O04.2 Hormonal Contraception is Associated with a Reduced Risk of Bacterial Vaginosis: A Systematic Review and Meta-Analysis. (13th July 2013)

• Record Type: Journal Article
• Authors: Vodstrcil, L A; Hocking, J S; Law, M; Walker, S; Fairley, C K; Tabrizi, S; Bradshaw, C S
• Is Part Of: Sexually transmitted infections. Volume 89(2013)Supplement 1
• Page Start: A32
• Page End: A33
• Publication Date: 2013-07-13
• Subjects: bacterial vaginosis -- hormonal contraception -- meta-analysis; Sexually transmitted diseases -- Periodicals; HIV infections -- Periodicals; 616.951005
• DOI: 10.1136/sextrans-2013-051184.0102
• Languages: English
• ISSNs: 1368-4973

Abstract

Abstract : Background: We conducted a systematic review and meta-analysis of published data to examine the association between hormonal contraception (HC) and bacterial vaginosis (BV). Methods: Three databases (Medline, Web of Science and Embase) were searched until the end of January 2013 and duplicate references removed. Inclusion criteria were (1) > 20 BV cases; (2) data available to derive the association between HC and BV; (3) > 10% of participants used HC; (4) accepted BV diagnostic method. Data extracted included: type of HC, BV diagnostic method, and BV outcome (prevalent, incident, recurrent). Meta-analyses were conducted to calculate overall and pooled odds/risk ratios (OR/RR), stratified by HC-type and BV outcome. This systematic review is registered with PROSPERO (CRD42013003699). Results: Of 1710 unique references identified, 328 were assessed for eligibility and 48 studies met inclusion criteria. Overall, 36 reported BV-prevalence, 12 BV-incidence and 3 BV-recurrence. Twenty three studies reported data for combined-HC, 9 for progesterone-only HC and 23 did not specify HC-type. Diagnostic methods included: Nugent's (n = 31), Amsel's (n = 15), Spiegel's (n = 1) and Ison-Hay (n = 1). Pooled BV prevalence was 30.7% (95% CI: 26.7–34.7%) and ranged from 4.7%–66.7%, with > 99% of the observed variance of prevalent BV explained by heterogeneity (I2 = 99.6%). The pooled effect of any HC-use on the composite-BV outcome (prevalent/incident/recurrent) was OR = 0.67 (95% CI: 0.62–0.71). When stratified by BV outcome, any HC-use was associated with decreased risk of prevalent (OR = 0.63; 0.58–0.68), incident (RR = 0.78; 0.68–0.87) and recurrent (RR = 0.61; 0.49–0.73) BV. When prevalent BV was stratified by HC-type, combined-HC (OR = 0.68; 0.62–0.74), unspecified HC-type (OR = 0.60; 0.53–0.67), and progesterone-only methods (OR = 0.67; 0.46–0.88) were all associated with decreased risk of prevalent BV. Conclusion: HC-use is associated with a significant and consistent decreased risk of all BV outcomes, with a greater reduction in risk for prevalent than incident BV. Surprisingly, both combined and progesterone-only contraceptive methods were associated with reduced risk of prevalent BV.