Contraception and STIs in women over 40

Transcription

1 Contraception and STIs in women over 40 Epidemiology Brigitte Frey Tirri ESC Congress The Hague, The Netherlands 19 to 22 May 2010

2 Some Datas WHO Incidence of bacterial curable STIs per year: >330 million all over the world - 16 million in western europe - Incidence of new HIV Infection : million (2006) Gerbase AC et al. Global prevalence and incidence estimates of selected curable STDs. Sex Transm Infect 1998-,74 (suppl1):s Holmes K.K. sexually transmitted diseases.4th edition

3 Consequences Enormous problem for medicine and for public health services worldwide. Specialy in underdeveloped countries of South-East Asia, Africa and Latin America STIs belong to the leading causes of illness and death. considerable health consequences, social and economic impact.

4 Epidemiology Within the framework of AIDS prevention campaigns dramatic reduction of bacterial STIs in western Europe between 1980 and 1995 But increase of reported infections since 1995

5 Epidemiology Fenton KA et al: ESSTI: Recent trends in the epidemiology of swxually transmitted infection in the EUI Sex Tranm Infect 2004;80:

6 Notifications of infectious syphilis

7 Trends in rates of genital chlamydial infection

8 Source of STI Datas Data sources vary in their coverage, detail and accuracy Wide variations in STI treatment and care services Different reporting systems: Voluntary or mandatory laboratory reporting Incomplete datas reported

9 Study designs Datas based on prospective cohort studies of incidence Often based on sporadic prevalence surveys, or solely on anecdotes Populations sampled in developing societies have most often included STI clinic patients or family planning clinic patients, who are not representative of the total population

10 Reasons for Increase of STI (1) Societal and behavioural factors: Decreases in marriage Delayed childbirth Population movement (migration) Sexual behaviour: - increase in rates of partner acquisition - inconsistent condom use - homosexual sexual behaviour

11 Reasons for Increase of STI (2) Technological developpements - improving our ability to diagnose and report STIs across Europe Changes in STI screening and diagnostic testing

12 What about women over 40? Women over 40- irresistible

13 Women over 40 few studies to find in the internet: To small cases to be of interest?

14 Sexual activity in women YEARS (AUSTRALIA) once / week 32% intercourse several times/ week 25% once in a month 22% (Deeks and Mc Cabe, 2001)

15 STIs HSV-2: second highest among women 30-39y. HIV- Infection highest among 30-34y. AIDS ( ) doubled in women older than 50 Chlamydia and gonorrhoea infections show lower rates, except some subgroups e.g. african american. Are they still having sex? STIs and unintended pregnancy among mit-life women. Sherman Christy et al.

16 Reasons for unprotected intercourse in women over 40. Review of 16 studies: Individual /personal reasons Interpersonal reasons Societal reasons Adejoke B. et al. Reasons for unprotected intercourse in adult women.. J womens health 2007

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18 Prevention behavioural habits Sexual history Screening vaccination, therapy

19 Prevention of STI in the office: An often missed opportunity. Study to evaluate the activity of prevention counseling in sexual health through Doctors in the office. Study to evaluate the sexual activity of the patients Study to evaluate the acceptance from patients to be asked About sexual health Institut universitaire de medecine sociale et préventive de Lausanne

20 Often asked questions to evaluate the history of a young adult

21 Reserved reaction of the p. Patient is not interested No time Doctors dont feel competent enough Doctor s feel embarassed Not beeing payed enough for this job Doctors are not interested in Reasons why doctors don t discuss sexual themes.

22 What should be asked in a discussion about sexual health?

23 Talking about sexuality: what do patients think about that?

24 No probabely not No, absolutely not Yes, quite sure Yes, sure Do you think it is normal that a doctor askes you about your sexual life?

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28 Abortionrate Age % UK 2006 (The ESHRE Capri Workshop Group, 2009)

29 Contraceptive methods for women over 40 Method Failure Non-contraceptive benefits Main risks rate (%) Natural Failure Barrier Failure Condom 15 STI prevention Not available OC 8 Reduces bleeding, bone loss, and Arterial and venous ovarian and endometrial cancer thrombosis risks Progestin only 8 Reduces ovarian and endometrial Irregular bleeding cancer risks Copper IUD < 1 Reduces endometrial cancer risks Irregular bleeding LNG IUS < 1 Reduces bleeding Expulsion Female Sterilization < 1 Reduces ovarian cancer risks Not reversible Male sterilization < 1 Not reversible

30 Europe: different contraceptive methods for women over 40 Sterilization OCP IUD Condom Rhythm Other All Year Female Male (+horm) Czech Repud France Greece Italy Netherlands Spain Switzerland United Kingdom (The ESHRE Capri Workshop Group, 2009)

31 effectivness of the condom for STI prevention Effectiveness of condoms STI men women HIV (80%) (80%) GO? ( ) Chlamydien? ( )? ( ) Trichomonaden?? Lues?? HSV I / II?? Weller S, Davis AR. The Cochrane Library, Issue 1, HPV Condylomata acc. Dysplasien Clinical effectiveness group (BASHH) guidelines 2001, 2002