Use of combined contraceptive vaginal rings raises risk for certain STIs, finds study

The use of combined contraceptive vaginal rings (CCVR) is associated with an increased risk for several types of sexually transmitted infections (STIs). The findings are based on data from a pair of studies presented at the annual clinical and scientific meeting of the American College of Obstetricians and Gynecologists (ACOG) 2024.

Previous studies have revealed that the use of a CCVR may promote changes in immunity in the female genital tract by upregulating immune-related genes in the endocervix and immune mediators within the cervicovaginal fluid, Amy Arceneaux, BS, a medical student at the University of Texas Medical Branch John Sealy School of Medicine, Galveston, and colleagues wrote.

The researchers note that the infection rate in the female genital tract can vary according to hormones in the local environment, and there is a need for continued safety analysis as CCVR use continues to rise.

In a retrospective chart review, the researchers assessed de-identified data from TriNetX, a patient database comprising 30,796 women who received ethinyl estradiol and etonogestrel CCVRs without segesterone and an equal number who were using oral contraceptive pills (OCP) without vaginal hormones. Patients were matched for race, age, and ethnicity.

The study led to the following findings:

· Use of CCVRs was significantly associated with an increased risk for Herpes simplex virus 2 (HSV-2; relative risk [RR], 1.790), acute vaginitis (RR, 1.722), subacute/chronic vaginitis (RR, 1.904), subacute/chronic vulvitis (RR, 1.969), acute vulvitis (RR, 1.894), candidiasis (RR, 1.464), trichomoniasis (RR, 2.162), and pelvic inflammatory disease (RR, 2.984).

· Use of CCVRs was significantly associated with a decreased risk for chlamydia (RR, 0.760).

· No differences in risk appeared for gonorrhea, syphilis, HIV, or anogenital warts between the CCVR and OCP groups.

Another study presented at the meeting focused on outcomes on vaginal health and infection risk in women who used CCVRs compared with women who did not use hormones.

The study, led by Kathleen Karam, BS, also a medical student at the University of Texas Medical Branch John Sealy School of Medicine, Galveston, Texas, included de-identified TriNetX data for two cohorts of 274,743 women.

The study found a significantly increased risk for gonorrhea, vaginitis, HSV-2, vulvitis, anogenital warts, pelvic inflammatory disease, and candidiasis in women using CCVR versus those using no hormonal contraception, while the risk for syphilis, chlamydia, and HIV was decreased in women using CCVR compared with those using no hormonal contraception.

The findings of both studies were limited primarily by the retrospective design, however, the findings suggest a need for further investigate of the effect of local hormone delivery on the vaginal mucosa, the researchers wrote.

As discussions continue surrounding the implications of vaginal ring use on STI risk, healthcare providers and policymakers alike are tasked with developing targeted interventions to promote sexual health and mitigate the spread of STIs among vulnerable populations. Through collaborative efforts and evidence-based strategies, progress can be made toward achieving a healthier and safer future for all.