Long Acting Reversible Contraceptives and Chlamydia: No Increased Risk

A team of researchers from Columbia University, New York City compared the incidence of chlamydia infection in adolescent LARC users to non-LARC users.

Among adolescents in the United States, chlamydia is the most prevalent sexually transmitted infection (STI). This is, in part, because adolescent individuals tend not to use condoms consistently, and they are more likely to engage in risky sexual behaviors than adults.

Long acting reversible contraceptives (LARCs), such as the subdermal contraceptive implant, and intrauterine devices, are very safe and highly effective. Health care providers often prefer LARCs for adolescents. Although efficacious and reversible, LARCs cannot prevent STIs. Only correct, consistent condom use is effective to protect against STIs.

Many health care providers have had concerns about increased STIs among female adolescents using LARCs. Furthermore, few studies compare STI prevalence in LARC users vs non-LARC users in an exclusively adolescent group. A team of researchers from Columbia University, New York City (NYC), addressed this issue. These researchers compared the incidence of chlamydia infection in adolescent LARC users to non-LARC users.

All study participants received free reproductive health care at 6 School Based Health Centers (SBHCs) in NYC. The research team hypothesized that incident chlamydia infection is not associated with LARCs, but rather incident chlamydia infection would be similar among both adolescent users of LARCs and non-LARCs.

The researchers analyzed electronic health records of these 2 groups. All participants received care at SBHCs between March 2015 and March 2017. They compared the occurrence of chlamydia infection, sexual risk factors, and demographics over a period of 1 year, and conducted final testing to determine the association between chlamydia infection and use of LARCs.

This study’s results proved the investigators’ hypothesis: the incidence of chlamydia infection between users of LARCs and non-LARCs was not statistically different, meaning LARC using adolescents did not have an increased prevalence of chlamydia infection. Moreover, they determined that LARC use did not create a greater risk of chlamydia.

After the conclusion of the study, the researchers suggested that healthcare providers should not allow risk for chlamydia infection to be a barrier to recommend LARCs to adolescents. Instead, healthcare providers need to be stronger proponents for regular condom use.

Daniela Barisano is a 2023 PharmD Candidate at The University of Connecticut in Storrs.

REFERENCE

Mendoza RM, Garbers S, Lin S, Stockwell MS, Warren M, Gold MA. Chlamydia infection among adolescent long-acting reversible contraceptive (LARC) and shorter acting hormonal contraceptive users receiving services at New York City school-based health centers. J Pediatr Adolesc Gynecol. 2019. doi: 10.1016/j.jpag.2019.09.006