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Investigating the effects of contraceptive use on inflammation in the female genital tract

Hormonal contraceptives are used worldwide by women of reproductive age (15-49 years). Immune cells, cytokines and antimicrobial peptides play an important role in the protection of the female genital tract (FGT) against infections, including HIV and other sexually transmitted infections (STIs). Con...

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Main Author: Harryparsad, Rushil
Other Authors: Riou, Catherine
Format: Thesis
Language:English
English
Published: Department of Pathology 2026
Subjects:
Hormonal contraceptives
female
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access_status_str Open Access
author Harryparsad, Rushil
author2 Riou, Catherine
author_browse Harryparsad, Rushil
Riou, Catherine
author_facet Riou, Catherine
Harryparsad, Rushil
author_sort Harryparsad, Rushil
collection Thesis
description Hormonal contraceptives are used worldwide by women of reproductive age (15-49 years). Immune cells, cytokines and antimicrobial peptides play an important role in the protection of the female genital tract (FGT) against infections, including HIV and other sexually transmitted infections (STIs). Contraceptives are thought to cause biological changes in the FGT, possibly altering susceptibility to infection. This project aimed to investigate the biological changes caused by contraceptive use that may impact risk of HIV and STI acquisition. Clinical samples were collected from two hundred and thirty-two participants in three clinical trials: (1) Evidence for Contraceptive Options and HIV Outcomes (ECHO; South Africa); (2) Extended Duration of Sayana Press (Brazil); and (3) Lower Dose medroxyprogesterone acetate (MPA) Pharmacokinetic/Pharmacodynamic (Brazil and Dominican Republic) studies. STIs were assessed by multiplex polymerase chain reaction and reverse hybridisation, cervical CD4+ T cell frequencies by flow cytometry, vaginal cytokines by Luminex and antimicrobial peptides by enzyme-linked immunosorbent assay. In women randomized to levonorgestrel (LNG) implant, copper intrauterine device (copper-IUD) or depot medroxyprogesterone acetate (DMPA-IM; 150mg) in the ECHO trial, even though STI incidence was exceptionally high (107.9/100 wy), there were no significant differences in incidence between arms over three months following contraceptive initiation. Women randomized to DMPA-IM had a greater proportion of cervical 7+CD4+ T cells compared to copper-IUD. Those using LNG implant had an increased proportion of cervical β7+CD4+ T cells following contraceptive initiation and an increased proportion of Th17 cells compared to the copper IUD group. Copper IUD users had significantly higher concentrations of FGT human beta defensin (HBD)-1 and 2 compared to LNG implant and DMPA-IM users post contraceptive initiation. In the Lower Dose study, FGT interleukin (IL)-8 and HBD-1 concentrations were significantly lower three months post contraceptive initiation among women receiving 104mg or 105mg MPA compared to the pre-contraceptive follicular, but not luteal phase. No significant changes in immune mediators were observed in the Sayana Press study over a follow-up period of 12 months. The findings of this study contribute to growing knowledge of the effects of contraceptives on FGT immune factors that may influence susceptibility in infection.
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institution University of Cape Town (South Africa)
language English
eng
last_indexed 2026-07-01T04:02:49.491Z
license_str Not specified — see source repository
provenance_str_mv Harvested via OAI-PMH from UCTD — University of Cape Town Open Access Repository
publishDate 2026
publishDateRange 2026
publishDateSort 2026
publisher Department of Pathology
publisherStr Department of Pathology
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source_str UCTD — University of Cape Town Open Access Repository
spelling oai:open.uct.ac.za:11427/43413 Investigating the effects of contraceptive use on inflammation in the female genital tract Harryparsad, Rushil Riou, Catherine Bunjun, Rubina Masson, Lindi Deese, Jennifer Hormonal contraceptives female Hormonal contraceptives are used worldwide by women of reproductive age (15-49 years). Immune cells, cytokines and antimicrobial peptides play an important role in the protection of the female genital tract (FGT) against infections, including HIV and other sexually transmitted infections (STIs). Contraceptives are thought to cause biological changes in the FGT, possibly altering susceptibility to infection. This project aimed to investigate the biological changes caused by contraceptive use that may impact risk of HIV and STI acquisition. Clinical samples were collected from two hundred and thirty-two participants in three clinical trials: (1) Evidence for Contraceptive Options and HIV Outcomes (ECHO; South Africa); (2) Extended Duration of Sayana Press (Brazil); and (3) Lower Dose medroxyprogesterone acetate (MPA) Pharmacokinetic/Pharmacodynamic (Brazil and Dominican Republic) studies. STIs were assessed by multiplex polymerase chain reaction and reverse hybridisation, cervical CD4+ T cell frequencies by flow cytometry, vaginal cytokines by Luminex and antimicrobial peptides by enzyme-linked immunosorbent assay. In women randomized to levonorgestrel (LNG) implant, copper intrauterine device (copper-IUD) or depot medroxyprogesterone acetate (DMPA-IM; 150mg) in the ECHO trial, even though STI incidence was exceptionally high (107.9/100 wy), there were no significant differences in incidence between arms over three months following contraceptive initiation. Women randomized to DMPA-IM had a greater proportion of cervical 7+CD4+ T cells compared to copper-IUD. Those using LNG implant had an increased proportion of cervical β7+CD4+ T cells following contraceptive initiation and an increased proportion of Th17 cells compared to the copper IUD group. Copper IUD users had significantly higher concentrations of FGT human beta defensin (HBD)-1 and 2 compared to LNG implant and DMPA-IM users post contraceptive initiation. In the Lower Dose study, FGT interleukin (IL)-8 and HBD-1 concentrations were significantly lower three months post contraceptive initiation among women receiving 104mg or 105mg MPA compared to the pre-contraceptive follicular, but not luteal phase. No significant changes in immune mediators were observed in the Sayana Press study over a follow-up period of 12 months. The findings of this study contribute to growing knowledge of the effects of contraceptives on FGT immune factors that may influence susceptibility in infection. 2026-06-29T13:35:50Z 2026-06-29T13:35:50Z 2026 2026-06-29T13:24:58Z Thesis / Dissertation Doctoral PhD http://hdl.handle.net/11427/43413 en eng application/pdf Department of Pathology Faculty of Health Sciences University of Cape Town
spellingShingle Hormonal contraceptives
female
Harryparsad, Rushil
Investigating the effects of contraceptive use on inflammation in the female genital tract
thesis_degree_str Doctoral
title Investigating the effects of contraceptive use on inflammation in the female genital tract
title_full Investigating the effects of contraceptive use on inflammation in the female genital tract
title_fullStr Investigating the effects of contraceptive use on inflammation in the female genital tract
title_full_unstemmed Investigating the effects of contraceptive use on inflammation in the female genital tract
title_short Investigating the effects of contraceptive use on inflammation in the female genital tract
title_sort investigating the effects of contraceptive use on inflammation in the female genital tract
topic Hormonal contraceptives
female
url http://hdl.handle.net/11427/43413
work_keys_str_mv AT harryparsadrushil investigatingtheeffectsofcontraceptiveuseoninflammationinthefemalegenitaltract

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