCHHSTP/DSTDP/ESB, CDC, Atlanta, GA, 3Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA

Background: Research has examined the possible role of combined oral contraceptives (COC) on CT infection. Some studies suggest that COC use increases CT risk. We investigated associations between various contraceptive methods (CMs) and CT infection among female Region X FP clinic clients aged 15-44 years, 2009-2011. 

Methods: We accessed Region X FP clinic visit records (CVRs), 2009-2011, where a CT test was performed (n=255,971), Infertility Prevention Project (IPP) CT test visits (n=274,573) for female FP clients, and U.S. Census 2007-11 American Community Survey (ACS) ZIP code-level records (n=1,536) used to generate area-based socioeconomic measures (ABSM). CVRs documented 19 CMs and were merged into IPP records via clinic, patient ID, birthdate, and visit date. We merged ABSM into IPP via client ZIP code. The final sample included 79,782 CT test records with known CM. CM was categorized as: no CM; non-hormonal, non-barrier; non-hormonal, barrier; hormonal progestin-only injection; and hormonal COC. CT result was stratified by demographic, behavioral, clinical, and ABSM characteristics. Crude/adjusted odds ratios (ORs) were generated by univariate and multivariate generalized mixed models with logistic link, incorporating clinic and ZIP code as random effects.

Results: 45% were aged 20-24 years; 71% were non-Hispanic white. Overall CT+ was 5.8%. CM and CT+ distributions were: no CM=9% (CT+=6.8%); non-hormonal/non-barrier=27% (CT+=5.9%); non-hormonal, barrier=24% (CT+=6.0%); hormonal progestin-only=8% (CT+=6.6%), and hormonal COC=32% (CT+=4.7%). Multivariate results adjusting for demographics, risk behaviors, clinical signs and ABSM, showed clients on COCs had significantly lower CT risk compared to women using no CM (AOR=0.71, 95% CI=0.65, 0.77).

Conclusions: Based on contraceptive method reported at their CT test visit, women using COCs attending Region X FP clinics had lower CT positivity than women using any other category of contraception. Historical CM use patterns and temporal ordering of CM and CT+ could not be assessed and is an area that warrants further investigation.