Starting to have sexual intercourse is associated with increases in cervicovaginal immune mediators in young women: a prospective study and meta-analysis
Department of Global Health, University of Washington, Seattle, United States; Centre for Virus Research, Kenya Medical Research Institute, Nairobi, Kenya
Lynda Oluoch
Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
Catherine Kiptinness
Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, United States; Department of Laboratory Medicine & Pathology, University of Washington, Seattle, United States; Department of Medicine, University of Washington, Seattle, United States; Department of Epidemiology, University of Washington, Seattle, United States
Mimi Ghosh
Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, United States
Department of Clinical Sciences, Unit of Tropical Bacteriology, Institute of Tropical Medicine, Antwerp, Belgium
Kenneth Ngure
Department of Global Health, University of Washington, Seattle, United States; Department of Community Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
Nelly R Mugo
Department of Global Health, University of Washington, Seattle, United States; Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
Department of Obstetrics and Gynecology, University of Washington, Seattle, United States; Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, United States; Department of Medicine, University of Washington, Seattle, United States
Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, United States; Department of Global Health, University of Washington, Seattle, United States; Department of Medicine, University of Washington, Seattle, United States; Department of Epidemiology, University of Washington, Seattle, United States
Background: Adolescent girls and young women (AGYW) are at high risk of sexually transmitted infections (STIs). It is unknown whether beginning to have sexual intercourse results in changes to immune mediators in the cervicovaginal tract that contribute to this risk. Methods: We collected cervicovaginal lavages from Kenyan AGYW in the months before and after first penile-vaginal sexual intercourse and measured the concentrations of 20 immune mediators. We compared concentrations pre- and post-first sex using mixed effect models. We additionally performed a systematic review to identify similar studies and combined them with our results by meta-analysis of individual participant data. Results: We included 180 samples from 95 AGYW, with 44% providing only pre-first sex samples, 35% matched pre and post, and 21% only post. We consistently detected 19/20 immune mediators, all of which increased post-first sex (p<0.05 for 13/19; Holm-Bonferroni-adjusted p<0.05 for IL-1β, IL-2, and CXCL8). Effects remained similar after excluding samples with STIs and high Nugent scores. Concentrations increased cumulatively over time after date of first sex, with an estimated doubling time of about 5 months. Conclusions: Cervicovaginal immune mediator concentrations were higher in women who reported that they started sexual activity. Results were consistent across three studies conducted on three different continents. Funding: This research was funded by R01 HD091996-01 (ACR), by P01 AI 030731-25 (Project 1) (AW), R01 AI116292 (FH), R03 AI154366 (FH) and by the Center for AIDS Research (CFAR) of the University of Washington/Fred Hutchinson Cancer Research Center AI027757.
