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Risk factors for urinary tract infection.

The authors carried out a case-control study in 1982-1983 to investigate the possible influence of behavioral factors on the risk of urinary tract infection. Study participants were college women attending a student health service. Cases were 43 women with culture-confirmed urinary tract infection. There were two control groups: 149 women with upper respiratory infection and 227 women visiting the gynecology clinic. Using each set of controls, the study confirmed that sexual intercourse is a risk factor and that there is a dose-response effect for increasing levels of coital frequency. The study also found that use of the diaphragm was significantly associated with urinary tract infection (odds ratios 3.0, 2.3), an association which remained significant even after controlling for possible confounding by coital frequency. The findings did not show an association with many of the factors commonly believed to be important such as type of clothing worn and volume of fluids consumed.

Adolescent↗

The contraceptive sponge's protection against Chlamydia trachomatis and Neisseria gonorrhoeae.

To investigate the effect of the contraceptive sponge on the incidence of sexually transmitted diseases, we conducted a clinical trial among a high-risk population of women in Bangkok, Thailand. Two hundred fifty-five women were randomly assigned either to use the sponge or not and were evaluated weekly for gonorrhea and chlamydial infection. After adjustment by logistic regression for potentially confounding factors, women using the sponge were less likely to have contracted chlamydial infection (odds ratio [OR], 0.6; 90% confidence interval [CI], 0.4-1.0) and gonorrhea (OR, 0.9; CI, 0.6-1.3) as compared with women not using the sponge. These estimates probably underestimate the degree of protection because some exposure was misclassified in this pilot phase of the study. These results are consistent with other studies indicating that spermicides protect against gonorrhea and also demonstrating protection against an organism of even greater public health concern, Chlamydia trachomatis.

Adult↗

Evaluation of the effects of a female condom on the female lower genital tract.

The purposes of this study were to determine if use of the female condom (Reality) was traumatic to the vaginal mucosa and/or vulvar skin and to determine its effect on resident vaginal bacterial flora. Thirty subjects were randomly assigned to utilize the female condom or diaphragm during the study period. Initially and during 3 follow-up visits, each subject underwent colposcopic examination of the vagina, cervix, and vulva with photographic record, and qualitative fungal, aerobic and anaerobic cultures of the vagina. The two groups were compared with respect to the frequency of abnormal physical findings determined by both macroscopic and colposcopic examination. Visits were compared within each contraceptive group with respect to changes in resident vaginal flora. There was no evidence of significant trauma associated with the use of either contraceptive device during the study period. The resident vaginal flora did not significantly change during the three follow-up visits in patients using the female condom. In diaphragm users, lactobacilli were less frequently isolated at the third (14/15 vs 6/15, P = 0.008) and fourth (14/15 vs 7/15, P = 0.039) follow-up visits when compared to the initial visit. In addition, aerobic gram-negative rods were more frequently isolated during the fourth visit (1/15 vs 9/15, P = 0.021) when compared to the first visit. We conclude that neither the female condom (Reality) nor the diaphragm is associated with trauma to the lower genital tract. Subjects using the diaphragm undergo a significant change in vaginal bacterial flora, becoming more likely to be colonized with coliform microorganisms and less likely to maintain lactobacilli colonization.

Adult↗

Midtrimester abortion induced by serial intravaginal administration of prostaglandin E2 suppositories in conjunction with a contraceptive diaphragm.

Midtrimester abortion was successfully induced in 68 of 69 patients with serial intravaginal administration of prostaglandin E2 suppositories behind a contraceptive diaphragm. The mean abortion time for the successful inductions was 13.07 hours; multiparous patients aborted somewhat faster, mean 12.72 hours, as compared to nulliparous patients, mean 14.22 hours. In 36 patients the PGE2 suppositories were placed behind an intact diaphragm and the mean abortion time was 14.89 hours. In 33 patients the PGE2 suppositories were placed behind a diaphragm modified by having an opening incised in the center, the mean time in these patients was 11.96 hours. Of the 68 successful abortions 59% of the patients aborted in 12 hours or less and 88% aborted within 24 hours. The most frequently encountered side effect was temperature elevation of 2 degrees F or higher which occurred in 68% of the patients. Temperatures returned to normal levels within 4 to 6 hours after the last adminstration of PGE2. Gastrointestinal side effects occurred in 45% of patients, but these side effects were well tolerated and did not require termination of drug administration in any of the patients. Intravaginal administration of PGE2 suppositories is a very effective abortifacient technque during the midtrimester, however the use of PGE2 in conjunction with a diaphragm did not appreciabley improve the technique although the amount of drug administered and the incidence of side effects was somewhat lower than when the PGE2 suppositories are used alone. If a diaphragm is to be used, a modified diaphragm is indicated since it simplifies the clinical management of the abortion, eases administration of the suppositories and permits a more accurate estimation of cervical changes, vaginal bleeding and abortion.

Abortion, Induced↗

Studies of cervical caps: I. Vaginal lesions associated with use of the Vimule cap.

Prior to investigating the contraceptive efficacy of cervical caps, we undertook a preliminary study to evaluate potential side effects of these devices. Women who had not previously used a cap were randomly assigned to wear either a Vimule or Cavity Rim Cap (CRC) for as long as seven days. The Vimule cap caused lesions of the portio vaginalis ranging from erythematous impressions to abrasions and frank lacerations. There was variation in the degree of trauma depending, in part, on the size of the cap and duration of wear. Disruption of the epithelium occurred in eight of twelve Vimule users, but the lesions were sometimes difficult to see owing to their location. CRCs were worn by 20 women. This device sometimes left a "suction ring" on the cervix but did not disrupt the epithelium. Two of three long-term users of the Vimule cap who were also studied had unusual formations of the vaginal mucosa suggesting a proliferative reaction to chronic irritation. It is recommended that all women using a Vimule Cap be carefully re-examined and counseled about further use of the device according to the findings of the examination.

Adolescent↗

Contraceptives of the future in the light of HIV infection.

The AIDS and sexually transmissible disease pandemics have helped to focus the world's attention on the need for good protection against transmission of infections during sexual intercourse. Most of the highly effective modern contraceptives provide only limited protection against STD transmission, although recent progress with the development of loose-fitting plastic male condoms and new spermicides gives some hope. Urgent attention must continue to be given to contraceptives with STD protective qualities which are under the woman's control. Refinements of the female condom and vaginal sponges with new spermicides and microbicides may be a step in this direction.

Acquired Immunodeficiency Syndrome↗

Incidence of sexually transmitted diseases among massage parlour employees in Bangkok, Thailand.

The results of a study of sexually transmitted disease (STD) incidence and related risk factors for STDs among uninfected women at high risk of contracting STD infection in Bangkok are reported. Comprising the control arm of a randomized controlled trial of a vaginal contraceptive sponge and STD incidence, 163 women aged 18 or older were recruited from 4 massage parlours and followed for evidence of new infections over a 6-week period or until cervical infection occurred. Gynaecological examinations were performed and endocervical specimens were obtained at weekly intervals, at which time women returned coital logs recording their number of sexual partners. There were 76.5 new STD infections per 100 woman-months, including 31.7 with gonorrhoea, 43.1 with chlamydia, 1.8 of trichomoniasis and 3.5 of candidiasis. None of the risk factors examined were good predictors of STD infection in this population, which may be related to the restricted admission criteria in the study.

Adolescent↗