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Heavy metals and prevalence of sexually transmitted infections: a cross-sectional study using data from the National Health and Nutrition Examination Survey (NHANES) 2003-2016

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Summary

Cross-sectional NHANES 2003-2016 study examining urinary metals against chlamydia and HPV infection prevalence (N approximately 4,363-4,370, ages 15-39 for HPV, 18-39 for chlamydia). Urinary antimony was independently associated with higher chlamydia prevalence (PR = 1.20, 95% CI 1.01-1.44) and HPV 16/18 (PR = 1.07, 95% CI 1.02-1.13) in the full sample, with stronger associations in females (chlamydia PR = 1.30, HPV 16/18 PR = 1.27). No significant association in males. This is interpreted by the authors as potential Sb-mediated immunosuppression.

Key numbers

Urinary Sb geometric means (ng/mL = microg/L), NHANES 2003-2016:

  • Males: 0.05 microg/L (SE 0.00)
  • Females 18-25: 0.07 microg/L (SE 0.00)
  • Females 26+: 0.05 microg/L (SE 0.00)
  • By race: Hispanic 0.07, NH White 0.05, NH Black 0.04, Other 0.04

Adjusted prevalence ratios for antimony (per one-unit increase in log Sb):

Overall sample:

  • Chlamydia: PR = 1.20 (95% CI 1.01-1.44)
  • HPV 16/18: PR = 1.07 (95% CI 1.02-1.13)

Females only:

  • Chlamydia: PR = 1.30 (95% CI 1.05-1.67)
  • HPV 16/18: PR = 1.27 (95% CI 1.11-1.46)

Males: no significant association for Sb with any STI outcome.

Evidence Fitness

Modeled or limited evidence. Cross-sectional design; urinary Sb is a snapshot measure with high within-person variability. The STI associations are consistent with mechanistic evidence of immunosuppression by Sb but cannot establish causality.

Methods (brief)

NHANES 2003-2016, N approximately 4,363-4,370. Chlamydia and high-risk HPV by laboratory confirmation. Urinary metals by ICP-MS. Poisson regression with robust variance, adjusted for age, smoking, race/ethnicity, sex, poverty-income ratio. Sex-stratified analyses and quintile g-computation metal mixture analysis.

Implications

  • Certification: a potential immune-function endpoint for urinary Sb; pattern is sex-specific and consistent with endocrine-disrupting mechanisms.
  • Courses: illustrates that heavy-metal panels typically designed for cardiometabolic outcomes may also capture immune endpoints.
  • App: not applicable.
  • Microbiome: not addressed.

Provenance notes

Open access, CC BY-NC-ND. File from PMC OA S3 (PMC13104216).

Update history

No substantive edit history is available in this build. The full commit record is available in git.

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