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Influence of contraceptive choice on vaginal bacterial and fungal microflora

European Journal of Clinical Microbiology & Infectious Diseases volume 36, pages 43–48 (2017)Cite this article

Abstract

The influence of contraception on vaginal microflora can have a major impact on the risk of developing acute or recurrent vaginal infections, but also may influence the risk of acquiring sexually transmissible infections (STI) such as HIV. A cohort of 248 women presenting for levonorgestrel-releasing intrauterine system (LNG-IUS) insertion or reinsertion were stratified according to their current contraceptive method. Information concerning their menstrual pattern and data about the medical history were collected. The composition of their vaginal microflora was studied by detailed phase contrast microscopy of fresh vaginal fluid, and aerobic cultures were taken to detect enteric bacterial growth and fungal colonisation. LNG-IUS and progesterone-only-pill (POP) users had significantly lower blood loss (p < 0.001) than other women. Regardless of the type of contraception used, all women reported similar rates of symptomatic lower genital tract infection during the preceding year. Women using combined oral contraception (COC) and long-term LNG-IUS had the same bacterial composition of vaginal microflora as non-contraceptive users, even when infections were combined. Both hormonal and non-hormonal intrauterine device users had an increased tendency to have more vaginal colonisation with Candida. Women on POPs or subcutaneous implants had a tendency towards increased vaginal atrophy, but had a lower Candida carriage rate compared to IUCD users (LNG-IUS and Copper-IUCD, p = 0.037). Women with an increased risk of acquiring STIs or recurrent BV could benefit from LNG-IUS or COC due to a well-preserved vaginal bacterial flora. Women with a susceptibility for RVVC should prefer POPs, and avoid intrauterine contraception.

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References

  1. van de Wijgert JH, Kilmarx PH, Jones HE, Karon JM, Chaikummao S (2008) Differentiating normal from abnormal rates of genital epithelial findings in vaginal microbicide trials. Contraception 77:122–129

    Article  PubMed  Google Scholar 

  2. Tibaldi C, Cappello N, Latino MA, Masuelli G, Marini S, Benedetto C (2009) Vaginal and endocervical microorganisms in symptomatic and asymptomatic non-pregnant females: risk factors and rates of occurrence. Clin Microbiol Infect 15:670–679

    CAS  Article  PubMed  Google Scholar 

  3. Schwebke JR (2005) Abnormal vaginal flora as a biological risk factor for acquisition of HIV infection and sexually transmitted diseases. J Infect Dis 192:1315–1317

    Article  PubMed  Google Scholar 

  4. Kumwenda NI, Kumwenda J, Kafulafula G, Makanani B, Taulo F, Nkhoma C et al (2008) HIV-1 incidence among women of reproductive age in Malawi. Int J STD AIDS 19:339–341

    CAS  Article  PubMed  Google Scholar 

  5. Pettifor A, Delany S, Kleinschmidt I, Miller WC, Atashili J, Rees H (2009) Use of injectable progestin contraception and risk of STI among South African women. Contraception 80:555–560

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  6. Heffron R, Donnell D, Rees H, Celum C, Mugo N, Were E et al (2012) Use of hormonal contraceptives and risk of HIV-1 transmission: a prospective cohort study. Lancet Infect Dis 12:19–26

    Article  PubMed  Google Scholar 

  7. Donders GG (2007) Definition and classification of abnormal vaginal flora. Best Pract Res Clin Obstet Gynaecol 21:355–373

    Article  PubMed  Google Scholar 

  8. Donders GG, Vereecken A, Bosmans E, Dekeersmaecker A, Salembier G, Spitz B (2002) Definition of a type of abnormal vaginal flora that is distinct from bacterial vaginosis: aerobic vaginitis. BJOG 109:34–43

    Article  PubMed  Google Scholar 

  9. Donders GG, Berger J, Heuninckx H, Bellen G, Cornelis A (2011) Vaginal flora changes on Pap smears after insertion of levonorgestrel-releasing intrauterine device. Contraception 83:352–356

    CAS  Article  PubMed  Google Scholar 

  10. Neale R, Knight I, Keane F (2009) Do users of the intrauterine system (Mirena) have different genital symptoms and vaginal flora than users of the intrauterine contraceptive device? Int J STD AIDS 20:423–424

    CAS  Article  PubMed  Google Scholar 

  11. Roy S (1991) Nonbarrier contraceptives and vaginitis and vaginosis. Am J Obstet Gynecol 165:1240–1244

    CAS  Article  PubMed  Google Scholar 

  12. Haukkamaa M, Stranden P, Jousimies-Somer H, Siitonen A (1986) Bacterial flora of the cervix in women using different methods of contraception. Am J Obstet Gynecol 154:520–524

    CAS  Article  PubMed  Google Scholar 

  13. Keane FE, Ison CA, Taylor-Robinson D (1997) A longitudinal study of the vaginal flora over a menstrual cycle. Int J STD AIDS 8:489–494

    CAS  Article  PubMed  Google Scholar 

  14. Hodoglugil NN, Aslan D, Bertan M (2000) Intrauterine device use and some issues related to sexually transmitted disease screening and occurrence. Contraception 61:359–364

    CAS  Article  PubMed  Google Scholar 

  15. Ferraz do LR, Simoes JA, Bahamondes L, Camargo RP, Perrotti M, Monteiro I (2003) Follow-up of users of intrauterine device with and without bacterial vaginosis and other cervicovaginal infections. Contraception 68:105–109

    Article  Google Scholar 

  16. Heffron R, Were E, Celum C, Mugo N, Ngure K, Kiarie J et al (2010) A prospective study of contraceptive use among African women in HIV-1 serodiscordant partnerships. Sex Transm Dis 37:621–628

    PubMed  Google Scholar 

  17. Donders G, Bellen G, Rezeberga D (2011) Aerobic vaginitis in pregnancy. BJOG 118:1163–1170

    Article  PubMed  Google Scholar 

  18. Lessard T, Simoes JA, Discacciati MG, Hidalgo M, Bahamondes L (2008) Cytological evaluation and investigation of the vaginal flora of long-term users of the levonorgestrel-releasing intrauterine system (LNG-IUS). Contraception 77:30–33

    CAS  Article  PubMed  Google Scholar 

  19. Toppozada M, Amer S, el-Ghazzawi E (1986) Effect of subdermal levonorgestrel contraceptive implants on vaginal candidiasis. Adv Contracept 2:117–122

    CAS  Article  PubMed  Google Scholar 

  20. Spacek J, Buchta V, Jilek P, Forstl M (2007) Clinical aspects and luteal phase assessment in patients with recurrent vulvovaginal candidiasis. Eur J Obstet Gynecol Reprod Biol 131:198–202

    Article  PubMed  Google Scholar 

  21. Nohmi T, Abe S, Dobashi K, Tansho S, Yamaguchi H (1995) Suppression of anti-Candida activity of murine neutrophils by progesterone in vitro: a possible mechanism in pregnant women’s vulnerability to vaginal candidiasis. Microbiol Immunol 39:405–409

    CAS  Article  PubMed  Google Scholar 

  22. Beigi RH, Meyn LA, Moore DM, Krohn MA, Hillier SL (2004) Vaginal yeast colonization in nonpregnant women: a longitudinal study. Obstet Gynecol 104:926–930

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Femicare vzw, Clinical Research for Women, Gasthuismolenstraat 31, B-3300, Tienen, Belgium

    G. Donders & G. Bellen

  2. Departments of Obstetrics and Gynaecology, General Regional Hospital Heilig Hart Tienen, Tienen, Belgium

    G. Donders

  3. General Regional Hospital Heilig Hart Tienen, Tienen, Belgium

    G. Donders

  4. University Hospital Antwerpen, Antwerp, Belgium

    G. Donders

  5. Private gynaecological practice, Turnhout, Belgium

    D. Janssens

  6. Algemeen Ziekenhuis St Jan, Genk, Belgium

    B. Van Bulck & P. Hinoul

  7. University Hospital Gasthuisberg, Leuven, Belgium

    J. Verguts

  8. Algemeen Ziekenhuis Virga Jesse, Hasselt, Belgium

    J. Verguts

Authors
  1. G. Donders
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  2. G. Bellen
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  3. D. Janssens
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  4. B. Van Bulck
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  5. P. Hinoul
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  6. J. Verguts
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Corresponding author

Correspondence to G. Donders.

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Funding

None.

Conflict of interest

None of the authors has any conflict of interest to disclose.

Ethical approval

Ethical Committee University Hospital Leuven (Number S50518, Commission E330) and of General Hospital H Hart Tienen.

Informed consent

Read and signed by every patient before being considered for the study.

Financial disclosure

None of the authors declares any financial interest.

Authorship contribution

GD: Study design, patient recruitment, statistics, writing, editing; GB Study design, microscopy, editing; PH, DJ, BVB: patient recruitment, writing.

Additional information

Summary

Contraceptive choice influences the vaginal flora. Intrauterine devices are not suitable for patients susceptible for Candida, and women at increased risk for STIs should be advised to take oral contraceptive pills or hormonal intrauterine contraception.

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Donders, G., Bellen, G., Janssens, D. et al. Influence of contraceptive choice on vaginal bacterial and fungal microflora. Eur J Clin Microbiol Infect Dis 36, 43–48 (2017). https://doi.org/10.1007/s10096-016-2768-8

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  • DOI: https://doi.org/10.1007/s10096-016-2768-8

Keywords

  • Bacterial Vaginosis
  • Vaginal Flora
  • Aerobic Vaginitis
  • Vaginal Atrophy
  • Trichomonas Vaginalis