Women using long-acting contraception less likely to use condoms

College women using long-acting reversible contraception (LARC), like IUDs or hormonal implants, may be less likely to get pregnant but more vulnerable to sexually transmitted disease compared to peers not on LARCs, a US study finds. Among sexually active women, those who used LARC methods were more than two times less likely to have used a condom in their last sexual encounter than women not on a long-acting contraceptive, researchers report in the journal Sexually Transmitted Diseases.

“Long-acting reversible contraception, which includes intrauterine devices and contraceptive implants, is one of the most effective ways to prevent pregnancy. While these methods are good at preventing pregnancy, there is no protection for sexually transmitted infections (STIs),” lead author Erika Thompson told Reuters Health in an email.

“One of the key findings is that condom use is lower among women using LARC methods compared to other forms of birth control (e.g., pill). Thus, LARC users may be placing themselves at risk for an STI because they are not using condoms for prevention,” said Thompson, a researcher at the Community and Family Health College of Public Health at the University of South Florida in Tampa. Sexually transmitted infections, such as chlamydia, gonorrhea and syphilis were at an all time high in the US in 2015, the study authors write. About half of new STIs occur in adolescents and young adults, they note.

Thompson’s team used data from the National College Health Assessment-II, a large survey-based study that examines the health status of US college students. The current study included 17,623 college women who were 18 years or older and reported having sex during the previous year. About 9 percent used a LARC method.

Researchers found that 24 percent of LARC users also used condoms in their last sexual encounter, compared to 57 percent of used a different contraceptive method plus a condom. This comparison excluded women whose only contraceptive was a condom. Most of the LARC users were over 21 years old, white and had insurance, the authors point out. Black and Hispanic LARC users were more likely than whites to use a condom as well.

“Couples in relationships may want to consider talking to a healthcare provider about STI testing prior to stopping condom use. It is important to note that serial monogamy, or having successive sexual partners, does not remove the risk for STIs, so condoms should be used initially in a relationship,” Thompson said. With the emergence of Zika Virus as a public health issue, this study may have applications to the prevention of sexual transmission of Zika virus, she added. “The Centers for Disease Control and Prevention recommends the use of effective birth control methods and condoms to reduce the risk of a pregnancy affected by Zika,” Thompson said.

The study can shed light on which groups of women may be least likely to use condoms while on an effective form of birth control, Thompson said. There were some limitations to the study, including a low response rate to the survey. The study authors also didn’t take the length of relationships into consideration and they didn’t ask if study participants were aware of the risk of STIs.

“It is an interesting study though I do not think the findings are surprising. People choose LARC for many reasons, including that they, or their partner, do not like condoms,” Dr Barbara M Gripshover told Reuters Health in an email. “More people chose this method who were in a relationship and therefore thought to be at less risk for STIs,” said Gripshover, medical director of the John T. Carey Special Immunology Unit at the University Hospitals Cleveland Medical Center in Cleveland, Ohio. Gripshover, who wasn’t involved in the study, said that a couple can feel safe about not using condoms for STI prevention when both partners do not have an STI and they are in a monogamous relationship. —Reuters