CDC Article-US Medical Eligibility Criteria for Contraceptive Use, 2010

40 MMWR June 18, 2010
TABLE. (Continued) Classifications for progestin-only contraceptives,* † including progestin-only pills, DMPA, and implants
Category
Condition
POP DMPA Implants
Clarifications/Evidence/Comments
Pelvic inflammatory disease (PID)
a. Past PID (assuming no current
risk factors for STIs)
i. With subsequent pregnancy 1 1 1
ii. Without subsequent
1 1 1
pregnancy
b. Current PID 1 1 1
Comment: Whether POCs, like COCs, reduce the risk for
PID among women with STIs is unknown, but they do not
protect against HIV or lower genital tract STI.
STIs
a. Current purulent cervicitis or
1 1 1
chlamydial infection or gonorrhea
b. Other STIs (excluding HIV and
1 1 1
hepatitis)
c. Vaginitis (including Trichomonas
1 1 1
vaginalis and bacterial vaginosis)
d. Increased risk for STIs 1 1 1 Evidence: Evidence suggests a possible increased risk
for chlamydial cervicitis among DMPA users at high risk for
STIs. For other STIs, either evidence exists of no association
between DMPA use and STI acquisition or evidence is
too limited to draw any conclusions. No evidence is available
about other POCs (151–158)
HIV/AIDS
High risk for HIV 1 1 1 Evidence: The balance of the evidence suggests no association
between POC use and HIV acquisition, although
findings from studies of DMPA use conducted among higher
risk populations have been inconsistent (159–183).
HIV infection § 1 1 1 Evidence: Most studies suggest no increased risk for HIV
disease progression with hormonal contraceptive use,
as measured by changes in CD4 cell count, viral load, or
survival. Studies observing that women with HIV who use
hormonal contraception have increased risks for STIs are
generally consistent with reports among uninfected women.
One direct study found no association between hormonal
contraceptive use and increased risk for HIV transmission to
uninfected partners; several indirect studies reported mixed
results about whether hormonal contraception is associated
with increased risk for HIV-1 DNA or RNA shedding from the
genital tract (171,184–200).
AIDS § 1 1 1 Clarification: Drug interactions might exist between
hormonal contraceptives and ARV drugs; refer to the
section on drug interactions.
Other Infections
Schistosomiasis
a. Uncomplicated 1 1 1 Evidence: Among women with uncomplicated schistosomiasis,
limited evidence showed that DMPA use had no
adverse effects on liver function (201).
b. Fibrosis of liver§
(if severe, see cirrhosis)
1 1 1
Tuberculosis §
a. Nonpelvic 1 1 1
b. Pelvic 1 1 1
Clarification: If a woman is taking rifampicin, refer to the
section on drug interactions. Rifampicin is likely to decrease
the effectiveness of some POCs.
Malaria 1 1 1