Skip to main content
PMC home page
Genitourinary Medicine logoLink to Genitourinary Medicine
. 1992 Aug;68(4):209–216. doi: 10.1136/sti.68.4.209

Chlamydia trachomatis and oral contraceptive use: a quantitative review.

J Cottingham 1, D Hunter 1
PMCID: PMC1194875  PMID: 1398654

Abstract

OBJECTIVES--Chlamydia trachomatis is now recognised as a major sexually transmitted disease; oral contraceptive use is rapidly increasing particularly in developing countries. There are thus important public health implications of the many reports that isolation of C trachomatis is more frequent among users of oral contraceptives. The aim of this analysis was to assess the strength and consistency of this association by summarising published studies between 1972 and 1990. DESIGN--Studies identified were grouped according to whether they were prospective or case-control studies. Data were extracted and pooled estimates of the unadjusted odds ratios were made for all studies, as well as for sub-groups defined by an index of study quality, background prevalence of C trachomatis, and the contraceptive comparison being made. LOCATION--Studies in the analysis were mainly conducted in Europe and North America; the meta-analysis was done at the Harvard School of Public Health, Boston, MA, USA. RESULTS--The pooled estimated unadjusted odds ratio for 29 case-control studies examined was 1.93 (95% CI, 1.77-2.11), indicating an almost twofold increased risk of chlamydial infection for oral contraceptive users. Neither study quality nor prevalence of C trachomatis modified this risk. When compared to the use of barrier contraceptives, however, the risk of infection for women using oral contraceptives increased to 2.91 (95% CI, 1.86-4.55). The pooled estimated protective effect of barrier methods in these studies was 0.34 (95% CI, 0.22-0.54). CONCLUSIONS--Cross-study comparisons of the relationship between oral contraceptive use and chlamydial infection are limited by the design and analysis of many component studies which did not control for confounding factors such as sexual behaviour and age. The almost twofold risk of increased chlamydial infection for oral contraceptive users, supported by the findings of two prospective studies, however, points to the importance of considering the risks and benefits of oral contraceptive use in women who are likely to be exposed to C trachomatis and other STDs. The protective effect of barrier methods emphasizes the continued need for promoting barrier methods of contraception.

Full text

PDF
209

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Addiss D. G., Vaughn M. L., Holzhueter M. A., Bakken L. L., Davis J. P. Selective screening for Chlamydia trachomatis infection in nonurban family planning clinics in Wisconsin. Fam Plann Perspect. 1987 Nov-Dec;19(6):252–256. [PubMed] [Google Scholar]
  2. Arya O. P., Mallinson H., Goddard A. D. Epidemiological and clinical correlates of chlamydial infection of the cervix. Br J Vener Dis. 1981 Apr;57(2):118–124. doi: 10.1136/sti.57.2.118. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Avonts D., Sercu M., Heyerick P., Vandermeeren I., Meheus A., Piot P. Incidence of uncomplicated genital infections in women using oral contraception or an intrauterine device: a prospective study. Sex Transm Dis. 1990 Jan-Mar;17(1):23–29. [PubMed] [Google Scholar]
  4. Barnes R. C., Katz B. P., Rolfs R. T., Batteiger B., Caine V., Jones R. B. Quantitative culture of endocervical Chlamydia trachomatis. J Clin Microbiol. 1990 Apr;28(4):774–780. doi: 10.1128/jcm.28.4.774-780.1990. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Barnes R. C., Katz B. P., Rolfs R. T., Batteiger B., Caine V., Jones R. B. Quantitative culture of endocervical Chlamydia trachomatis. J Clin Microbiol. 1990 Apr;28(4):774–780. doi: 10.1128/jcm.28.4.774-780.1990. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Beaujean G., Willems I. Prevalence of Chlamydia trachomatis infection in pregnant women in Zaire. Genitourin Med. 1990 Apr;66(2):124–125. doi: 10.1136/sti.66.2.124-a. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Blum M., Pery J., Kitai E. The link between contraceptive methods and Chlamydia trachomatis infection. Adv Contracept. 1988 Sep;4(3):233–239. doi: 10.1007/BF01849443. [DOI] [PubMed] [Google Scholar]
  8. Blythe M. J., Katz B. P., Orr D. P., Caine V. A., Jones R. B. Historical and clinical factors associated with Chlamydia trachomatis genitourinary infection in female adolescents. J Pediatr. 1988 Jun;112(6):1000–1004. doi: 10.1016/s0022-3476(88)80236-1. [DOI] [PubMed] [Google Scholar]
  9. Braddick M. R., Ndinya-Achola J. O., Mirza N. B., Plummer F. A., Irungu G., Sinei S. K., Piot P. Towards developing a diagnostic algorithm for Chlamydia trachomatis and Neisseria gonorrhoeae cervicitis in pregnancy. Genitourin Med. 1990 Apr;66(2):62–65. doi: 10.1136/sti.66.2.62. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Bro F., Juul S. Predictors of Chlamydia trachomatis infection in women in general practice. Fam Pract. 1990 Jun;7(2):138–143. doi: 10.1093/fampra/7.2.138. [DOI] [PubMed] [Google Scholar]
  11. Burns D. C., Darougar S., Thin R. N., Lothian L., Nicol C. S. Isolation of Chlamydia from women attending a clinic for sexually transmitted disease. Br J Vener Dis. 1975 Oct;51(5):314–318. doi: 10.1136/sti.51.5.314. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Carael M., Van de Perre P. H., Lepage P. H., Allen S., Nsengumuremyi F., Van Goethem C., Ntahorutaba M., Nzaramba D., Clumeck N. Human immunodeficiency virus transmission among heterosexual couples in Central Africa. AIDS. 1988 Jun;2(3):201–205. [PubMed] [Google Scholar]
  13. Chacko M. R., Lovchik J. C. Chlamydia trachomatis infection in sexually active adolescents: prevalence and risk factors. Pediatrics. 1984 Jun;73(6):836–840. [PubMed] [Google Scholar]
  14. Chow J. M., Yonekura M. L., Richwald G. A., Greenland S., Sweet R. L., Schachter J. The association between Chlamydia trachomatis and ectopic pregnancy. A matched-pair, case-control study. JAMA. 1990 Jun 20;263(23):3164–3167. [PubMed] [Google Scholar]
  15. Evans D. L., Demetriou E., Shalaby H., Waner J. L. Detection of Chlamydia trachomatis in adolescent females using direct immunofluorescence. Clin Pediatr (Phila) 1988 May;27(5):223–228. doi: 10.1177/000992288802700501. [DOI] [PubMed] [Google Scholar]
  16. Fraser J. J., Jr, Rettig P. J., Kaplan D. W. Prevalence of cervical Chlamydia trachomatis and Neisseria gonorrhoeae in female adolescents. Pediatrics. 1983 Mar;71(3):333–336. [PubMed] [Google Scholar]
  17. Glenney K. F., Glassman D. M., Cox S. W., Brown H. P. The prevalence of positive test results for Chlamydia trachomatis by direct smear for fluorescent antibodies in a south Texas family planning population. J Reprod Med. 1988 May;33(5):457–462. [PubMed] [Google Scholar]
  18. Handsfield H. H., Jasman L. L., Roberts P. L., Hanson V. W., Kothenbeutel R. L., Stamm W. E. Criteria for selective screening for Chlamydia trachomatis infection in women attending family planning clinics. JAMA. 1986 Apr 4;255(13):1730–1734. [PubMed] [Google Scholar]
  19. Harrison H. R., Costin M., Meder J. B., Bownds L. M., Sim D. A., Lewis M., Alexander E. R. Cervical Chlamydia trachomatis infection in university women: relationship to history, contraception, ectopy, and cervicitis. Am J Obstet Gynecol. 1985 Oct 1;153(3):244–251. doi: 10.1016/s0002-9378(85)80105-8. [DOI] [PubMed] [Google Scholar]
  20. Hilton A. L., Richmond S. J., Milne J. D., Hindley F., Clarke S. K. Chlamydia A in the female genital tract. Br J Vener Dis. 1974 Feb;50(1):1–10. doi: 10.1136/sti.50.1.1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Jaffe L. R., Siqueira L. M., Diamond S. B., Diaz A., Spielsinger N. A. Chlamydia trachomatis detection in adolescents. A comparison of direct specimen and tissue culture methods. J Adolesc Health Care. 1986 Nov;7(6):401–404. doi: 10.1016/s0197-0070(86)80242-x. [DOI] [PubMed] [Google Scholar]
  22. Kinghorn G. R., Waugh M. A. Oral contraceptive use and prevalence of infection with Chlamydia trachomatis in women. Br J Vener Dis. 1981 Jun;57(3):187–190. doi: 10.1136/sti.57.3.187. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Kreiss J., Caraël M., Meheus A. Role of sexually transmitted diseases in transmitting human immunodeficiency virus. Genitourin Med. 1988 Feb;64(1):1–2. doi: 10.1136/sti.64.1.1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Leclerc A., Frost E., Collet M., Goeman J., Bedjabaga L. Urogenital Chlamydia trachomatis in Gabon: an unrecognised epidemic. Genitourin Med. 1988 Oct;64(5):308–311. doi: 10.1136/sti.64.5.308. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Lefèvre J. C., Averous S., Bauriaud R., Blanc C., Bertrand M. A., Lareng M. B. Lower genital tract infections in women: comparison of clinical and epidemiologic findings with microbiology. Sex Transm Dis. 1988 Apr-Jun;15(2):110–113. doi: 10.1097/00007435-198804000-00009. [DOI] [PubMed] [Google Scholar]
  26. Louv W. C., Austin H., Perlman J., Alexander W. J. Oral contraceptive use and the risk of chlamydial and gonococcal infections. Am J Obstet Gynecol. 1989 Feb;160(2):396–402. doi: 10.1016/0002-9378(89)90456-0. [DOI] [PubMed] [Google Scholar]
  27. Macaulay M. E., Riordan T., James J. M., Leventhall P. A., Morris E. M., Neal B. R., Ellis D. A. A prospective study of genital infections in a family-planning clinic. 2. Chlamydia infection--the identification of a high-risk group. Epidemiol Infect. 1990 Feb;104(1):55–61. doi: 10.1017/s0950268800054522. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Magder L. S., Harrison H. R., Ehret J. M., Anderson T. S., Judson F. N. Factors related to genital Chlamydia trachomatis and its diagnosis by culture in a sexually transmitted disease clinic. Am J Epidemiol. 1988 Aug;128(2):298–308. doi: 10.1093/oxfordjournals.aje.a114970. [DOI] [PubMed] [Google Scholar]
  29. McCormack W. M., Rosner B., McComb D. E., Evrard J. R., Zinner S. H. Infection with Chlamydia trachomatis in female college students. Am J Epidemiol. 1985 Jan;121(1):107–115. doi: 10.1093/oxfordjournals.aje.a113971. [DOI] [PubMed] [Google Scholar]
  30. Oh M. K., Feinstein R. A., Soileau E. J., Cloud G. A., Pass R. F. Chlamydia trachomatis cervical infection and oral contraceptive use among adolescent girls. J Adolesc Health Care. 1989 Sep;10(5):376–381. doi: 10.1016/0197-0070(89)90214-3. [DOI] [PubMed] [Google Scholar]
  31. Oriel J. D., Johnson A. L., Barlow D., Thomas B. J., Nayyar K., Reeve P. Infection of the uterine cervix with Chlamydia trachomatis. J Infect Dis. 1978 Apr;137(4):443–451. doi: 10.1093/infdis/137.4.443. [DOI] [PubMed] [Google Scholar]
  32. Pereira L. H., Embil J. A., Haase D. A., Manley K. M. Cytomegalovirus infection among women attending a sexually transmitted disease clinic: association with clinical symptoms and other sexually transmitted diseases. Am J Epidemiol. 1990 Apr;131(4):683–692. doi: 10.1093/oxfordjournals.aje.a115552. [DOI] [PubMed] [Google Scholar]
  33. Pungetti D., Calderara M. A., Panozzo M., Pignataro R., Selleri M. C., Travisani D., Cantiero D., Mazzoli F., Maurizio G., Zanardi E. The incidence of Chlamydia trachomatis-induced infection in women suffering from cervicovaginitis. Acta Eur Fertil. 1988 Mar-Apr;19(2):93–97. [PubMed] [Google Scholar]
  34. Ripa K. T., Svensson L., Mårdh P. A., Weström L. Chlamydia trachomatis cervicitis in gynecologic outpatients. Obstet Gynecol. 1978 Dec;52(6):698–702. [PubMed] [Google Scholar]
  35. Ruijs G. J., Kauer F. M., van Gijssel P. M., Schirm J., Schroder F. P. Direct immunofluorescence for Chlamydia trachomatis on urogenital smears for epidemiological purposes. Eur J Obstet Gynecol Reprod Biol. 1988 Apr;27(4):289–297. doi: 10.1016/0028-2243(88)90041-x. [DOI] [PubMed] [Google Scholar]
  36. Schachter J., Stoner E., Moncada J. Screening for chlamydial infections in women attending family planning clinics. West J Med. 1983 Mar;138(3):375–379. [PMC free article] [PubMed] [Google Scholar]
  37. Shafer M. A., Beck A., Blain B., Dole P., Irwin C. E., Jr, Sweet R., Schachter J. Chlamydia trachomatis: important relationships to race, contraception, lower genital tract infection, and Papanicolaou smear. J Pediatr. 1984 Jan;104(1):141–146. doi: 10.1016/s0022-3476(84)80614-9. [DOI] [PubMed] [Google Scholar]
  38. Simonsen J. N., Plummer F. A., Ngugi E. N., Black C., Kreiss J. K., Gakinya M. N., Waiyaki P., D'Costa L. J., Ndinya-Achola J. O., Piot P. HIV infection among lower socioeconomic strata prostitutes in Nairobi. AIDS. 1990 Feb;4(2):139–144. doi: 10.1097/00002030-199002000-00007. [DOI] [PubMed] [Google Scholar]
  39. Svensson L., Weström L., Mårdh P. A. Chlamydia trachomatis in women attending a gynaecological outpatient clinic with lower genital tract infection. Br J Vener Dis. 1981 Aug;57(4):259–262. doi: 10.1136/sti.57.4.259. [DOI] [PMC free article] [PubMed] [Google Scholar]
  40. Tait I. A., Rees E., Hobson D., Byng R. E., Tweedie M. C. Chlamydial infection of the cervix in contacts of men with nongonococcal urethritis. Br J Vener Dis. 1980 Feb;56(1):37–45. doi: 10.1136/sti.56.1.37. [DOI] [PMC free article] [PubMed] [Google Scholar]
  41. Washington A. E., Gove S., Schachter J., Sweet R. L. Oral contraceptives, Chlamydia trachomatis infection, and pelvic inflammatory disease. A word of caution about protection. JAMA. 1985 Apr 19;253(15):2246–2250. [PubMed] [Google Scholar]
  42. Wasserheit J. N. The significance and scope of reproductive tract infections among Third World women. Suppl Int J Gynecol Obstet. 1989;3:145–168. doi: 10.1016/0020-7292(89)90115-x. [DOI] [PubMed] [Google Scholar]
  43. Winter L., Goldy A. S., Baer C. Prevalence and epidemiologic correlates of Chlamydia trachomatis in rural and urban populations. Sex Transm Dis. 1990 Jan-Mar;17(1):30–36. [PubMed] [Google Scholar]
  44. Woolfitt J. M., Watt L. Chlamydial infection of the urogenital tract in promiscuous and non-promiscuous women. Br J Vener Dis. 1977 Apr;53(2):93–95. doi: 10.1136/sti.53.2.93. [DOI] [PMC free article] [PubMed] [Google Scholar]
  45. Wølner-Hanssen P., Eschenbach D. A., Paavonen J., Kiviat N., Stevens C. E., Critchlow C., DeRouen T., Holmes K. K. Decreased risk of symptomatic chlamydial pelvic inflammatory disease associated with oral contraceptive use. JAMA. 1990 Jan 5;263(1):54–59. doi: 10.1001/jama.1990.03440010052029. [DOI] [PubMed] [Google Scholar]

Articles from Genitourinary Medicine are provided here courtesy of BMJ Publishing Group

RESOURCES