contraceptives | MY SPECIAL DOCTOR

In recent weeks, there has been much discussion of regional and national initiatives directed toward offering free condoms and other contraceptives to youth and disadvantaged populations. As is often the case when it comes to sexuality, the proposed measures have elicited divided opinions, based more on ideological considerations and political expediency than public health protection, underestimating the seriousness of the situation.

Epidemiological reality says that among Italian under-25s. sexually transmitted diseases (STDs) are clearly on the rise, creating not only serious discomfort for those who experience them, but also entailing non-negligible risks to fertility and reproductive health (especially women’s) and an additional cost to the National Health Service (NHS), which has to bear the burden of their treatment.

The most recent data on STDs published by theNational Institute of Health indicate that:

Between 2010 and 2015, the number of people with a confirmed STD increased, while the number of foreigners in Italy with a confirmed STD has stabilized over the past decade (in essence, new infections mainly affect Italians);
Between 2004 and 2015, reports of ano-genital condylomas (caused by Human Papilloma virus, HPV, against which an effective vaccine has been available for a decade) increased by 153 percent;
Since 2008, cases of Chlamydia trachomatis infection have steadily increased, especially among adolescent girls and young women (15-24 years old);
Since 2000, stage I-II syphilis cases have increased by 350% since the 1990s (meaning they have more than tripled);
Between 2010 and 2015, cases of latent syphilis (i.e., without obvious symptoms) and gonorrhea also increased slightly;
Between 2008 and 2015, the proportion of HIV+ people among people with a confirmed STD increased (it should be remembered that the presence of an STD facilitates further HIV infection during risky relationships);
In 2015, the prevalence of HIV infection among people with a confirmed STD was about sixty times higher than that estimated in the general Italian population.

Additional data collected by the AIDS Operations Center (AOC) of ISS related to HIV infection, updated in 2017, report that:

3,443 new diagnoses of HIV infection were reported in 2017, representing an incidence of 5.7 new cases per 100,000 residents (similar to other European countries);
The incidence of new HIV+ diagnoses declined slightly between 2012 and 2015, stabilizing thereafter for all modes of transmission;
In 2017, the highest incidence of HIV infection involved young adults (25-29 years old);
In general, new HIV+ diagnoses were mainly related to transmission of the virus during heterosexual intercourse, while new infections during homosexual intercourse prevailed in the male population;
In recent years, the number of women newly diagnosed with HIV+ has remained constant, as did the number of new diagnoses among foreign persons between 2012 and 2017.

What do these data tell us as a whole? First, that some severe STDs that had become “niche” infections in the late twentieth century (syphilis, chlamydia, gonorrhea, etc.) have once again become a serious public health problem, especially among young people. Second: that information/education about STDs and associated risks coupled with active prevention interventions, such as promoting condom use during all types of sexual intercourse, can substantially reduce their prevalence, as the case of HIV infection shows.

Reliable information on STDs and prevention can be obtained from the websites of the Ministry of Health (http://www.salute.gov.it/portale/news/p3_2_6_1_1.jsp?lingua=italiano&menu=campagne&p=dacampagne&id=120), COA-ISS (http://old.iss.it/ccoa/index.php?lang=1) and EpiCentro (http://www.epicentro.iss.it/temi/ist/aggiornamenti.asp).

Sources

Salfa MC et al. Sexually Transmitted Infections: update of data from the two Sentinel Surveillance Systems active in Italy as of December 31, 2015. Not Ist Super Health 2017;30(7-8):3-27
Istisan Newsletter 2018; Vol. 31(9):Supplement 1
Suligoi B, Salfa MC. Sexually transmitted infections. How to recognize and prevent them. Editorial Pathways by Carocci publisher, Rome – 2018).

The pill is considered the most effectivecontraceptive. It can happen, however, to get pregnant despite taking the drug. If malabsorption is ruled out, for example by vomiting or diarrhea, the simplest explanation is that the woman forgot an intake, or did something wrong. A new study, however, opens up new scenarios.

The study

Research from the University of Colorado School of Medicine suggests that some women carry a genetic variant that interferes with contraceptive hormones, putting them at risk of unwanted pregnancies. Conducting the study was Aaron Lazorwitz’s group, which suspected that there might be more behind the failure of hormonal contraceptive systems than human error. As reported in Inverse, the research team argues that each woman might respond differently to the drug.

Genetic variants

The scientists initiated a study of pharmacogenomics, a branch of research that investigates the relationship between genetic variants and the variability in drug response that exists among individuals. They recruited 350 fertile women (average age 22.5 years) who had been using a hormone implant for contraceptive purposes for 12-36 months, and analyzed their genomes, looking for variants in genes involved in hormone metabolism.

The results

What has emerged of interest concerns a genetic variant. About 5 percent of the sample, in fact, were found to carry a variant of the Cyp3a7*1c gene, which appears to be responsible for lowering the levels of hormones released by the contraceptive in the blood. Women with this genetic variant had a significantly lower proportion of contraceptive hormones in their bloodstream than non-carriers, despite the fact that the implantation method releases a fixed amount for all. Even for contraceptives toward personalized medicine.It is well known that the pill is the safest means of contraception unless….. one forgets to take it or, due to vomiting or diarrhea, there is a problem with absorption.But are we really sure that this is the case?Prof. Aaron Lazorwitz’s group at the University of Colorado conducted a study of Pharmacogenomics (a branch of research that relates genetic variants in individuals to the incidence of drug response) on 350 women of childbearing age who had been taking the contraceptive pill for 12-36 months, analyzing their genomes for individual variations in genes involved in hormone metabolism.The research, published in Inverse, showed that 5 percent of the women examined carried a variant of the gene Cyp3a7*1c ( a gene that contributes to hormone level lowering), so significantly less contraceptive hormones circulated in their bloodstream than in other women.This supports the hypothesis that each woman, might respond differently to the administration of the same amount of hormones.