WP 130 Prevalence and Predictors of STIs Among Women Initiating Contraceptive Implants in Kingston, Jamaica

Wednesday, September 21, 2016
Galleria Exhibit Hall
Margaret Snead, PhD1, Jeffrey Wiener, PhD1, Christi Phillips, PhD1, Tina Hylton-Kong, MD2, Natalie Medley-Singh, MD3, Jennifer Legardy-Williams, MPH1, Betsy Costenbader, PhD4, John Papp, PhD1, Lee Warner, PhD1 and Athena Kourtis, MD PhD MPH1, 1CDC, Atlanta, GA, 2STD Clinics, Kingston, Jamaica, 3UWI, Kingston, Jamaica, 4FHI, Durham, NC

Background: There is limited information on rates of STIs in Jamaica due to syndromic management and limited etiologic surveillance. We examined the prevalence and incidence of Chlamydia trachomatis (CT), Neisseria gonorrhea (NG), and Trichomonas vaginalis(TV)  and characteristics associated with STIs among sexually active women who participated in a randomized trial in Jamaica (the Sino-Implant Study, SIS).

Methods: SIS was a randomized trial conducted in Kingston, Jamaica from 2012 – 2014 to evaluate whether initiation of the Sino-Implant (II) reduced condom use among women ages 18 - 42.  Data collected included self-reported questionnairesand vaginal swabs for a biomarker of recent semen exposure (Prostate Specific Antigen, PSA) and  tests for sexually transmitted infections (STIs).    As a secondary analysis, we examined associations between STIs and PSA, sexual behavior, and insertion of an implant, with a repeated measures analysis using generalized estimating equations (GEE) (SAS Institute, version 9.3, Cary, NC); vaginal swabs from 335 of 414 study participants were tested for STIs using the Aptima Combo 2 assay for CT/NG and Aptima TV assay with the Panther system (Hologic, San Diego, CA).  

Results: At baseline, 29% of the participants had lab-confirmed CT, 5% NG, and 23% TV.  In a repeated measures analysis adjusted for study arm, those who had PSA detected did not have an increased risk of any STI [RR = 1.1 (95% CI = 0.9-1.3)], whereas risk decreased among those who were older [RR = 0.98 (95% CI = 0.97 – 0.99)], and increased for those with reported unprotected sex in the past 2 days [RR = 1.2 (95% CI = 1.0-1.4)]. Implant insertion was not associated with increases in any STI in subsequent visits [RR = 1.1 (95% CI = 0.9, 1.3)].

Conclusions: Although the prevalence of laboratory-confirmed STIs was high, the initiation of an implant did not lead to higher STI rates over 3 months.