Abstract
The present study aimed to examine the impacts of use of various contraceptive methods on vaginal microbiome and reproductive tract infections (RTI) in females. A cross-sectional study in Jammu Province of Jammu and Kashmir was conducted in which 796 sexually active married women of reproductive age were recruited as participants. A well-structured questionnaire was used to collect the data and the analysis was performed using linear and binary logistic regression with 95% confidence interval (CI). The p value of < 0.05 was considered as significant. Previous studies have consistently shown that disturbances in the vaginal microbiome can lead to reproductive tract infections in women. The prevalence of contraceptive use and RTI in the studied population was 53.1% (CI 49.6–56.7%) and 44.7% (CI 41.2–48.3%) respectively. Several sociodemographic factors like age, place of residence, educational qualification, religion, and caste of the participant significantly governed the method of contraception used by the females. It was observed from the data obtained that the use of condoms and hormonal oral contraceptives reduced the risk of RTI as they maintain vaginal eubiosis in the females by 1.97-folds (AOR:1.97; CI 1.02–2.86) and 1.68 folds (AOR:1.68; CI 0.78–2.50) respectively. The likelihood of developing RTI increased by 2.31 (AOR:2.31; CI 1.05–3.57), 3.62 (AOR:1.97; CI 1.02–2.86), and 4.97 (AOR:4.97; CI 3.50–6.00) folds in females who opted for IUDs, tubal ligation, and unprotected sex respectively, these methods may interfere with the host vaginal microbiome, alter it and making the female more susceptible to the microbial infections and pathogenic attack. The research proposes that the use of hormonal oral contraceptives and condoms as the means of contraception is a safe method and the females opting for them are less prone to RTI.
Similar content being viewed by others
Abbreviations
- IUD:
-
Intrauterine device
- AOR:
-
Adjusted odds ratio
- CI:
-
Confidence interval
- COR:
-
Crude odds ratio
References
Ademas A, Adane M, Sisay T, Kloos H, Eneyew B, Keleb A, Lingerew M, Derso A, Alemu K (2020) Does menstrual hygiene management and water, sanitation, and hygiene predict reproductive tract infections among reproductive women in urban areas in Ethiopia? PLoS ONE 15:e0237696
WORLD HEALTH, O. (2005) Sexually transmitted and other reproductive tract infections : a guide to essential practice. World Health Organization, Geneva
Kafle P, Ss B (2016) Prevalence and factors associated with reproductive tract infections in Gongolia Village, Rupandehi District. Nepal Adv Public Health 2016:8063843
Gawande KB, Srivastava AS, Kumar P (2018) Reproductive tract infection and health seeking behaviour: a cross sectional community based study. IJCMPH 5:1524
Torondel B, Sinha S, Mohanty JR, Swain T, Sahoo P, Panda B et al (2018) Association between unhygienic menstrual management practices and prevalence of lower reproductive tract infections: a hospital-based cross-sectional study in Odisha, India. BMC Infect Dis 18:1–12
Rahman S, Currie MJ, Breiman RF, Reza M, Rahman M, Nessa K (2012) Reproductive tract infections associated with vaginal discharge and their socio-demographic and reproductive determinants among clinic attendees in Bangladesh. SEAJPH 2:67–72
Sallam S, Mahfouz A, Dabbous N, El Barrawy M, El Said M (2001) Reproductive tract infections among married women in upper Egypt. EMHJ 7(1–2):139–146
Kerubo E, Laserson KF, Otecko N, Odhiambo C, Mason L, Nyothach E et al (2016) Prevalence of reproductive tract infections and the predictive value of girls’ symptom-based reporting: findings from a cross-sectional survey in rural western Kenya. Sex Transm Infect 92:251–256
Verma A, Kumar Meena J, Banerjee B (2015) A comparative study of prevalence of RTI/STI symptoms and treatment seeking behaviour among the married women in urban and rural areas of Delhi. Int J Reprod Med 2015:1–8
Sabarwal S, Santhya K (2012) Treatment-seeking for symptoms of reproductive tract infections among young women in India. IPSRH : 90–98
Balamurugan SS, Bendigeri N (2012) Community-based study of reproductive tract infections among women of the reproductive age group in the urban health training centre area in Hubli Karnataka. IJCM 37:34
Khuda P, Gupta N, Palaka N, Kaur G (2021) Prevalence and determinants of spacing contraceptive use among rural married women of Jammu, India. Indian J Community Med 7:92–99
Teal S, Edelman A (2021) Contraception selection, effectiveness, and adverse effects: a review. JAMA 326:2507–2518
Osborn JA, Sriram R, Karthikeyan S, Ravishankar SL (2021) A study on contraceptive prevalence rate and factors influencing it in a rural area of Coimbatore, South India. J Family Med Prim Care 10:2246–2251
Wang LY, Ouyang L, Tong F, Zhang XJ, Li XD, Wang CC (2016) The effect of contraceptive methods on reproductive tract infections risk: a cross-sectional study having a sample of 52,481 women. Arch Gynecol Obstet 294:1249–1256
Chopra C, Bhushan I, Mehta M, Koushal T, Gupta A, Sharma S et al (2022) Vaginal microbiome: considerations for reproductive health. Future Microbiol 17:1501–1513
Gupta S, Kakkar V, Bhushan I (2019) Crosstalk between vaginal microbiome and female health: a review. Microb Pathog 136:103696
Noyes N, Cho KC, Ravel J, Forney LJ, Abdo Z (2018) Associations between sexual habits, menstrual hygiene practices, demographics and the vaginal microbiome as revealed by Bayesian network analysis. PLoS ONE 13:e0191625
Chehoud C, Stieh DJ, Bailey AG, Laughlin AL, Allen SA, Mccotter KL et al (2017) Associations of the vaginal microbiota with HIV infection, bacterial vaginosis and demographic factors. AIDS (London, England) 31:895
Carda-Diéguez M, Cárdenas N, Aparicio M, Beltrán D, Rodríguez JM, Mira A (2019) Variations in vaginal, penile, and oral microbiota after sexual intercourse: a case report. Front Med 6:178
Shree V, Prasad R, Kumar S, Sinha S, Choudhary SK (2017) Factors for non-acceptance of contraceptive methods amongst married women of reproductive age group in rural Patna. Int J Community Med Public Health 4:1882–1887
Makade KG, Padhyegurjar M, Padhyegurjar SB, Kulkarni R (2012) Study of contraceptive use among married women in a slum in Mumbai. Natl J Community Med 3:40–43
Gupta RK, Singh P, Gupta R, Akhtar N, Gupta C, Sharma P (2017) Contraceptive use: its prevalence, awareness, practices and determinants in a rural population of Northern India. Int J Med Sci Public Health 6:1543–1548
Kumar N, Das V, Agarwal A, Pandey A, Agrawal S (2020) Pregnancy in women with previous two healthy children, associated factors, and acceptability of contraception among these women: a questionnaire-based, cross-sectional KAP study in world’s second most populated country advocating two-child norm. Fam Med Prim Care Rev 9:2899
Oppong FB, Logo DD, Agbedra SY, Adomah AA, Amenyaglo S, Arhin-Wiredu K (2021) Determinants of contraceptive use among sexually active unmarried adolescent girls and young women aged 15–24 years in Ghana: a nationally representative cross-sectional study. BMJ Open 11:e043890
Barman S (2013) Socio-economic and demographic differentials of contraceptive usage in Indian States: a study based on NFHS data. J Hum Ecol 42:53–68
Nagdeve DA, Dongardive PB (2022) Family planning differentials by religion in India. Mortal India Spec Ref Mater Height 45:220
Nanda J, Adak DK, Bharati P (2011) Contraceptive practices among adolescent married women in Tamil Nadu, India. Asian Pac J Trop Dis 1:137–141
Mamta KN, Kaur N (2014) Reproductive tract infections: Prevalence and health seeking behaviour among women of reproductive age group. Int J Sci Res 3:138–142
Rani V, Dixit AM, Kumar S, Singh NP, Jain PK, Peeyush K (2016) Reproductive morbidity profile among ever married women (15–44) years of rural Etawah District, Uttar Pradesh: a cross-sectional study. Natl j Community Med 7:35–40
Hegde SK, Agrawal T, Ramesh N, Sugara M, Joseph PM, Singh S et al (2013) Reproductive tract infections among women in a peri-urban under privileged area in Bangalore, India: Knowledge, prevalence, and treatment seeking behavior. ATMPH 6(2):215–220
Durai V, Varadharajan S, Muthuthandavan AR (2019) Reproductive tract infections in rural India—a population-based study. J Family Med Prim Care 8:3578–3583
Thekdi KP, Patel K, Patel NK, Thekdi PI (2014) A cross sectional study on the prevalence of reproductive tract infections amongst married women in the rural area of Surendranagar district. Int J Res Med Sci 2:215–221
Bastianelli C, Farris M, Bianchi P, Benagiano G (2021) The effect of different contraceptive methods on the vaginal microbiome. Expert Rev Clin Pharmacol 14:821–836
Brooks JP, Edwards DJ, Blithe DL, Fettweis JM, Serrano MG, Sheth NU et al (2017) Effects of combined oral contraceptives, depot medroxyprogesterone acetate and the levonorgestrel-releasing intrauterine system on the vaginal microbiome. Contracept 95:405–413
Tuddenham S, Gajer P, Burke AE, Murphy C, Klein SL, Stennett CA, et al (2023) Lactobacillus-dominance and rapid stabilization of vaginal microbiota in combined oral contraceptive pill users examined through a longitudinal cohort study with frequent vaginal sampling over two years. EBioMedicine. 87
Balle C, Happel AU, Heffron R, Jaspan HB (2023) Contraceptive effects on the cervicovaginal microbiome: recent evidence including randomized trials. Am J Reprod Immunol 90:e13785
Noël-Romas L, Perner M, Molatlhegi R, Farr Zuend C, Mabhula A, Hoger S et al (2020) Vaginal microbiome-hormonal contraceptive interactions associate with the mucosal proteome and HIV acquisition. PLoS Pathog 16:e1009097
Hong X, Qin P, Gao L, Huang L, Shi Y, Peng D et al (2023) Change of the vaginal microbiome with oral contraceptive therapy in women with polycystic ovary syndrome: a 6-month longitudinal cohort study. BMC Med 21:478
Tandon D, Patil AD, Goriwale, M (2022) Effect of various hormonal and non-hormonal contraceptive methods on the vaginal milieu—a narrative review. medRxiv, p. 22275192
Achilles SL, Austin MN, Meyn LA, Mhlanga F, Chirenje ZM, Hillier SL (2018) Impact of contraceptive initiation on vaginal microbiota. AJOG 218:622
Ocak S, Cetin M, Hakverdi S, Dolapcioglu K, Gungoren A, Hakverdi AU (2007) Effects of intrauterine device and oral contraceptive on vaginal flora and epithelium. Saudi Med J 28:727
Riggs M, Klebanoff M, Nansel T, Zhang JUN, Schwebke J, Andrews W (2007) Longitudinal association between hormonal contraceptives and bacterial vaginosis in women of reproductive age. Sex Transm Dis 34:954–959
Brown BP, Feng C, Tanko RF, Jaumdally SZ, Bunjun R, Dabee S (2023) Copper intrauterine device increases vaginal concentrations of inflammatory anaerobes and depletes lactobacilli compared to hormonal options in a randomized trial. Nat Commun 14:499
Oliveras-Alsina N, Navarrete-Cortés M, Romaguera J, Tosado-Rodríguez E (2023) Association of the cervicovaginal microbiome with contraceptive methods in hispanic women living in puerto rico. OBGYN 141:9S-9S
Peebles K, Kiweewa FM, Palanee-Phillips T, Chappell C, Singh D, Bunge KE et al (2021) Elevated risk of bacterial vaginosis among users of the copper intrauterine device: a prospective longitudinal cohort study. Clin Infect Dis 73:513–520
Costescu D, Chawla R, Hughes R, Teal S, Merz M (2022) Discontinuation rates of intrauterine contraception due to unfavourable bleeding: a systematic review. BMC Womens Health 22:82
Schreiber CA, Teal SB, Blumenthal PD, Keder LM, Olariu AI, Creinin MD (2018) Bleeding patterns for the Liletta® levonorgestrel 52 mg intrauterine system. Eur J Contracept Reprod Health Care 23:116–120
Holdcroft AM, Ireland DJ, Payne MS (2023) The vaginal microbiome in health and disease—What role do common intimate hygiene practices play? Microorganisms 11(2):298
Ma L, Lv Z, Su J, Wang J, Yan D, Wei J (2013) Consistent condom use increases the colonization of Lactobacillus crispatus in the vagina. PLoS ONE 8:e70716
Borgogna JLC, Grace SG, Holm JB, Zuniga TA, Kadriu H, He X et al (2023) Investigating the impact of condomless vaginal intercourse and lubricant use on the vaginal metabolome: a pre-post observational study. Sex Transm Infect 99(7):489–496
Singh M, Saini S, Goyal P, Gupta E, Goswami S (2022) Prevalence and risks of reproductive tract infections among women of urban slums in North India: a cross-sectional study. Asian Pac J Reprod 11:253–260
Crosby RA, Milhausen RR, Graham CA, Yarber WL, Sanders SA, Charnigo R et al (2014) Likelihood of condom use when sexually transmitted diseases are suspected: results from a clinic sample. Health Educ Behav 41:449–454
Mitra A, Macintyre DA, Ntritsos G, Smith A, Tsilidis KK, Marchesi JR (2020) The vaginal microbiota associates with the regression of untreated cervical intraepithelial neoplasia 2 lesions. Nat Comm 11:1999
Winer RL, Hughes JP, Feng Q, O’reilly S, Kiviat NB, Holmes KK (2006) Condom use and the risk of genital human papillomavirus infection in young women. NEJM 354:2645–2654
Pati S, Cullins V (2000) Female sterilization: evidence. Obstet Gynecol 27:859–899
Mcnicholas C, Tessa M, Secura G, Peipert JF (2014) The contraceptive CHOICE project round up: what we did and what we learned. Clin Obstet Gynecol 57:635
Madhivanan P, Bartman MT, Pasutti L, Krupp K, Arun A, Reingold AL et al (2009) Prevalence of Trichomonas vaginalis infection among young reproductive age women in India: implications for treatment and prevention. Sex Health 6:339–344
Thulkar J, Kriplani A, Agarwal N, Vishnubhatla S (2010) Aetiology & risk factors of recurrent vaginitis & its association with various contraceptive methods. Indian J Med Res 131:83–87
Jespers V, Crucitti T, Menten J, Verhelst R, Mwaura M, Mandaliya K et al (2014) Prevalence and correlates of bacterial vaginosis in different sub-populations of women in sub-Saharan Africa: a cross-sectional study. PLoS ONE 9:e109670
Singh BK, Lall B, Gupta N, Bose DK, Singh RK (2014) Knowledge and attitude on HIV-AIDS and practice of sexual behavior among female sex workers; a pilot study in Jhapa. Nepal IOSR-JDMS 13:46–52
Marrazzo JM (2018) Biomedical prevention of Hiv in women: challenges and approaches, with particular reference to the vaginal microbiome. Trans Am Clin Climatol Assoc 129:63–73
Mehta SD, Zhao D, Green SJ, Agingu W, Otieno F, Bhaumik R et al (2020) The microbiome composition of a man’s penis predicts incident bacterial vaginosis in his female sex partner with high accuracy. Front Cell Infect 10:433
Mehta SD, Nandi D, Agingu W, Green SJ, Bhaumik DK, Bailey RC (2020) Vaginal and penile microbiome associations with herpes simplex virus type 2 in women and their male sex partners. J Infect Dis 226:644–654
Rajpoot SS, Gupta K (2016) Awareness about RTI and facts of HIV/AIDS among rural college going girls in Varanasi district. Int J Home Sci 2:71–73
Acknowledgements
We are grateful to the School of Biotechnology, Shri Mata Vaishno Devi University and also our colleagues and students who were involved in this work for their unremitting efforts.
Funding
Nil.
Author information
Authors and Affiliations
Contributions
Chitrakshi Chopra: Project development, Data collection, Data management, Data analysis, Manuscript writing; Divya Sharma: Data analysis; Vinay Kumar: Data collection; Indu Bhushan: Manuscript editing.
Corresponding author
Ethics declarations
Conflict of interest
There are no conflicts of interest.
Consent to Participate
Informed consent was obtained from all individual participants included in the study.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Chopra, C., Sharma, D., Kumar, V. et al. Contraceptives Association with Vaginal Microbiome and RTI: A Cross-Sectional Survey in Females of Jammu and Kashmir, India. Indian J Microbiol (2024). https://doi.org/10.1007/s12088-024-01226-5
Received:
Accepted:
Published:
DOI: https://doi.org/10.1007/s12088-024-01226-5