Intrauterine Devices and Sexually Transmitted Infection among Older Adolescents and Young Adults in a Cluster Randomized Trial

Alison M. El Ayadi; Corinne H. Rocca; Sarah H. Averbach; Suzan Goodman; Philip D. Darney; Ashlesha Patel; Cynthia C. Harper

doi:10.1016/j.jpag.2020.11.022

Intrauterine Devices and Sexually Transmitted Infection among Older Adolescents and Young Adults in a Cluster Randomized Trial

Alison M. El Ayadi^*, Corinne H. Rocca, Sarah H. Averbach, Suzan Goodman, Philip D. Darney, Ashlesha Patel, Cynthia C. Harper

^*Corresponding author for this work

Obstetrics and Gynecology

Research output: Contribution to journal › Article › peer-review

5 Scopus citations

Abstract

Study Objective: Provider misconceptions regarding intrauterine device (IUD) safety for adolescents and young women can unnecessarily limit contraceptive options offered; we sought to evaluate rates of Neisseria gonorrhoeae or Chlamydia trachomatis (GC/CT) diagnoses among young women who adopted IUDs. Design: Secondary analysis of a cluster-randomized provider educational trial. Setting: Forty US-based reproductive health centers. Participants: We followed 1350 participants for 12 months aged 18-25 years who sought contraceptive care. Interventions: The parent study assessed the effect of provider training on evidence-based contraceptive counseling. Main Outcome Measures: We assessed incidence of GC/CT diagnoses according to IUD use and sexually transmitted infection risk factors using Cox regression modeling and generalized estimating equations. Results: Two hundred four participants had GC/CT history at baseline; 103 received a new GC/CT diagnosis over the 12-month follow-up period. IUDs were initiated by 194 participants. Incidence of GC/CT diagnosis was 10.0 per 100 person-years during IUD use vs 8.0 otherwise. In adjusted models, IUD use (adjusted hazard ratio [aHR], 1.31; 95% confidence interval [CI], 0.71-2.40), adolescent age (aHR, 1.28; 95% CI, 0.72-2.27), history of GC/CT (aHR, 1.23; 95% CI, 0.75-2.00), and intervention status (aHR, 1.12; 95% CI, 0.74-1.71) were not associated with GC/CT diagnosis; however, new GC/CT diagnosis rates were significantly higher among individuals who reported multiple partners at baseline (aHR, 2.0; 95% CI, 1.34-2.98). Conclusion: In this young study population with GC/CT history, this use of IUDs was safe and did not lead to increased GC/CT diagnoses. However, results highlighted the importance of dual sexually transmitted infection and pregnancy protection for participants with multiple partners.

Original language	English (US)
Journal	Journal of pediatric and adolescent gynecology
DOIs	https://doi.org/10.1016/j.jpag.2020.11.022
State	Accepted/In press - 2021

Funding

This work was supported by the William and Flora Hewlett Foundation (grant numbers: 2010-5442, 2012-7650, 2013-8607), and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (grant numbers: K99HD086232, K12HD052163, and K12HD001259). Teva Pharmaceuticals Industries and Bayer HealthCare provided educational samples of IUDs for the training. The study sponsors had no role in study design, collection, analysis and interpretation of data, writing of the report, and in the decision to submit the article for publication. This work was supported by the William and Flora Hewlett Foundation (grant numbers: 2010-5442, 2012-7650, 2013-8607), and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (grant numbers: K99HD086232, K12HD052163, and K12HD001259). Teva Pharmaceuticals Industries and Bayer HealthCare provided educational samples of IUDs for the training. The study sponsors had no role in study design, collection, analysis and interpretation of data, writing of the report, and in the decision to submit the article for publication. The authors thank Johanna Morfesis and Planned Parenthood investigators and research coordinators at these affiliates: Northern, Central and Southern New Jersey; Columbia Willamette; Great Northwest and Hawaiian Islands; Greater Ohio; Greater Washington and North Idaho; Mar Monte; Michigan; Minnesota, North Dakota, South Dakota; Mt. Baker; Northern California; Pacific Southwest; Pasadena and San Gabriel Valley; Rocky Mountains; South Atlantic; Southeastern Pennsylvania; Southern New England; and Southwest and Central Florida. All of these contributors received compensation. The authors also thank Dr Charles McCulloch for design expertise. The findings and conclusions in this article are those of the authors and do not necessarily represent the views of Planned Parenthood Federation of America, Inc.

Keywords

Adolescent
Chlamydia trachomatis
Contraception
Intrauterine device
Neisseria gonorrhoeae
Sexually transmitted diseases

ASJC Scopus subject areas

Obstetrics and Gynecology
Pediatrics, Perinatology, and Child Health

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.jpag.2020.11.022

Cite this

@article{6b3fc5e1d68446289723a38407e8a97a,

title = "Intrauterine Devices and Sexually Transmitted Infection among Older Adolescents and Young Adults in a Cluster Randomized Trial",

abstract = "Study Objective: Provider misconceptions regarding intrauterine device (IUD) safety for adolescents and young women can unnecessarily limit contraceptive options offered; we sought to evaluate rates of Neisseria gonorrhoeae or Chlamydia trachomatis (GC/CT) diagnoses among young women who adopted IUDs. Design: Secondary analysis of a cluster-randomized provider educational trial. Setting: Forty US-based reproductive health centers. Participants: We followed 1350 participants for 12 months aged 18-25 years who sought contraceptive care. Interventions: The parent study assessed the effect of provider training on evidence-based contraceptive counseling. Main Outcome Measures: We assessed incidence of GC/CT diagnoses according to IUD use and sexually transmitted infection risk factors using Cox regression modeling and generalized estimating equations. Results: Two hundred four participants had GC/CT history at baseline; 103 received a new GC/CT diagnosis over the 12-month follow-up period. IUDs were initiated by 194 participants. Incidence of GC/CT diagnosis was 10.0 per 100 person-years during IUD use vs 8.0 otherwise. In adjusted models, IUD use (adjusted hazard ratio [aHR], 1.31; 95% confidence interval [CI], 0.71-2.40), adolescent age (aHR, 1.28; 95% CI, 0.72-2.27), history of GC/CT (aHR, 1.23; 95% CI, 0.75-2.00), and intervention status (aHR, 1.12; 95% CI, 0.74-1.71) were not associated with GC/CT diagnosis; however, new GC/CT diagnosis rates were significantly higher among individuals who reported multiple partners at baseline (aHR, 2.0; 95% CI, 1.34-2.98). Conclusion: In this young study population with GC/CT history, this use of IUDs was safe and did not lead to increased GC/CT diagnoses. However, results highlighted the importance of dual sexually transmitted infection and pregnancy protection for participants with multiple partners.",

keywords = "Adolescent, Chlamydia trachomatis, Contraception, Intrauterine device, Neisseria gonorrhoeae, Sexually transmitted diseases",

author = "{El Ayadi}, {Alison M.} and Rocca, {Corinne H.} and Averbach, {Sarah H.} and Suzan Goodman and Darney, {Philip D.} and Ashlesha Patel and Harper, {Cynthia C.}",

note = "Funding Information: This work was supported by the William and Flora Hewlett Foundation (grant numbers: 2010-5442, 2012-7650, 2013-8607), and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (grant numbers: K99HD086232, K12HD052163, and K12HD001259). Teva Pharmaceuticals Industries and Bayer HealthCare provided educational samples of IUDs for the training. The study sponsors had no role in study design, collection, analysis and interpretation of data, writing of the report, and in the decision to submit the article for publication. Funding Information: This work was supported by the William and Flora Hewlett Foundation (grant numbers: 2010-5442, 2012-7650, 2013-8607), and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (grant numbers: K99HD086232, K12HD052163, and K12HD001259). Teva Pharmaceuticals Industries and Bayer HealthCare provided educational samples of IUDs for the training. The study sponsors had no role in study design, collection, analysis and interpretation of data, writing of the report, and in the decision to submit the article for publication. The authors thank Johanna Morfesis and Planned Parenthood investigators and research coordinators at these affiliates: Northern, Central and Southern New Jersey; Columbia Willamette; Great Northwest and Hawaiian Islands; Greater Ohio; Greater Washington and North Idaho; Mar Monte; Michigan; Minnesota, North Dakota, South Dakota; Mt. Baker; Northern California; Pacific Southwest; Pasadena and San Gabriel Valley; Rocky Mountains; South Atlantic; Southeastern Pennsylvania; Southern New England; and Southwest and Central Florida. All of these contributors received compensation. The authors also thank Dr Charles McCulloch for design expertise. The findings and conclusions in this article are those of the authors and do not necessarily represent the views of Planned Parenthood Federation of America, Inc. Publisher Copyright: {\textcopyright} 2020 North American Society for Pediatric and Adolescent Gynecology",

year = "2021",

doi = "10.1016/j.jpag.2020.11.022",

language = "English (US)",

journal = "Journal of pediatric and adolescent gynecology",

issn = "1083-3188",

publisher = "Elsevier Inc.",

}

TY - JOUR

T1 - Intrauterine Devices and Sexually Transmitted Infection among Older Adolescents and Young Adults in a Cluster Randomized Trial

AU - El Ayadi, Alison M.

AU - Rocca, Corinne H.

AU - Averbach, Sarah H.

AU - Goodman, Suzan

AU - Darney, Philip D.

AU - Patel, Ashlesha

AU - Harper, Cynthia C.

N1 - Funding Information: This work was supported by the William and Flora Hewlett Foundation (grant numbers: 2010-5442, 2012-7650, 2013-8607), and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (grant numbers: K99HD086232, K12HD052163, and K12HD001259). Teva Pharmaceuticals Industries and Bayer HealthCare provided educational samples of IUDs for the training. The study sponsors had no role in study design, collection, analysis and interpretation of data, writing of the report, and in the decision to submit the article for publication. Funding Information: This work was supported by the William and Flora Hewlett Foundation (grant numbers: 2010-5442, 2012-7650, 2013-8607), and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (grant numbers: K99HD086232, K12HD052163, and K12HD001259). Teva Pharmaceuticals Industries and Bayer HealthCare provided educational samples of IUDs for the training. The study sponsors had no role in study design, collection, analysis and interpretation of data, writing of the report, and in the decision to submit the article for publication. The authors thank Johanna Morfesis and Planned Parenthood investigators and research coordinators at these affiliates: Northern, Central and Southern New Jersey; Columbia Willamette; Great Northwest and Hawaiian Islands; Greater Ohio; Greater Washington and North Idaho; Mar Monte; Michigan; Minnesota, North Dakota, South Dakota; Mt. Baker; Northern California; Pacific Southwest; Pasadena and San Gabriel Valley; Rocky Mountains; South Atlantic; Southeastern Pennsylvania; Southern New England; and Southwest and Central Florida. All of these contributors received compensation. The authors also thank Dr Charles McCulloch for design expertise. The findings and conclusions in this article are those of the authors and do not necessarily represent the views of Planned Parenthood Federation of America, Inc. Publisher Copyright: © 2020 North American Society for Pediatric and Adolescent Gynecology

PY - 2021

Y1 - 2021

N2 - Study Objective: Provider misconceptions regarding intrauterine device (IUD) safety for adolescents and young women can unnecessarily limit contraceptive options offered; we sought to evaluate rates of Neisseria gonorrhoeae or Chlamydia trachomatis (GC/CT) diagnoses among young women who adopted IUDs. Design: Secondary analysis of a cluster-randomized provider educational trial. Setting: Forty US-based reproductive health centers. Participants: We followed 1350 participants for 12 months aged 18-25 years who sought contraceptive care. Interventions: The parent study assessed the effect of provider training on evidence-based contraceptive counseling. Main Outcome Measures: We assessed incidence of GC/CT diagnoses according to IUD use and sexually transmitted infection risk factors using Cox regression modeling and generalized estimating equations. Results: Two hundred four participants had GC/CT history at baseline; 103 received a new GC/CT diagnosis over the 12-month follow-up period. IUDs were initiated by 194 participants. Incidence of GC/CT diagnosis was 10.0 per 100 person-years during IUD use vs 8.0 otherwise. In adjusted models, IUD use (adjusted hazard ratio [aHR], 1.31; 95% confidence interval [CI], 0.71-2.40), adolescent age (aHR, 1.28; 95% CI, 0.72-2.27), history of GC/CT (aHR, 1.23; 95% CI, 0.75-2.00), and intervention status (aHR, 1.12; 95% CI, 0.74-1.71) were not associated with GC/CT diagnosis; however, new GC/CT diagnosis rates were significantly higher among individuals who reported multiple partners at baseline (aHR, 2.0; 95% CI, 1.34-2.98). Conclusion: In this young study population with GC/CT history, this use of IUDs was safe and did not lead to increased GC/CT diagnoses. However, results highlighted the importance of dual sexually transmitted infection and pregnancy protection for participants with multiple partners.

AB - Study Objective: Provider misconceptions regarding intrauterine device (IUD) safety for adolescents and young women can unnecessarily limit contraceptive options offered; we sought to evaluate rates of Neisseria gonorrhoeae or Chlamydia trachomatis (GC/CT) diagnoses among young women who adopted IUDs. Design: Secondary analysis of a cluster-randomized provider educational trial. Setting: Forty US-based reproductive health centers. Participants: We followed 1350 participants for 12 months aged 18-25 years who sought contraceptive care. Interventions: The parent study assessed the effect of provider training on evidence-based contraceptive counseling. Main Outcome Measures: We assessed incidence of GC/CT diagnoses according to IUD use and sexually transmitted infection risk factors using Cox regression modeling and generalized estimating equations. Results: Two hundred four participants had GC/CT history at baseline; 103 received a new GC/CT diagnosis over the 12-month follow-up period. IUDs were initiated by 194 participants. Incidence of GC/CT diagnosis was 10.0 per 100 person-years during IUD use vs 8.0 otherwise. In adjusted models, IUD use (adjusted hazard ratio [aHR], 1.31; 95% confidence interval [CI], 0.71-2.40), adolescent age (aHR, 1.28; 95% CI, 0.72-2.27), history of GC/CT (aHR, 1.23; 95% CI, 0.75-2.00), and intervention status (aHR, 1.12; 95% CI, 0.74-1.71) were not associated with GC/CT diagnosis; however, new GC/CT diagnosis rates were significantly higher among individuals who reported multiple partners at baseline (aHR, 2.0; 95% CI, 1.34-2.98). Conclusion: In this young study population with GC/CT history, this use of IUDs was safe and did not lead to increased GC/CT diagnoses. However, results highlighted the importance of dual sexually transmitted infection and pregnancy protection for participants with multiple partners.

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KW - Chlamydia trachomatis

KW - Contraception

KW - Intrauterine device

KW - Neisseria gonorrhoeae

KW - Sexually transmitted diseases

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Intrauterine Devices and Sexually Transmitted Infection among Older Adolescents and Young Adults in a Cluster Randomized Trial

Abstract

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UN SDGs

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