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Chlamydia testing and diagnosis following initiation of long-acting reversible contraception: A retrospective cohort study.
Aust N Z J Obstet Gynaecol 2017; 57(6):665-675AN

Abstract

BACKGROUND

Long-acting reversible contraception (LARC) effectively protects against pregnancy but provides no protection against sexually transmitted infections (STIs).

AIM

To compare rates of chlamydia testing and diagnosis for women initiating long-acting versus oral contraception.

MATERIALS AND METHODS

Retrospective cohort study involving data collection for 6160 women initiating post-abortion contraception at a large New Zealand regional public hospital abortion clinic (2009-2012), with chlamydia testing data obtained from the local laboratory during two-year follow up. Negative binomial regression modelling examined the effect of contraceptive method on two outcome measures: chlamydia testing and chlamydia diagnosis (adjusting for potential covariates of age, ethnicity, past chlamydia infection, pregnancy history) in year one and two of follow up.

RESULTS

Two thousand seven hundred and twenty nine women (44%) received a LARC and 1764 (28.6%) were prescribed oral contraception. Adjusted testing rates differed by contraceptive method only in year one (P < 0.01): with higher rates among copper intrauterine device users (relative risk (RR) 1.2, 95% CI 1.06-1.35), and lower rates for implant users (RR 0.84, 95% CI 0.72-0.99) compared with oral contraceptive users (reference group). No significant differences were observed in chlamydia diagnosis rates by contraceptive method (P > 0.05). Younger age, past chlamydia infection, Maori and Pacific ethnicity were associated with higher rates of chlamydia diagnosis (P < 0.01).

CONCLUSIONS

Known STI-related risk factors (age, ethnicity, past infection) but not contraceptive method were independently related to rates of subsequent chlamydia diagnosis. This suggests that increased LARC uptake would not occur at the expense of chlamydia control. Regular screening and risk reduction advice (including condom use) are important chlamydia control measures for at-risk groups.

Authors+Show Affiliations

Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand.Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand.Biostatistical Group, University of Otago, Wellington, New Zealand.Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28832936

Citation

Rose, Sally B., et al. "Chlamydia Testing and Diagnosis Following Initiation of Long-acting Reversible Contraception: a Retrospective Cohort Study." The Australian & New Zealand Journal of Obstetrics & Gynaecology, vol. 57, no. 6, 2017, pp. 665-675.
Rose SB, Garrett SM, Stanley J, et al. Chlamydia testing and diagnosis following initiation of long-acting reversible contraception: A retrospective cohort study. Aust N Z J Obstet Gynaecol. 2017;57(6):665-675.
Rose, S. B., Garrett, S. M., Stanley, J., & Pullon, S. R. H. (2017). Chlamydia testing and diagnosis following initiation of long-acting reversible contraception: A retrospective cohort study. The Australian & New Zealand Journal of Obstetrics & Gynaecology, 57(6), pp. 665-675. doi:10.1111/ajo.12685.
Rose SB, et al. Chlamydia Testing and Diagnosis Following Initiation of Long-acting Reversible Contraception: a Retrospective Cohort Study. Aust N Z J Obstet Gynaecol. 2017;57(6):665-675. PubMed PMID: 28832936.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Chlamydia testing and diagnosis following initiation of long-acting reversible contraception: A retrospective cohort study. AU - Rose,Sally B, AU - Garrett,Susan M, AU - Stanley,James, AU - Pullon,Susan R H, Y1 - 2017/08/22/ PY - 2016/11/21/received PY - 2017/07/10/accepted PY - 2017/8/24/pubmed PY - 2018/7/26/medline PY - 2017/8/24/entrez KW - Chlamydia trachomatis KW - contraceptive implant KW - intrauterine contraception KW - long-acting reversible contraception KW - oral contraception SP - 665 EP - 675 JF - The Australian & New Zealand journal of obstetrics & gynaecology JO - Aust N Z J Obstet Gynaecol VL - 57 IS - 6 N2 - BACKGROUND: Long-acting reversible contraception (LARC) effectively protects against pregnancy but provides no protection against sexually transmitted infections (STIs). AIM: To compare rates of chlamydia testing and diagnosis for women initiating long-acting versus oral contraception. MATERIALS AND METHODS: Retrospective cohort study involving data collection for 6160 women initiating post-abortion contraception at a large New Zealand regional public hospital abortion clinic (2009-2012), with chlamydia testing data obtained from the local laboratory during two-year follow up. Negative binomial regression modelling examined the effect of contraceptive method on two outcome measures: chlamydia testing and chlamydia diagnosis (adjusting for potential covariates of age, ethnicity, past chlamydia infection, pregnancy history) in year one and two of follow up. RESULTS: Two thousand seven hundred and twenty nine women (44%) received a LARC and 1764 (28.6%) were prescribed oral contraception. Adjusted testing rates differed by contraceptive method only in year one (P < 0.01): with higher rates among copper intrauterine device users (relative risk (RR) 1.2, 95% CI 1.06-1.35), and lower rates for implant users (RR 0.84, 95% CI 0.72-0.99) compared with oral contraceptive users (reference group). No significant differences were observed in chlamydia diagnosis rates by contraceptive method (P > 0.05). Younger age, past chlamydia infection, Maori and Pacific ethnicity were associated with higher rates of chlamydia diagnosis (P < 0.01). CONCLUSIONS: Known STI-related risk factors (age, ethnicity, past infection) but not contraceptive method were independently related to rates of subsequent chlamydia diagnosis. This suggests that increased LARC uptake would not occur at the expense of chlamydia control. Regular screening and risk reduction advice (including condom use) are important chlamydia control measures for at-risk groups. SN - 1479-828X UR - https://www.unboundmedicine.com/medline/citation/28832936/Chlamydia_testing_and_diagnosis_following_initiation_of_long_acting_reversible_contraception:_A_retrospective_cohort_study_ L2 - https://doi.org/10.1111/ajo.12685 DB - PRIME DP - Unbound Medicine ER -