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Sexually Transmitted Infection Prevalence in a Population Seeking No-Cost Contraception

McNicholas, Colleen DO; Peipert, Jeffrey F. MD, PhD; Maddipati, Ragini MSW; Madden, Tessa MD, MPH; Allsworth, Jenifer E. PhD; Secura, Gina M. PhD, MPH

Sexually Transmitted Diseases: July 2013 - Volume 40 - Issue 7 - p 546–551
doi: 10.1097/OLQ.0b013e31829529eb
Original Study

Background We used universal screening to determine the prevalence rates of Neisseria gonorrhoeae (GC), Chlamydia trachomatis (CT), and Trichomonas vaginalis (TV) in 9256 women enrolling into a contraceptive study.

Methods We offered screening using nucleic acid amplification or culture to all participants enrolling into the Contraceptive CHOICE Project. Demographic characteristics were collected through staff-administered questionnaires. Univariate and multivariable analyses were performed to assess the risk of sexually transmitted infection at baseline and to compare risk profiles of CT and TV.

Results Results were available for 8347 consenting women with satisfactory results; 656 (7.9%) were tested positive for 1 or more infections. Approximately one third of participants were older than 26 years, and half were identified as African American. There were 35 cases of GC for a prevalence of 0.4% (95% confidence interval [CI], 0.3–0.6), 260 cases of CT for a prevalence of 3.1% (95% CI, 2.8–3.5), and 410 cases of TV for a prevalence of 4.9% (95% CI, 4.4–5.4). Black women were more likely to be tested positive (odds ratio, 3.95; 95% CI, 3.08–5.06) compared with white women and accounted for 81.3% of cases. T. vaginalis was more prevalent in black women (8.9%) compared with white women (0.9%). Older age was a risk factor for TV, whereas younger age was associated with CT. Of the 656 positive cases, 106 (16%) were diagnosed in women older than 25 years, falling outside traditional screening guidelines.

Conclusion We found GC, CT, and TV to be more prevalent than current national statistics, with TV being the most prevalent. Current screening recommendations would have missed 16% of infected women.

Prevalence of Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis was higher than current national statistics in a population seeking no-cost contraception.

From the Division of Clinical Research, Washington University School of Medicine, St Louis, MO

The Contraceptive CHOICE Project was funded by the Susan T. Buffett Foundation. This research was also supported, in part, by the National Center for Research Resources Grant No. UL1 RR024992, National Institutes of Health T32 Research Training Grant No. 5T32HD055172-03, and the Eunice Kennedy Shriver National Institute of Child Health and Human Development Award No. K23HD070979.

Financial disclosure: Dr Madden is a former speaker for Bayer HealthCare Pharmaceuticals. The other authors did not report any potential conflicts of interest.

Correspondence: Colleen McNicholas, DO, Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University in St Louis, Campus Box 8219, 4533 Clayton Ave, St Louis, MO 63110. E-mail:

Received for publication January 17, 2013, and accepted April 2, 2013.

© Copyright 2013 American Sexually Transmitted Diseases Association