1
|
Walsh TL, Snead MC, St Claire BJ, Schwartz JL, Mauck CK, Frezieres RG, Blithe DL, Archer DF, Barnhart KT, Jensen JT, Nelson AL, Thomas MA, Wan LS, Weaver MA. Comparison of self-reported female condom failure and biomarker-confirmed semen exposure. Contraception 2019; 100:406-412. [PMID: 31381878 DOI: 10.1016/j.contraception.2019.07.143] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 07/20/2019] [Accepted: 07/24/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To investigate whether rates of self-reported Woman's Condom (WC) clinical failure and semen exposure from a functionality study are comparable to results from a contraceptive efficacy substudy. STUDY DESIGN We structured our comparative analysis to assess whether functionality studies might credibly supplant contraceptive efficacy studies when evaluating new female condom products. Couples not at risk of pregnancy in the functionality (breakage/slippage/invagination/penile misdirection) study and women in the contraceptive efficacy study completed condom self-reports and collected precoital and postcoital vaginal samples for up to four uses of the WC. Both studies used nearly identical self-report questions and the same self-sampling procedures and laboratory for prostatic specific antigen (PSA), a well-studied semen biomarker. We compared condom failure and semen exposure proportions using generalized estimating equations methods accounting for within-couple correlation. RESULTS Ninety-five (95) efficacy substudy participants used 334 WC and 408 functionality participants used 1572 WC. Based on self-report, 19.2% WC (64 condoms) clinically failed in the efficacy substudy compared to 12.3% WC (194 condoms) in the functionality study (p=.03). Of the 207 WC efficacy uses with evaluable postcoital PSA levels, 14.5% (30 uses) resulted in semen exposure compared to 14.2% (184 uses) of the 1293 evaluable WC functionality study uses. CONCLUSIONS When evaluating the ability of an experimental condom to prevent semen exposure, the rate of clinical condom failure reported by participants risking pregnancy in an efficacy substudy was significantly higher than the rate reported by participants not risking pregnancy in a functionality study. The rate of semen exposure, assessed by an objective biomarker was nearly identical for the two studies. IMPLICATIONS Our results suggest that an objective marker of semen exposure in functionality studies could provide a reasonable alternative to contraceptive efficacy studies in evaluating risk of unintended pregnancy and inferring protection from sexually transmitted infection than condom failure rates based on self-report.
Collapse
Affiliation(s)
- Terri L Walsh
- Essential Access Health (formerly California Family Health Council), 3600 Wilshire Blvd., Ste. 600, Los Angeles, CA 90010.
| | - Margaret C Snead
- Division of Reproductive Health, Centers for Disease Control and Prevention, 1600 Clifton Rd., Atlanta, GA 30333
| | - Breione J St Claire
- Essential Access Health (formerly California Family Health Council), 3600 Wilshire Blvd., Ste. 600, Los Angeles, CA 90010
| | - Jill L Schwartz
- CONRAD/EVMS, 1911 N. Fort Myer Drive, Ste. 900, Arlington, VA 22209
| | | | - Ron G Frezieres
- Essential Access Health (formerly California Family Health Council), 3600 Wilshire Blvd., Ste. 600, Los Angeles, CA 90010
| | - Diana L Blithe
- Contraceptive Development Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, 6710B Rockledge Dr, Bethesda, MD 20817
| | - David F Archer
- Obstetrics & Gynecology, Eastern Virginia Medical School, PO Box 1980, Norfolk, VA 23501
| | - Kurt T Barnhart
- University of Pennsylvania Medical Center, 3701 Market St., Ste. 800, Philadelphia, PA 19104
| | - Jeffrey T Jensen
- Department of Obstetrics & Gynecology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, OR 97239
| | - Anita L Nelson
- Essential Access Health (formerly California Family Health Council), 3600 Wilshire Blvd., Ste. 600, Los Angeles, CA 90010
| | - Michael A Thomas
- Department of Obstetrics & Gynecology, University of Cincinnati Medical Center, 234 Goodman St., Cincinnati, OH 45219
| | - Livia S Wan
- Department of Obstetrics & Gynecology, New York University,462 First Ave., New York, NY 10016
| | - Mark A Weaver
- Department of Mathematics and Statistics, Elon University, Elon, NC 27244
| |
Collapse
|
2
|
Giguère K, Leblond FA, Goma-Matsétsé E, Dave V, Béhanzin L, Guédou FA, Alary M. A novel nested polymerase chain reaction targeting the testis-specific protein Y-encoded family of genes for high sensitivity of recent semen exposure detection: Comparison with four other assays of semen detection. PLoS One 2019; 14:e0220326. [PMID: 31344101 PMCID: PMC6657882 DOI: 10.1371/journal.pone.0220326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 07/12/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Because self-report of sexual behaviours is prone to biases, biomarkers of recent semen exposure are increasingly used to assess unprotected sex. We aimed to present a novel nested polymerase chain reaction (PCR) assay targeting testis-specific protein Y-encoded (TSPY) genes and to compare its performance in detecting recent semen exposure with that of four other assays. METHODS Forty-five vaginal samples were selected at baseline of a prospective observational demonstration study of early antiretroviral treatment and pre-exposure prophylaxis among female sex workers in Benin. Semen exposure was assessed with: a rapid prostate-specific antigen (PSA) detection assay, a quantitative PCR targeting the sex-determining region (SRY) gene, a standard PCR targeting SRY, a standard PCR targeting TSPY, and a nested PCR targeting TSPY (n-TSPY). Because we had hypothesized that n-TSPY would be the most sensitive of the five assays while remaining specific, and as our results suggested that it was the case, sensitivity and specificity were calculated for each assay in comparison with n-TSPY. RESULTS The n-TSPY could detect male DNA at concentration 16 and 64 times lower compared to s-TSPY and s-SRY, respectively. Among the 45 vaginal samples, prevalences of semen exposure according to the different assays varied from 22.2% (95%CI: 11.2%-37.1%) to 70.5% (95%CI: 54.8%-83.2%), with the highest prevalence measured with n-TSPY. The n-TSPY products were of expected size and we observed no false-positive in female DNA controls. The assay that offered the second best performance in detecting semen exposure was the PSA rapid test, with a sensitivity of 61.3% and a specificity of 100% compared to n-TSPY. CONCLUSIONS Compared to n-TSPY, all other PCR assays had poor performance to detect semen exposure. The n-TSPY is an accessible assay that may have great utility in assessing semen exposure in studies where many factors are expected to accelerate biomarkers' clearance.
Collapse
Affiliation(s)
- Katia Giguère
- Centre de recherche du CHU de Québec, Université Laval, Québec, Québec, Canada
- Département de médecine sociale et préventive, Université Laval, Québec, Québec, Canada
| | - François A. Leblond
- Centre de Recherche de l’Hôpital Maisonneuve Rosemont, Montréal, Québec, Canada
| | | | - Vibhuti Dave
- Centre de Recherche de l’Hôpital Maisonneuve Rosemont, Montréal, Québec, Canada
| | - Luc Béhanzin
- Centre de recherche du CHU de Québec, Université Laval, Québec, Québec, Canada
- Dispensaire IST, Centre de santé communal de Cotonou 1, Cotonou, Bénin
- École Nationale de Formation des Techniciens Supérieurs en Santé Publique et en Surveillance Épidémiologique, Université de Parakou, Parakou, Bénin
| | - Fernand A. Guédou
- Centre de recherche du CHU de Québec, Université Laval, Québec, Québec, Canada
- Dispensaire IST, Centre de santé communal de Cotonou 1, Cotonou, Bénin
| | - Michel Alary
- Centre de recherche du CHU de Québec, Université Laval, Québec, Québec, Canada
- Département de médecine sociale et préventive, Université Laval, Québec, Québec, Canada
- Institut national de santé publique du Québec, Québec, Québec, Canada
- * E-mail:
| |
Collapse
|
3
|
Yang L, Hao Y, Hu J, Kelly D, Li H, Brown S, Tasker C, Roche NE, Chang TL, Pei Z. Differential effects of depot medroxyprogesterone acetate administration on vaginal microbiome in Hispanic White and Black women. Emerg Microbes Infect 2019; 8:197-210. [PMID: 30866773 PMCID: PMC6455113 DOI: 10.1080/22221751.2018.1563458] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 12/13/2018] [Accepted: 12/17/2018] [Indexed: 12/27/2022]
Abstract
The use of depot medroxyprogesterone acetate (DMPA), a 3-monthly injectable hormonal contraceptive, is associated with an increased risk of HIV acquisition possibly through alteration of the vaginal microbiome. In this longitudinal interventional study, we investigated the impact of DMPA administration on the vaginal microbiome in Hispanic White and Black women at the baseline (visit 1), 1 month (visit 2), and 3 months (visit 3) following DMPA treatment by using 16S rRNA gene sequencing. No significant changes in the vaginal microbiome were observed after DMPA treatment when Hispanic White and Black women were analysed as a combined group. However, DMPA treatment enriched total vaginosis-associated bacteria (VNAB) and Prevotella at visit 2, and simplified the correlational network in the vaginal microbiome in Black women, while increasing the network size in Hispanic White women. The microbiome in Black women became more diversified and contained more VNAB than Hispanic White women after DMPA treatment. While the Firmicutes to Bacteroidetes (F/B) ratio and Lactobacillus to Prevotella (L/P) ratio were comparable between Black and Hispanic White women at visit 1, both ratios were lower in Black women than in Hispanic White women at visit 2. In conclusion, DMPA treatment altered the community network and enriched VNAB in Black women but not in Hispanic White women. The Lactobacillus deficiency and enrichment of VNAB may contribute to the increased risk of HIV acquisition in Black women. Future studies on the impact of racial differences on the risk of HIV acquisition will offer insights into developing effective strategies for HIV prevention. Abbreviations: DMPA: depot medroxyprogesterone acetate; PCR: polymerase chain reaction; OTU: operational taxonomic unit; STI: sexually transmitted infections; VNAB: vaginosis-associated bacteria.
Collapse
Affiliation(s)
- Liying Yang
- Department of Pathology, New York University School of Medicine, New York, NY, USA
- Department of Medicine, New York University School of Medicine, New York, NY, USA
| | - Yuhan Hao
- Department of Pathology, New York University School of Medicine, New York, NY, USA
- Applied Bioinformatics Laboratories, New York University School of Medicine, New York, NY, USA
- Department of Biology, Center for Genomics and Systems Biology, New York University, New York, NY, USA
| | - Jiyuan Hu
- Department of Population Health, New York University School of Medicine, New York, NY, USA
- Department of Environmental Medicine, New York University School of Medicine, New York, NY, USA
| | - Dervla Kelly
- Department of Pathology, New York University School of Medicine, New York, NY, USA
| | - Huilin Li
- Department of Population Health, New York University School of Medicine, New York, NY, USA
- Department of Environmental Medicine, New York University School of Medicine, New York, NY, USA
| | - Stuart Brown
- Applied Bioinformatics Laboratories, New York University School of Medicine, New York, NY, USA
| | - Carley Tasker
- Department of Microbiology, Biochemistry and Molecular Genetics, Rutgers, The State University of New Jersey, New Jersey Medical School, Newark, NJ, USA
| | - Natalie E. Roche
- Department of Obstetrics, Gynecology & Women’s Health, Rutgers, the State University of New Jersey, New Jersey Medical School, Newark, NJ, USA
| | - Theresa L. Chang
- Department of Microbiology, Biochemistry and Molecular Genetics, Rutgers, The State University of New Jersey, New Jersey Medical School, Newark, NJ, USA
- Public Health Research Institute, Rutgers, The State University of New Jersey, New Jersey Medical School, Newark, NJ, USA
| | - Zhiheng Pei
- Department of Medicine, New York University School of Medicine, New York, NY, USA
- Department of Veterans Affairs New York Harbor Healthcare System, New York, NY, USA
| |
Collapse
|