Initiating contraception in sexually transmitted disease clinic setting: a randomized trial

Am J Obstet Gynecol. 2003 Aug;189(2):473-81. doi: 10.1067/s0002-9378(03)00493-9.


Objective: Our purpose was to determine the effectiveness of sexually transmitted disease (STD) clinic-initiated contraceptive care.

Study design: Nonpregnant women (n=877) attending an urban STD clinic using either no contraception or only condoms were randomly assigned to either an intervention (n=437) or control group (n=440). Both groups received condoms with spermicide and a referral list of primary care providers (PCP) for ongoing reproductive health care, and the intervention group also received enhanced contraceptive counseling, initial provision of contraception, and facilitated referral to a PCP. Outcomes measured at 4-, 8-, and 12-month follow-up were transition to a PCP, effective contraceptive use (ECU), interval pregnancy, and STD.

Results: The median time to PCP transition was 79 days for the intervention group versus 115 days for the control group (P=.007). Rates of ECU were higher for the intervention group than for control group at the 4-month visit (50% vs 22%, P<.0001) as well as the 8-month visit, although in the intervention group ECU diminished over the course of the study. During follow-up, pregnancy outcomes were documented for 229 women (26.1%), for an overall pregnancy rate of 38.2 per 100 person-years of follow-up. Of the 159 pregnancies defined by patient self-report, 153 (96.2%) were described as unintended and 32 (20%) resulted in a therapeutic abortion. The pregnancy rate was 15% lower in the intervention (105/437, 24.0%) than the control group (124/440, 28.2%) (P=.16), but this difference was not statistically significant.

Conclusion: The intervention helped women transition to a PCP and initiate ECU but did not significantly reduce the pregnancy rate. More intensive interventions are needed to prevent unintended pregnancy in this high-risk population.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Abortion, Therapeutic / statistics & numerical data
  • Adult
  • Ambulatory Care Facilities*
  • Condoms
  • Contraception*
  • Counseling
  • Female
  • Humans
  • Incidence
  • Middle Aged
  • Pregnancy / statistics & numerical data
  • Pregnancy Rate
  • Primary Health Care
  • Referral and Consultation
  • Sex Counseling
  • Sexually Transmitted Diseases* / epidemiology
  • Spermatocidal Agents
  • United States


  • Spermatocidal Agents