Education And Debate

Hormonal markers of susceptibility to sexually transmitted infections: are we taking them seriously?

BMJ 2001; 323 doi: (Published 18 August 2001) Cite this as: BMJ 2001;323:394
  1. Loretta Brabin, reader, women's health (
  1. Academic Unit of Obstetrics and Gynaecology and Reproductive Health Care, St Mary's Hospital, Manchester M13 0JH
  • Accepted 17 May 2001

When the body is invaded by pathogens, each individual reacts with a battery of non-specific and specific immune defence mechanisms. Sex hormones play an important part in the host's resistance to sexually transmitted infections. This is shown by sex differences,1 variations in detection of infection according to phase of the menstrual cycle,2 increased susceptibility during pregnancy,3 and evidence that use of hormonal contraception predisposes to infection. 4 5 The mechanisms by which specific sex hormones modulate the immune system have been reviewed.6 This is a complex subject, and it is unfortunate that, in spite of its potential importance, no clear message about sex hormones has emerged or been harnessed to the development of strategies for controlling infection. This paper revisits some of the evidence that hormonal status influences susceptibility to sexually transmitted infections, especially in adolescents, and considers the practical implications of this evidence.

Summary points

Sex hormones influence susceptibility to sexually transmitted infections, especially in adolescents

Anatomical differences do not adequately explain sex differences in the epidemiology of genital herpes and HIV infection

The host's hormonal status, rather than high risk sexual behaviour, may govern the course of infection after a primary exposure to chlamydia or human papillomavirus

Menstrual irregularities indicate hormonal disturbance in adolescent girls

Strategies for preventing infection could be improved if the actions of sex hormones were better understood

Sex differences

The best example of sex differences in rates of infection and disease for …

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