Introduction
Given mixed findings regarding the relationship between long-acting reversible contraception
and condom use, this systematic review and meta-analysis synthesizes studies comparing
sexually transmitted infection‒related outcomes between users of long-acting reversible
contraception (intrauterine devices, implants) and users of moderately effective contraceptive
methods (oral contraceptives, injectables, patches, rings).
Methods
MEDLINE, Embase, PsycINFO, Global Health, CINAHL, Cochrane Library, and Scopus were
searched for articles published between January 1990 and July 2018. Eligible studies included those that (1) were published in the English language,
(2) were published in a peer-reviewed journal, (3) reported empirical, quantitative
analyses, and (4) compared at least 1 outcome of interest (condom use, sexual behaviors
other than condom use, sexually transmitted infection‒related service receipt, or
sexually transmitted infections/HIV) between users of long-acting reversible contraception
and users of moderately effective methods. In 2020, pooled ORs were calculated for
condom use, chlamydia/gonorrhea infection, and trichomoniasis infection; findings
for other outcomes were synthesized qualitatively. The protocol is registered on the
International Prospective Register of Systematic Reviews (CRD42018109489).
Results
A total of 33 studies were included. Long-acting reversible contraception users had
decreased odds of using condoms compared with oral contraceptive users (OR=0.43, 95%
CI=0.30, 0.63) and injectable, patch, or ring users (OR=0.58, 95% CI=0.48, 0.71);
this association remained when limited to adolescents and young adults only. Findings
related to multiple sex partners were mixed, and only 2 studies examined sexually
transmitted infection testing, reporting mainly null findings. Pooled estimates for
chlamydia and/or gonorrhea were null, but long-acting reversible contraception users
had increased odds of trichomoniasis infection compared with oral contraceptive users
(OR=2.01, 95% CI=1.11, 3.62).
Discussion
Promoting condom use specifically for sexually transmitted infection prevention may
be particularly important among long-acting reversible contraception users at risk
for sexually transmitted infections, including adolescents and young adults.
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Published online: September 16, 2021
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Published by Elsevier Inc. on behalf of American Journal of Preventive Medicine.
