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

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.