Association between sexually transmitted infections and reproductive lifespan: analysis of the NHANES 1999-2023

Reproductive lifespan (RLS), defined as the interval from menarche to natural menopause, serves as a comprehensive indicator of a woman's reproductive capacity. Sexually transmitted infections (STIs) induce various outcomes, including accelerated ovarian aging, miscarriage, pregnancy loss, preterm birth, sexually tract microenvironmental dysregulation and decreased ovarian reserve markers Anti-Mullerian hormone (AMH). However, there is currently a rareness of population-bases epidemiological studies on the relationship between STIs and RLS. This study aimed to evaluate the association between STIs and RLS among females in the United States.

Using data from the National Health and Nutrition Examination Survey (NHANES) 1999-2023. Multiple linear regression models were constructed to assess the association between STIs and RLS. Interaction tests and subgroups analyses were conducted to assess heterogeneity across different subgroups.

The analysis included a nationally representative cohort of 1,715 women. After adjusting for potential confounding factors, HPV infection positive was significantly associated with a shorter RLS, corresponding to a reduction of 0.65 years (95% CI: -1.22, -0.07; P = 0.027). High-risk HPV was negatively associated with RLS (β= -1.26,95%CI: -2.04, -0.49, p = 0.001), indicating that higher HPV infection was associated with a shorter RLS, while non-high-risk HPV infection positive was associated with a reduction of 1.03 years (95% CI: -1.75, -0.32; P = 0.005). Subgroup analysis reveals high-risk HPV consistently showed stronger associations with shorter RLS, with interaction effects observed mainly for educational level (P for interaction = 0.018) and marital status (P for interaction < 0.001). Unfortunately, no significant associations were observed between RLS and other infections, including HSV-2, BV, TV, GC, and CT.

Our findings reveal that STIs impair female reproductive potential, with HPV infection in particular significantly shortening RLS. Prevent and control STIs will bring benefits to human reproductive health.