DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20213833

Comparative study of cervical-vaginal microbial flora changes in women using Cu-T380A contraceptive device and LNG-IUS in Ibadan: a two-centre clinical COHORT study

Benjamin C. Oranye, Adeyemi O. Adekunle, Ayo O. Arowojolu, Olufunmilola Makanjuola, Babatunde Tayo

Abstract


Background: Intrauterine devices cause various changes in the female genital tract which might result in altered microbial flora and risk of genital infections. The aim of this study was to determine the change in bacterial flora of women using Copper-bearing T380A and levonorgestrel intrauterine system and the risk of genital infections.

Methods: This was a two-center clinical cohort study of women using Cu-T380A IUD and LNG-IUS in Ibadan, Nigeria. The study was conducted from March to August, 2016 and it involved 130 women (66 Cu-T380A and 64 LNG-IUS) at 2 family planning clinics in Ibadan, Nigeria. The clients were clinically assessed before admission into the study and high vaginal and endocervical swabs were taken before insertion of the devices, and at 3 and 6months after insertion.

Results: Fifty-seven clients with LNG and 63 with copper T380A completed the study. The mean age in LNG-IUS was 34.4years (SD= 6.3) and Cu-T380A was 35.4 years (SD=5.6). All participants had one sexual partner. There was no previous or current STIs/PID at recruitment. The organisms isolated included coagulase negative Staphylococcus (CNS), Staphylococcus aureus, Streptococcus spp, Escherichia coli, Candida spp, Neisseria gonorrhoeae and Klebsiella spp. Cu-T380A women had an increase or persistence of CNS, Staphylococci, Klebsiella and Candida at 3 months while in the LNG-IUS group only CNS increased. The HVS revealed that participants with Cu-T380A had higher risks (33.3%) for asymptomatic genital infections than the LNG-IUS (5.3%) group at 6 months (p value <0.001).

Conclusions: Cu-T380A has a higher likelihood of altering the microbial flora in the cervix and vagina and therefore encouraging the growth of a variety of other organisms compared to LNG-IUS.


Keywords


Cervical, Vaginal, Microbial flora, Contraceptive device

Full Text:

PDF

References


Kroon SJ, Ravel J, Huston WD. Cervico-vaginal microbiota, women’s health and reproductive outcomes. Fertility Sterility. 2018;110(3):45-9.

Srinvasan S, Liu C, Mitchel CM, Fiedler TL, Thomas KK, Agnew KT, et al. Temporary variability of human vaginal bacteria and relationship with bacterial vaginosis. PLoS One. 2010;5:e10197.

Tachedjian G, O'Hanlon DE, Ravel J. The implausible “in vivo” role of hydrogen peroxide as an antimicrobial factor produced by vaginal microbiota. Microbiome. 2018;6:29.

Aldunate M, Srbinovski D, Hearps AC, Latham CF, Ramsland PA, Gugasyan R, et al. Antimicrobial and immune modulatory effects of lactic acid and short chain fatty acids produced by vaginal microbiota associated with eubiosis and bacterial vaginosis. Front Physiol. 2015;6:164.

Breshears LM, Edwards VL, Ravel J, Peterson ML. Lactobacillus crispatus inhibits growth of Gardnerella vaginalis and Neisseria gonorrhoeae on a porcine vaginal mucosa model. BMC Microbiol. 2015;15:276.

Srinivasan S, Liu CC, Mitchell CM, Fiedler TL, Thomas KK, Agnew KJ, et al. Temporal variability of human vaginal bacteria and relationship with bacterial vaginosis. PLoS One. 2012;5:e10197.

Ronnquist PD, Forsgren-Brusk UB, Grahn-Håkansson EE. Lactobacilli in the female genital tract in relation to other genital microbes and vaginal pH. Acta Obstet Gynecol Scand. 2006;85:726-35.

Achilles SL, Austin MN, Meyn LA, Mhlanga F, Chirenje ZM and Hillier SL. Impact of contraceptive initiation on vaginal microbiota. Am J Obs Gyn. 2018;218(6):622.

Bassis CM, Allsworth JE, Wahi DE, Young VB, Bell JD. Effects of intrauterine contraception on the vaginal microbiota, Contraception. 2017;96:189-95.

Jacobson JC, Turok DK, Dermish AI, Nygaard ML, Settles ML. Vaginal microbiome changes with levonorgestrel intrauterine system placement. Contraception. 2014;90:130-5.

Auler ME, Morreira D, Rodrigues FFO, Margarideo PFR, Matsumoto FE, Silva EG, et al. Biofilm formation on intrauterine devices in patients with recurrent vulvovaginal candidiasis. Med Mycol. 2014;48(1):211-6.

El-Hamid ANA, Sayyed TM. Salem EH, Hassan AN. Screening for bacterial vaginosis before and after intrauterine device insertion. Menofia Med J. 2019; 32:1411-6.

Yen S, Shaffer MA, Moncada J, Campbell CJ. Bacterial vaginosis in sexually experienced and non-sexually experienced young women entering the military. Obstet Gynaecol. 2003;102:972-3.

Fortney JA, Feldblum PJ, Raymond EG. Intrauterine devices. The optimal long-term contraceptive method?. J Reprod Med. 1999;44(3):269-74.

Grimes DA. Intrauterine device and upper genital tract infection. Lancet. 2000;356(9234):1013-9.

Donders GGG, Bellen G, Ruban K, Ruban K, Van Buick B. Short and long-term influence of the levonorgestrel-releasing intrauterine system (MirenaR) on vaginal microbiota and Candida. J Med Microbiol. 2018;67:308-13.

Donders GGG, Viera-Baptisa P. Bacterial vaginosis and inflammatory response showed association with severity of cervical neoplasm in HPV-positive women. Diagn Cytopathol. 2017;45:472-3.

Caixeta RC, Ribeira AA, Segatti KD, Saddi VA, Figueredo Alves RR, et al. Association between the human papillomavirus, bacterial vaginosis and cervicitis and the detection of abnormalities in cervical smears from teenage girls and young women. Diagn Cytopathol. 2015;43:780-5.

Ferraz do Lago R, Simoes JA, Bahamondes L, Camargo RPS, Perrotti M, Monterio I. Follow-up of users of intrauterine device with or without bacterial vaginosis and other cervicovaginal infections. Contracept J. 2003;68:105-9.

Hubacher D. The levonorgestrel intrauterine system: Reasons to expand access to the public sector of Africa. Global Health Sci Practice. 2015;3(4):532-7.

Daniel WM. Biostatistics: a foundation for analysis in health sciences. 7th ed. New York: Wiley; 1999.

Tille PM. In: Bailey and Scott;s diagnostic microbiology. 14th ed. Missuori: Elsvier; 2014: 9780.

Brunie A, Rademacher KH, Nwala AA, Danna K, Saleh M, Afolabi K. Provision of the levonorgestrel intrauterine system in Nigeria: Provider perspectives and service delivery cost. Gates Open Res. 2020;4: 119.

Radermacher KH, Sripipatana T, Pfitzer A, Mackay A, Thurston S, Jackson A, Menotti E, Traeger H. A global learning agenda for the levonorgestrel intrauterine system (LNG IUS): addressing challenges and opportunities to increase access. Glob Health Sci Pract. 2018;6(4):635-43.

Sabah Abd Al, Kareem Al, Daniz TB, Shafaq, TB, Kareem Al, et al. Biofilm Formation on Intrauterine Device and Associated Infections. Iraqi Postgrad Med J. 2013;12(4):562-7.

Haukkamma M, Stranden P, Jousimies-Somer H, Siitonen A. Bacterial flora of the cervix in women using different methods of contraception. Am J Obstet Gynecol. 1986;154(3):520-4

Kaliterna V, Kučišec-Tepeš N, Pejković L, Zavorović S, Petrović S, Barišić Z. An intrauterine device as a possible cause of change in the microbial flora of the female genital system. J Obstet Gynaecol Res. 2011; 37(8):1035-40.

Wahab SA, Altaieb S, Saleh A, Sakr E, Hamly AK, Hegab M, et al. Effect of Copper T intrauterine device on cervico-vaginal flora. Int J Gynaecol Obstet. 1985; 23(2):153-6.

Baris H, Arman-Karakaya Y. Effects of contraception on cervical cytology: data from Mardin City. Türk Patoloji Derg. 2013;29(2):117-21.

Kanat-Pektas M, Ozat M, Gungor T. The effects of TCu-380A on cervicovaginal flora. Arch Gynecol Obstet. 2008;277(5):429-32.

Lessard T, Simões JA, Discacciati MG, Hidalgo M, Bahamondes L. Cytological evaluation and investigation of the vaginal flora of long-term users of the levonorgestrel-releasing intrauterine system (LNG-IUS). Contraception. 2008;77(1):30-3.

Enrol O, Simavlı S, Derbent AU, Ayrım A, Kafalı H. The impact of copper-containing and levonorgestrel-releasing intrauterine contraceptives on cervicovaginal cytology and microbiological flora: a prospective study. Eur J Contracept Reprod Health Care. 2014;19(3):187-93.

Nander G, Rademarcher K, Solomon M, Mercer S, Wawire J, Ngahu R. Experience with the levogestrel releasing intrauterine system in Kenya: Qualitative interviews with users and their partners. Eur J Contracept. 2018;28(4):303-8.