Relationship of hormonal contraception and cervical ectopy as measured by computerized planimetry to chlamydial infection in adolescents

Denise L. Jacobson, Ligia Peralta, Mychelle Farmer, Neil M H Graham, Charlotte A Gaydos, Jonathan Mark Zenilman

Research output: Contribution to journalArticle

Abstract

Background: Adolescents are at increased risk for chlamydial infection and its sequelae. Hormonal contraception and cervical ectopy were previously suggested risk factors for chlamydia. Goal: To determine if chlamydia is more prevalent in female participants with greater ectopy and in hormonal contraceptive users. Study Design: Ninety-seven adolescent females aged 11 to 20 years were recruited from two Baltimore inner-city clinics. After administering a reproductive history questionnaire, endocervical specimens were tested for Chlamydia trachomatis by polymerase chain reaction. After acetic acid application to the cervix, cervical photographs were taken, the area of ectopy was quantified by computerized planimetry, and ectopy was categorized as none (0 mm2), mild (<22 mm2), and moderate (> 22mm2). The likelihood of chlamydia by ectopy and type of hormonal contraceptive use was determined by logistic regression adjusted for age and sexual partners. Results: The odds of chlamydial infection was similar in persons with mild ectopy compared with no ectopy (adjusted odds ratio [OR], 0.76; 95% CI, 0.14- 4.03), and in persons with moderate ectopy compared with no ectopy (adjusted OR, 1.94; 95% CI, 0.40-9.39). The likelihood of chlamydia was higher in depot-medroxyprogesterone acetate users compared with nonhormone users (adjusted OR, 5.44; 95% CI, 1.25-23.6). Oral contraceptive users did not have an increased likelihood of chlamydia (adjusted OR, 0.92; 95% CI, 0.10-8.78). Conclusion: Using a new, reliable, and standardized technique to quantify cervical ectopy, the authors did not find an elevated prevalence of chlamydial infection in adolescents with cervical ectopy. Depot- medroxyprogesterone acetate use may increase the risk of chlamydial infection compared with combined estrogen-progestin oral contraceptives.

Original languageEnglish (US)
Pages (from-to)313-319
Number of pages7
JournalSexually Transmitted Diseases
Volume27
Issue number6
StatePublished - Jul 2000

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Chlamydia
Contraception
Odds Ratio
Infection
Medroxyprogesterone Acetate
Oral Contraceptives
Contraceptive Agents
Reproductive History
Baltimore
Sexual Partners
Chlamydia trachomatis
Progestins
Cervix Uteri
Acetic Acid
Estrogens
Logistic Models
Polymerase Chain Reaction

ASJC Scopus subject areas

  • Dermatology
  • Public Health, Environmental and Occupational Health
  • Microbiology (medical)

Cite this

Relationship of hormonal contraception and cervical ectopy as measured by computerized planimetry to chlamydial infection in adolescents. / Jacobson, Denise L.; Peralta, Ligia; Farmer, Mychelle; Graham, Neil M H; Gaydos, Charlotte A; Zenilman, Jonathan Mark.

In: Sexually Transmitted Diseases, Vol. 27, No. 6, 07.2000, p. 313-319.

Research output: Contribution to journalArticle

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abstract = "Background: Adolescents are at increased risk for chlamydial infection and its sequelae. Hormonal contraception and cervical ectopy were previously suggested risk factors for chlamydia. Goal: To determine if chlamydia is more prevalent in female participants with greater ectopy and in hormonal contraceptive users. Study Design: Ninety-seven adolescent females aged 11 to 20 years were recruited from two Baltimore inner-city clinics. After administering a reproductive history questionnaire, endocervical specimens were tested for Chlamydia trachomatis by polymerase chain reaction. After acetic acid application to the cervix, cervical photographs were taken, the area of ectopy was quantified by computerized planimetry, and ectopy was categorized as none (0 mm2), mild (<22 mm2), and moderate (> 22mm2). The likelihood of chlamydia by ectopy and type of hormonal contraceptive use was determined by logistic regression adjusted for age and sexual partners. Results: The odds of chlamydial infection was similar in persons with mild ectopy compared with no ectopy (adjusted odds ratio [OR], 0.76; 95{\%} CI, 0.14- 4.03), and in persons with moderate ectopy compared with no ectopy (adjusted OR, 1.94; 95{\%} CI, 0.40-9.39). The likelihood of chlamydia was higher in depot-medroxyprogesterone acetate users compared with nonhormone users (adjusted OR, 5.44; 95{\%} CI, 1.25-23.6). Oral contraceptive users did not have an increased likelihood of chlamydia (adjusted OR, 0.92; 95{\%} CI, 0.10-8.78). Conclusion: Using a new, reliable, and standardized technique to quantify cervical ectopy, the authors did not find an elevated prevalence of chlamydial infection in adolescents with cervical ectopy. Depot- medroxyprogesterone acetate use may increase the risk of chlamydial infection compared with combined estrogen-progestin oral contraceptives.",
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