Changes in key vaginal bacteria among postpartum African women initiating intramuscular depot-medroxyprogesterone acetate

• Published in: PloS one Vol. 15; no. 3; p. e0229586
• Main Authors: Whitney, Bridget M, Guthrie, Brandon L, Srinivasan, Sujatha, Tapia, Kenneth, Muriuki, Eric Munene, Chohan, Bhavna H, Wallis, Jacqueline M, Liu, Congzhou, McClelland, R Scott, Fredricks, David N, Roxby, Alison C
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 05-03-2020; Public Library of Science (PLoS)
• Subjects: Acetic acid; Adult; Africa; Bacteria; Bacteria - growth & development; Bacterial Infections - microbiology; Biology and Life Sciences; Birth control; Cancer; Contraception; Contraception - methods; Contraceptive Agents, Female - administration & dosage; Contraceptives; Deoxyribonucleic acid; DNA; Ecology and Environmental Sciences; Engineering and Technology; Epidemiology; Family planning; Female; HIV; Hormones; Human immunodeficiency virus; Humans; Infectious diseases; Laboratories; Medical research; Medicine and Health Sciences; Medroxyprogesterone; Medroxyprogesterone acetate; Medroxyprogesterone Acetate - administration & dosage; Menstruation; Methods; Microbiota; Polymerase chain reaction; Postpartum; Postpartum Period; Prospective Studies; Reproductive health; Studies; Taxa; Tropical diseases; Vaccines; Vagina; Vagina - microbiology; Women; Womens health; Young Adult; Africa; Kenya; United States > US
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0229586

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.
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.
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).
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.