Open AccessChanges in key vaginal bacteria among postpartum African women initiating intramuscular depot-medroxyprogesterone acetate
Author(s) -
Bridget M. Whitney,
Brandon L. Guthrie,
Sujatha Srinivasan,
Kenneth Tapia,
Eric Munene Muriuki,
Bhavna Chohan,
Jacqueline M Wallis,
Congzhou Liu,
R. Scott McClelland,
David N. Fredricks,
Alison C. Roxby
Publication year - 2020
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0229586
Subject(s) - medroxyprogesterone acetate , medicine , gynecology , medroxyprogesterone , obstetrics , hormonal contraception , population , vagina , family planning , physiology , hormone , research methodology , environmental health , surgery
Background The ECHO trial has relieved apprehension about intramuscular depot medroxyprogesterone acetate (DMPA-IM), however it is still important to understand how DMPA-IM affects the vaginal environment. We sought to describe how DMPA-IM initiation influences vaginal bacteria associated with HIV acquisition in postpartum women. Methods Vaginal swabs were collected for Nugent score determination and taxon-specific quantitative PCR of eight bacteria. Enrollment occurred at contraceptive initiation (DMPA-IM or non-hormonal contraception (non-HC)) and repeat vaginal swabs were collected after three months. Generalized estimating equations were used to estimate changes in Nugent score, total bacterial load, and taxa concentrations among contraceptive groups. Results Women who chose DMPA-IM (n = 33) were more likely to be married (97%vs.67%) and have resumed intercourse since delivery (52%vs.29%) compared to women who chose non-HC (n = 21). After three months, significant decreases in the concentrations of Sneathia species, Mycoplasma hominis , and Parvimonas species Type 1 were seen among non-HC users, however concentrations remained stable among DMPA-IM users; contraceptive method was associated with significantly different changes in M . hominis concentration between groups (p = 0.010). Conclusions Our findings suggest that postpartum use of DMPA-IM and non-HC may have differential impacts on the vaginal concentrations of some bacteria that have previously been associated with HIV acquisition.