P369 Incidence of vaginal infections in kenyan women randomized to continuous or cyclic contraceptive ring (CVR)
Year: 2019
Type: conference-abstract
Abstract: Background Bacterial vaginosis (BV) is common in sub-Saharan African women, confers elevated risk for HIV acquisition, and is associated with menses. Antibiotic treatment provides symptomatic relief, but recurrence is common. Limited data support a favorable effect of a CVR containing estrogen and progesterone (NuvaRing) on vaginal bacteria, increasing quantities of favorable Lactobacillus species and reducing those of BV-associated bacteria (BVAB). We randomized women treated for BV in Thika, Kenya to continuous (menstrual suppression) vs cyclic (regular menses) use of NuvaRing, and assessed effects on BV. Methods Women aged 18–40 years were enrolled and treated for BV defined by Amsel clinical criteria. One month later, they were randomized and evaluated monthly for 7 months. We used a logistic regression model with robust standard errors to compare BV incidence in each study arm at two months (immediate post-CVR) and 3–6 months (sustained post-CVR) relative to the 1-month visit (pre-CVR). Results Between April 2016 to November 2017, 151 women (median age 27 y) were enrolled and 122 (81.9%) initiated CVR; 30 (24.6%) were HIV-infected. Six women (4.9%) had BV at the pre-CVR visit. Over a median duration of follow-up of 4.7 months, BV incidence/recurrence was 10.2% at the immediate post-CVR visit and 7.1% over the sustained post-CVR visits. In a model combining CVR arms that adjusted for age and unprotected sex, we observed a non-significant increase in BV incidence/recurrence immediately post-CVR (adjusted OR = 2.5 (0.9, 7.2), after which BV returned to a level comparable to CVR insertion (AOR=1.2 (0.8, 1.9). Conclusion Cumulative incidence of recurrent BV in the 6 months after CVR initiation is lower than historically reported rates in prospective studies, which are typically in ≥50% range. Concomitant incidence of vulvovaginal candidiasis, however, requires further study. The CVR should be considered for potential long-term optimization of the vaginal environment. Disclosure No significant relationships.
Source: Sexually Transmitted Infections
Authors: Jeanne Marrazzo, Lei Wang, Nelly Mugo, Katherine Thomas, Kenneth Ngure, Kate Heller, Meighan Krows, Elizabeth Irungu
Language: English
Subfield: Microbiology
Field: Immunology and Microbiology
Domain: Life Sciences
Open Access status: bronze
OpenAlex ID: W3021423287