CONTRACEPTIVE CHOICE, SEXUALLY-TRANSMITTED DISEASES, HIV-INFECTION, AND FUTURE FECUNDITY

Because contraception affects not only the risk of unplanned pregnancy , but also that of sexually transmitted infections, the choice of part icular methods is important to future fertility. However, certain trad e-offs are necessary. Contraceptives with the best record of preventin g pregnancy provide little protection against sexually transmitted dis eases (STDs). Conversely, those barrier methods with higher failure ra tes for pregnancy can reduce the risk of acquiring or transmitting an STD. For example, condoms used correctly and consistently provide the best protection against infection. Although spermicides reduce lower g enital tract bacterial STD, their effectiveness against HIV is still u nknown, In contrast to barrier methods, the intrauterine device is ass ociated with an increased risk for developing upper genital tract infe ction, primarily in the first month after insertion. Current literatur e raises paradoxical questions regarding the role of hormonal contrace ption in STD and pelvic inflammatory disease. Moreover, epidemiologica l studies are equivocal regarding the public health value of recommend ing dual methods of contraception, one to prevent unplanned pregnancy and the other to prevent STDs. Investigations to date have focused on the use of the male condom added to other methods of contraception. In general, where participants were using primary methods other than the condom, the more effective the primary contraceptive method was in pr eventing pregnancy, the lower the level of consistent use of the male condom. Continued biologic and behavioural research will be necessary to disentangle these complex relationships.