LARC users less likely to use condoms

A literature review in the American Journal of Preventive Medicine revealed that long-acting reversible contraception (LARC) users are significantly less likely to use condoms than oral contraceptive users or injectable, patch, or ring users. This connection was also evident when limited to adolescents and young adults.¹

In addition, only 2 studies assessed sexually transmitted infection (STI) testing, reporting primarily null results.

Pooled estimates for chlamydia and/or gonorrhea were also null, but LARC users were significantly more likely to contract trichomoniasis infection compared to oral contraceptive users.

The authors searched for studies published between January 1990 and July 2018 in MEDLINE, Embase, PsycINFO, Global Health, Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, and Scopus.

Eligible studies were limited to those published in English and in a peer-reviewed journal. A total of 33 studies met inclusion criteria.

LARC users had decreased odds of using condoms compared to oral contraceptive users: odds ratio (OR) = 0.43; 95% confidence interval (CI) =0.30 to 0.63.

LARC users also had decreased odds of using condoms versus injectable, patch or ring users: OR=0.58; 95% CI = 0.48 to 0.71.

Furthermore, LARC users had increased odds of trichomoniasis infection compared to oral contraceptive users: OR = 2.01; 95% CI = 1.11 to 3.62.

However, this trichomoniasis link did not remain significant in the sensitivity analysis confined to prospective studies. “The reasons for these mixed findings are unclear,” wrote the authors. “One possibility is that the null findings reflect limited statistical power given the relatively low prevalence of STIs. Another possibility is that observed differences reflect biological rather than behavioral mechanisms unique to specific STIs and contraceptives.”

Although there are insufficient data on STI-related services by contraceptive type, the authors were encouraged that most findings did not imply that the reduced need for contraceptive visits with LARC methods impacted receipt of STI services.

Heterogeneity among indicators of sexual risk emphasizes a need to identify and consistently use the most appropriate measures to evaluate STI risk. Behaviors and characteristics of partnerships, such as the number of sex partners and partner concurrency, might be highly relevant. Network analyses that consider differences in sexual networks by contraceptive type may also be beneficial.

Differences in testing for chlamydia and gonorrhea by contraceptive type among sexually active female adults younger than 25 years old is advised because these services are recommended annually for this population.

However, the authors said it is important to distinguish between new and continuing LARC users because any reduction in STI testing than the recommended annual testing may be observed in the years after LARC method initiation.

Moreover, potential variation in condom use over time by contraceptive type needs further exploration.

The review underscores the value of integrating pregnancy and STI prevention in health education and clinical practice, as well as reinforces the potential value of multipurpose prevention technologies that prevent both pregnancy and select STIs.

“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,” wrote the authors.

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Reference

1. Steiner RJ, Pampati S, Kortsmit KM, et al. Long-acting reversible contraception, condom use, and sexually transmitted infections: a systematic review and meta-analysis. Am J Prev Med. 2021 Nov; 61(5):750-760. doi:10.1016/j.amepre.2021.04.032