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Starting to have sexual intercourse is associated with increases in cervicovaginal immune mediators in young women: a prospective study and meta-analysis

Year: 2022
Type: review
Abstract: Background: Adolescent girls and young women (AGYW) are at high risk of sexually transmitted infections (STIs). It is unknown whether beginning to have sexual intercourse results in changes to immune mediators in the cervicovaginal tract that contribute to this risk. Methods: We collected cervicovaginal lavages from Kenyan AGYW in the months before and after first penile-vaginal sexual intercourse and measured the concentrations of 20 immune mediators. We compared concentrations pre- and post-first sex using mixed effect models. We additionally performed a systematic review to identify similar studies and combined them with our results by meta-analysis of individual participant data. Results: We included 180 samples from 95 AGYW, with 44% providing only pre-first sex samples, 35% matched pre and post, and 21% only post. We consistently detected 19/20 immune mediators, all of which increased post-first sex (p<0.05 for 13/19; Holm-Bonferroni-adjusted p<0.05 for IL-1β, IL-2, and CXCL8). Effects remained similar after excluding samples with STIs and high Nugent scores. Concentrations increased cumulatively over time after date of first sex, with an estimated doubling time of about 5 months.Our systematic review identified two eligible studies, one of 93 Belgian participants, and the other of 18 American participants. Nine immune mediators were measured in at least two-thirds of studies. Meta-analysis confirmed higher levels post-first sex for 8/9 immune mediators (p<0.05 for six mediators, most prominently IL-1α, IL-1β, and CXCL8). Conclusions: Cervicovaginal immune mediator concentrations were higher in women who reported that they started sexual activity. Results were consistent across three studies conducted on three different continents. Funding: This research was funded by R01 HD091996-01 (ACR), by P01 AI 030731-25 (Project 1) (AW), R01 AI116292 (FH), R03 AI154366 (FH) and by the Center for AIDS Research (CFAR) of the University of Washington/Fred Hutchinson Cancer Research Center AI027757.
Source: eLife
DOI: 10.7554/elife.78565
Authors: Sean M. Hughes, Claire N. Levy, Fernanda L. Calienes, Katie A. Martinez, Stacy Selke, Kenneth Tapia, Bhavna H. Chohan, Lynda Oluoch, Catherine Kiptinness, Anna Wald, Mimi Ghosh, Liselotte Hardy, Kenneth Ngure, Nelly R. Mugo, Florian Hladik, Alison C. Roxby
Institutions: University of Washington, Fred Hutch Cancer Center, Kenya Medical Research Institute, George Washington University, Institute of Tropical Medicine, Nagasaki University, Instituut voor Tropische Geneeskunde, Jomo Kenyatta University of Agriculture and Technology
Language: English
Subfield: Microbiology
Open Access status: gold
Estimated APC paid: $2,500
Funders: University of Washington, National Institutes of Health, Center for AIDS Research, University of Washington, Oregon National Primate Research Center, National Institute of Allergy and Infectious Diseases, Eunice Kennedy Shriver National Institute of Child Health and Human Development
Awards: G1294778923, G2219438539, Clinical Epidemiology and Pathogenesis of Asymptomatic HSV, Incident STIs in Kenyan Girls: a prospective cohort spanning sexual debut, G3570552662, G3985073149, G4363346449, Cervicovaginal immune factors throughout the menstrual cycle: analysis of a cohort of Kenyan adolescents, systematic review, and meta-analysis, G6125818729, G6492514785, G7791962275, Systems and carcinogenic impact assessment of topical microbicides on human mucosa, G884035938, G9000186388, G9000292184, University of Washington/Fred Hutch Center for AIDS Research, Support for National Primate Research Center
OpenAlex ID: W4307182546
FWCI: 0.299
Cites: 53
Cited by: 14
Related to: 10