标题：Use of injectable hormonal contraception and women's risk of herpes simplex virus type 2 acquisition: a prospective study of couples in Rakai, Uganda
摘要：SummaryBackground The injectable hormonal contraceptive depo-medroxyprogesterone acetate (DMPA) has been associated with increased risk of {HIV} acquisition, but findings are inconsistent. Whether {DMPA} increases the risk of other sexually transmitted viral infections is unknown. We assessed the association between {DMPA} use and incident herpes simplex virus type 2 (HSV2) infection in women. Methods In this prospective study, we enrolled HIV-negative and HSV2-negative women aged 15–49 years whose HIV-negative male partners were concurrently enrolled in a randomised trial of male circumcision in Rakai, Uganda. We excluded women if either they or their male partners {HIV} seroconverted. The primary outcome was {HSV2} seroconversion, assessed annually. The male circumcision trial was registered with ClinicalTrials.gov, number NCT00425984. Findings Between Aug 11, 2003, and July 6, 2006, we enrolled 682 women in this study. We noted {HSV2} seroconversions in 70 (10%) women. Incidence was 13·5 per 100 person-years in women consistently using {DMPA} (nine incident infections per 66·5 person-years), 4·3 per 100 person-years in pregnant women who were not using hormonal contraception (18 incident infections per 423·5 person-years), and 6·6 per 100 person-years in women who were neither pregnant nor using hormonal contraception (35 incident infections per 529·5 person-years). Women consistently using {DMPA} had an adjusted hazard ratio for {HSV2} seroconversion of 2·26 (95% {CI} 1·09–4·69; p=0·029) compared with women who were neither pregnant nor using hormonal contraception. Of 132 women with HSV2-seropositive partners, seroconversion was 36·4 per 100 person-years in consistent {DMPA} users (four incident infections per 11 person-years) and 10·7 per 100 person-years in women who were neither pregnant nor using hormonal contraception (11 incident infections per 103 person-years; adjusted hazard ratio 6·23, 95% {CI} 1·49–26·3; p=0·012). Interpretation Consistent {DMPA} use might increase risk of {HSV2} seroconversion; however, study power was low. These findings should be assessed in larger populations with more frequent follow-up than in this study, and other contraceptive methods should also be assessed. Access to a wide range of highly effective contraceptive methods is needed for women, particularly in sub-Saharan Africa. Funding Bill and Melinda Gates Foundation, Doris Duke Charitable Foundation, {US} National Institutes of Health, and Fogarty International Center.
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