Safety net or double-edged sword? Long-acting reversible contraception (LARC) use and STBBI risk in young Canadians

Canadians under the age of 25 are at increased risk for chlamydia and gonorrhea, both of which are surging across Canada. Adolescent girls and young women merit special attention, bearing a disproportionately high burden of disease; this is especially important as both chlamydia and gonorrhea are often asymptomatic in females, which can delay treatment, increase the likelihood of continued transmission, and lead to secondary complications like pelvic inflammatory disease (potentially compromising fertility). As disease incidence continues to climb in this subgroup, so to does the promotion of long-acting reversible contraception (LARC) like intrauterine devices (IUDs). Despite their impressive contraceptive performance, LARC methods do not offer any protection against STBBIs; additional use of barrier methods (condoms) is therefore essential, but this is considerably less common among LARC users than users of other types of contraception. The issue appears to be amplified in younger groups, which is troubling given their increased risk for STBBIs. The proposed exploratory work is a direct response to a call for additional research on LARC use and STBBI risk among young adults. Our goal is not to deter young Canadians from using these highly-effective forms of contraception; rather, we aim to inform clinical and public health practice as these methods become more prevalent. We have two overarching aims, both of which lay the foundation for future work in this domain: 1.Conduct a systematic review and meta-analysis on the relationship between LARC use and STBBI risk in people under 25, focusing specifically on adolescent girls/young women. 2.Estimate the population-level impact of LARC on chlamydia/gonorrhea incidence among adolescent girls and young women in Ontario.