Category: Infection

Urinary tract infections are not only painful, unpleasant, and potentially hazardous but also present a considerable challenge for physicians. They’re difficult to diagnose quickly, and conventional diagnostic typically methods take several days. These are several days in which the doctor usually prescribes a treatment, without being sure whether or not it will actually be effective. Electron micrograph of phages. Image credits: Matthew Dunne / ScopeM / ETH Zurich. A team of researchers at ETH Zurich wanted to have a better diagnostic tool. In partnership with Balgrist University Hospital, they have developed a rapid test that uses bacteriophages — viruses that infect bacteria — to identify the pathogens that cause the infection. The team genetically modified the phages to make them more efficient to target bacteria. Each type of phage targets only one particular type or strain of bacteria. The researchers led by Martin Loessner are now taking advantage of this characteristic with their new rapid test. Better testing for bladder infections Initially, the researchers focused on identifying phages capable of effectively targeting the three primary bacteria responsible for urinary tract infections: Escherichia coli, Klebsiella, and Enterococci. These natural phages then underwent modifications to prompt any bacteria they infect to generate a readily detectable light signal. This method enabled the researchers to reliably detect the pathogenic bacteria from a urine sample in less than four hours – instead of the several days of conventional methods. It’s still early days, but once further refined, the approach could enable the researchers to prescribe antibiotics right after diagnosis. But it doesn’t end there. This method also allows doctors to predict which patients are likely to respond well to tailored phage therapy. This is because the strength of the light signal produced during the assay shows how efficient the phages are in attacking bacteria. The stronger the glow, the better the bacterium will respond to the therapy — so clinicians can prescribe the most effective treatment from the get go. Phage therapies go way back but were largely left behind in Western countries with the discovery of penicillin. However, as antibiotic resistance increases, they are increasingly becoming a subject of interest. They also have the important advantage of going after one single bacterium, instead of trying to cover a wide spectrum, as many antibiotics do. However, previous approaches had one problem. “Phages aren’t interested in completely killing their host, the pathogenic bacterium,” Samuel Kilcher, a study author, said in a statement. To address this, the team genetically modified the phages. These can now produce new phages in the infected host and their own antibiotics. “There are also many academic and commercial clinical trials underway worldwide that are systematically investigating the potential of natural and genetically optimized phages,” Matthew Dunne, study author, said in a statement. However, there’s a long way before this happens, as extensive clinical studies still need to be carried out. While this was only a proof of concept for now, the team will now test its efficacy in a clinical trial with a group of selected patients. The findings were published in this study and in this one, both in the journal Nature Communications.

Two cases of Vibrio, a potentially serious and sometimes fatal illness, were reported in Dare County from July 20 to 25, the local health department announced today. The new cases bring the statewide total to 47 so far this year, according to North Carolina health department data. This number is significantly higher than the 31 cases reported for all of 2017. In 2019, the state logged 41 cases. Vibrio bacteria is found naturally in warm sea water and brackish water. People can contract Vibrio by getting the contaminated water in open wounds, cuts, sores, punctures or burns. For example, people who cut themselves while peeling crabs or stepping on sharp objects on the shore and then coming into contact with the bacteria can be at risk. People can also become ill with Vibrio after eating raw or undercooked shellfish, especially oysters. Signs of infection include fever and chills, nausea or vomiting, or a skin infection that appears red and warm to the touch. People should seek medical attention immediately if they are experiencing symptoms after eating shellfish or being exposed to seawater. Those at higher risk for infection and complications include those with compromised immune systems, especially those with chronic liver disease: https://www.cdc.gov/vibrio/faq.html. Ocean temperatures along the North Carolina coast are running five to seven degrees above average for July. (Map: NOAA) Most cases of Vibrio in the U.S. occur from May through October, when water temperatures are warm. But climate change is heating up the oceans, lengthening the seasons when the bacteria can thrive — and extending the Vibrio’s range farther north. This summer abnormally hot marine waters have spread from the Gulf of Mexico, the Caribbean and north to the mid-Atlantic. For example, at Oregon Inlet on the Outer Banks the water temperature today is 87.3 degrees, according to federal weather data. The average water temperature for July at that monitoring station is 80.3 degrees. Farther south in Beaufort, the water is 86.9 degrees, more than seven degrees higher than the monthly average. At 85.5 degrees, Wilmington and Wrightsville are running five to seven degrees hotter than average. The USDA reported last month that climate change is expected to increase the human and financial costs of Vibrio infections. According to scientific projections, U.S. cases of illness from Vibrio infections could increase 50% by 2090 compared with 1995 because of higher sea surface temperatures associated with moderate increases in greenhouse gas concentrations, the USDA report said. Annual total cost of these illnesses more than doubles from nearly $2.6 billion in 1995 to $6.1 billion in 2090 (in 2022 dollars), based on this scenario. About 95% of total costs are attributable to deaths caused by Vibrio infections, according to the USDA.

TUESDAY, July 25, 2023 (HealthDay News) — Results from more than 26,000 respiratory tests in late 2022 found simultaneous infections with COVID-19, influenza or respiratory syncytial virus (RSV) in more than 1% of positive tests. Co-infections were especially widespread in children and teens. In people under age 21, researchers saw a 6% co-infection rate of SARS-CoV-2 and influenza A.

by KOMO News Staff Tue, July 25th 2023, 10:11 PM UTC A photo showing the outside of the Tacoma Pierce County Health Department in Tacoma, Wash. A woman with tuberculosis was under home monitoring and treatment and is now deemed no longer infectious. (KOMO)

New findings to be presented at AACC 2023 Annual Scientific Meeting ANAHEIM, Calif., July 25, 2023 /PRNewswire/ — Today, at the 2023 AACC Annual Scientific Meeting & Clinical Lab Expo, scientists will present new data about rates of co-infections with SARS-CoV-2, influenza, and respiratory syncytial virus (RSV) in the United States, providing one of the first snapshots of the interplay among these common but potentially deadly viruses. Their work could lead to better diagnosis and patient management for all three illnesses. The research, which garnered results from more than 26,000 respiratory tests of U.S. adults and children in late 2022, found co-infections in more than 1% of positive samples. Co-infections were especially widespread among those under the age of 21. The findings could have implications for how clinicians approach respiratory disease testing during future epidemics and seasonal outbreaks. “With changing behaviors as the COVID pandemic began to recede, we felt it was important to investigate the resurgence of other respiratory viruses and potential incidents of co-infection, especially with the additional circulation of SARS-CoV-2,” said lead scientist George Pratt, PhD, at Quest Diagnostics in Marlborough, Massachusetts. Household respiratory viruses such as RSV pose major burdens on public health systems. Co-infections tend to occur when there are multiple outbreaks of respiratory diseases, such as in winter during flu season. Patients with multiple infections have a higher risk of severe disease and treatment complications, making it critical to understand how common co-infections are in the general population. Co-infections can be especially problematic during an epidemic. For example, in late 2022, there was a spike in cases of RSV in the United States, which coincided with the ongoing spread of COVID-19 and the appearance of seasonal influenza. But researchers have lacked the data to define rates of co-infections during this outbreak of RSV, which until recently had no vaccine. Now, Pratt and colleagues present one of the first wide-ranging studies of co-infection rates in the U.S. during the COVID-19 pandemic. In a retrospective study, they analyzed 26,657 respiratory tests from a clinical laboratory, gathered during a 107-day period in autumn of 2022. These tests included 9,800 samples from pediatric patients under the age of 21. The scientists tested the samples for RSV, SARS-CoV-2, and influenza A/B with the Roche cobas® and Cepheid Xpert® platforms. “The most novel part of our research is the large sample size of results we had available as a part of co-testing in the Northeast,” Pratt said. “Being able to look at over 26,000 test results was a great asset for our study.” Overall, the tests revealed that co-infections with two or more of the viruses occurred in 1.33% of positive results and in .55% of the studied samples. The positivity rates varied by the viruses involved, ranging from .38% in adults for both SARS-CoV-2 and RSV to 2.28% in adults for both influenza A and SARS-CoV-2. However, co-infection rates in the pediatric group were higher than in the adult population for all three viruses. Pratt noted that his team was surprised by the very high 6% co-infection rate of SARS-CoV-2 and influenza A in those under 21, which he said matched what was previously observed by the Centers for Disease Control and Prevention in hospitalized pediatric patients. “As we experience more flu-seasons and future epidemics of respiratory viruses, we’ll be able to acquire more co-infection rate data,” Pratt said. “Our current work would make a useful data point to help evaluate whether future co-infection rates are shrinking or growing,” he added. About the 2023 AACC Annual Scientific Meeting & Clinical Lab ExpoThe 2023 AACC Annual Scientific Meeting offers 5 days packed with opportunities to learn about exciting science from July 23-27 in Anaheim, California. Plenary sessions will explore microbiome-directed therapies for undernutrition, big data for practicing precision medicine, healthcare equity, cardiovascular disease in women, and promising sickle cell disease treatments. At the Clinical Lab Expo, more than 900 exhibitors will fill the show floor of the Anaheim Convention Center in Anaheim, California, with displays of the latest diagnostic technology, including but not limited to COVID-19 testing, artificial intelligence, point-of-care, and automation. About the Association for Diagnostics & Laboratory Medicine (ADLM) Dedicated to achieving better health through laboratory medicine, ADLM (formerly AACC) brings together more than 70,000 clinical laboratory professionals, physicians, research scientists, and business leaders from around the world focused on clinical chemistry, molecular diagnostics, mass spectrometry, translational medicine, lab management, and other areas of progressing laboratory science. Since 1948, ADLM has worked to advance the common interests of the field, providing programs that advance scientific collaboration, knowledge, expertise, and innovation. For more information, visit www.myadlm.org. CONTACT: Bill MaloneAACCDirector, Communications & News Publications(p) 202.835.8756[email protected] Molly PolenAACCSenior Director, Communications & PR(p) 202.420.7612(c) 703.598.0472[email protected] SOURCE ADLM

Cases of tuberculosis (TB) — an illness that kills more people than any other infectious disease — rose in the U.S. during 2022, per the Centers for Disease Control and Prevention (CDC). And some doctors are concerned that limitations of testing at the border could be partly to blame for the surge. In 2021, the disease infected nearly 11 million people and caused 1.6 million deaths worldwide, according to the World Health Organization (WHO). Tuberculosis is a highly contagious disease caused by a bacterial infection. It primarily affects the lungs, but can also affect the brain, kidneys and spine. Required testing may have limitations: CDC The CDC states that all refugees ages two and older must be tested for tuberculosis before entering the U.S. TEXAS CITY REPORTS SYPHILIS OUTBREAK AMID ‘LIMITED SUPPLY’ OF PENICILLIN DRUG “By law, refugees diagnosed with an inadmissible condition are not permitted to depart for the United States until the condition has been treated,” the agency states on its website. Some doctors are concerned that limitations of testing at the border could be partly to blame for the rise in tuberculosis cases. (iStock) The CDC uses its Electronic Disease Notification (EDN) system to notify federal, state and local health departments of any immigrants and refugees who are found to have medical conditions that require follow-up. There are limitations to that process, however. “By design, the EDN system only collects information for the approximately 10% of immigrants who have an overseas medical classification,” explained Neha Sood, health communication specialist for the CDC in Atlanta, Georgia, in a statement to Dr. Marc Siegel, clinical professor of medicine at NYU Langone Medical Center and a Fox News medical contributor. “Human error likely caused some losses, resulting in possible underestimates of immigrants with medical classifications.” “Thus, DHS [Department of Homeland Security] data were used to approximate the immigrant denominators.” There is also some degree of human error that comes into play, Sood added. “Because data transfer for immigrants during the study period primarily relied on staff at ports of entry to correctly review, retain and route paper forms for each immigrant with a medical classification, human error likely caused some losses, resulting in possible underestimates of immigrants with medical classifications,” she said. DENGUE FEVER CASES COULD REACH NEAR-RECORD HIGHS THIS YEAR: WHAT TO KNOW ABOUT THE TROPICAL INFECTIOUS DISEASE While health departments are “encouraged and provided incentives” to share the results of immigrants’ testing with the CDC, Sood said there is always the chance of “underreporting.” She added, “The proportion of immigrants, refugees and eligible others who completed a post-arrival examination might be higher than indicated in this report.” Although the CDC has “comprehensive surveillance systems” to track communicable diseases within the U.S., the agency does not track diseases by immigration status, Sood explained. Tuberculosis is a highly contagious disease that primarily affects the lungs, but can also affect the brain, kidneys and spine. (Spencer Platt/Getty Images) Linda Yancey, M.D., a specialist in infectious disease who is affiliated with Memorial Hermann Health System in Houston, Texas, said she regularly sees people who have screened positive for the disease and need treatment to prevent developing symptomatic illness. “Tuberculosis is quite common in Texas, especially in the big cities,” she told Fox News Digital. “Houston is an international port of entry, so we get people from TB-endemic areas coming here frequently.” Most of the imported tuberculosis cases seen at Memorial Hermann are among people coming from Africa and the Indian subcontinent, Yancey said. “People can be exposed to TB years before they become contagious.” <!–> “This is why immigrants coming into the U.S. are screened at the time of entry,” she said. “People can be exposed to TB years before they become contagious,” she went on. “By doing early screening, we are able to treat people long before they develop severe pneumonia.” WHY ANTIBIOTICS MAY NOT HELP PATIENTS SURVIVE THEIR VIRAL INFECTIONS: NEW RESEARCH Immigrants who have positive screenings are given three to four months of pills to protect their TB from developing into an illness, Yancey said. In a 2022 study by the University of Texas, researchers analyzed patterns in tuberculosis patients who had been diagnosed when crossing into the U.S. from the Mexican state of Tamaulipas, which serves as a “migration waypoint.” A diagnosis of tuberculosis can be made via a skin test or a blood test. (iStock) The study, which was published in the Journal of Immigrant and Minority Health, found that an average of 30% of immigrants screened positive for tuberculosis over an eight-year period. Immigrants with tuberculosis may be less likely to get successful treatment due to various factors, the study authors also wrote in a discussion of their findings. The barriers to treatment that were cited included mobile living conditions, economic constraints, fear of deportation and the policy of the host country to provide free TB therapies. Drug-resistant tuberculosis poses treatment challenge Another concern is the type of TB that potentially could be coming into the U.S. James Hodges, M.D., an internist in Waco, Texas, is concerned that immigrants are bringing in a drug-resistant strain of the disease. “Immigrants who are positive for tuberculosis are more likely to have a drug-resistant type.” –> “I have found that immigrants who are positive for TB are more likely to have a drug-resistant type,” he told Siegel. “This is likely due to the over-the-counter meds and antibiotics that are available in Mexico and other central and South American countries — these patients have incompletely treated coughs on their own,” Hodges continued. “This is becoming more common with the last two years of an open border,” Dr. Hodges of Waco, Texas, said of drug-resistant tuberculosis cases entering the United States of America. (iStock) “This is becoming more common with the last two years of an open border.” Tuberculosis treatments need to be “specialized, complex regimens,” Dr. Siegel explained. “Here in the U.S., we use INH, Rifampin, PZA, Ethambutol and others. If you use an over-the-counter antibiotic that only partially

Chris Hani Baragwanath Hospital in Johannesburg has recorded the most hospital infections. Sydney Seshibedi A total of 7 457 patients were infected at public health facilities in Gauteng. Chris Hani Baragwanath Hospital recorded the most – 1 542 infections. This was revealed by Nomantu Nkomo-Ralehoko in the Gauteng legislature. Johannesburg’s Chris Hani Baragwanath Hospital recorded the most hospital-acquired infections in 2022, primarily due to poor infection control measures. This was according to Gauteng Health MEC Nomantu Nkomo-Ralehoko, in a written response to questions by the DA’s Jack Bloom in the Gauteng legislature. According to Nkomo-Ralehoko, in 2022, 7 457 of 116 366 patients got nosocomial infections, of which 5 032 were in the seven central and tertiary hospitals in the province. “The technical name for hospital-acquired infections is nosocomial, which refers to infections picked up in hospitals, often caused by organisms resistant to antibiotics. “The most prevalent nosocomial infection is CRE/CPE, which are Carbapenem-resistant or Carbapenemase-producing bacteria that cause a variety of infections, including urinalysis tract infections, wound infections, gastroenteritis, meningitis, septicaemia and pneumonia,” Bloom said. READ | Hospital food supply: Several service providers voluntarily terminate contracts with Gauteng health dept In her response, Nkomo-Ralehoko said there were weekly and monthly healthcare-associated infection surveillance records, but no data was collected for 2020 and 2021 because of Covid-19. Nkomo-Ralehoko said 1 542 infections were reported at Chris Hani Baragwanath Hospital. “Whereas Chris Hani Baragwanath Hospital had 376 nosocomial infections in 2014, these have rocketed to 1 542 last year,” Bloom said. Steve Biko Academic Hospital recorded the second highest number of hospital-acquired infections (1 365), followed by Charlotte Maxeke Hospital (1 157) and Helen Joseph Hospital (613). Other tertiary hospitals included Kalafong Hospital (337), George Mukhari Hospital (312) and Tembisa Hospital (238). Bloom said nine regional hospitals had accounted for 1 617 of all hospital-acquired infections. Among the 12 smaller district hospitals, the Kopanong and Odi Hospitals had the highest number of nosocomial infections – 194 and 176 respectively. “The antibiotic-resistant infections are a particular horror as they are difficult to treat, leading to longer hospital stays and sometimes even death. “It is distressing that more than one in 20 patients will pick up an infection while in hospital. The latest figures indicate the need for tight infection controls and proper hygiene to cut hospital infections as much as possible,” Bloom said.

Having dipped somewhat during the pandemic, sexually transmitted infections (STIs) are on the rise again around the world. In England and Ireland in 2022, rates of chlamydia, gonorrhoea and syphilis exceeded levels recorded before COVID. The number of gonorrhoea diagnoses recorded in England was in fact the highest since annual records began. Untreated STIs can result in serious health complications for both men and women including infertility, increased risk of miscarriage and stillbirth, various cancers and reduced life expectancy, among others. So what do you do if you find out you’ve got an STI? Disclosing the infection is a double-edged sword. On one hand you are being honest, responsible and respectful to your partner (or partners), and protecting their health. This article is part of Quarter Life, a series about issues affecting those of us in our twenties and thirties. From the challenges of beginning a career and taking care of our mental health, to the excitement of starting a family, adopting a pet or just making friends as an adult. The articles in this series explore the questions and bring answers as we navigate this turbulent period of life. You may be interested in: If you’re sending intimate photos, taking a selfie is legally safer – here’s how to protect yourself Four ways to have hard conversations with your friends – without making things worse Planning for a baby? Why both men and women should consider quitting alcohol before and during pregnancy On the other hand, you may risk being shamed, discriminated against or isolated for disclosing your sexual activities, behaviours or preferences. This might be related to having multiple sexual partners, engaging the services of sex workers, or your sexual orientation, to name just a few. While navigating these conversations can be difficult, cultural and societal attitudes towards sex and sexuality should not discourage you from disclosing your STI status. Letting sexual partners know if you have an STI is essential to the prevention, treatment and control of these infections. Honesty is the best policy If you receive a positive test, don’t panic. Consult with a healthcare provider as soon as possible. There are effective treatments available for several STIs. For example, a single course of antibiotics will often clear chlamydia, gonorrhoea, syphilis and “trich” (trichomoniasis). While it’s not possible to cure HIV or herpes, drugs called antiretrovirals can alter the course of the disease and reduce the risk of transmission. Disclosing an STI can be an uncomfortable and often embarrassing conversation. It’s totally normal to be anxious about your partner’s response and the potential effect on your relationship, whether casual or long term. After you’ve told them, consider discussing how sexually active you have been in recent times, whether you have had sexual encounters with men, women, or both, and if you’ve sought medical treatment for the STI. Encourage your partner to ask questions, and give them time to think and process the news. If you and your partner have been sexually active (with or without a condom) and you’re concerned about transmission, you could also provide them with information on where to seek STI testing (GP or local STI clinc) or direct them to reputable websites where they could access a home testing kit. If you are uncomfortable telling a sexual partner you have an STI, a healthcare professional can undertake contact tracing to maintain your anonymity. It’s also important to disclose if you have an STI before starting a sexual relationship with someone new. What if a partner discloses that they have an STI? You will probably have lots of questions in relation to your partner’s STI disclosure as it may pre-date or overlap with your relationship. When asking these questions, try to be mindful of the language you use, and avoid placing blame. Most importantly, get tested as soon as possible. An early STI diagnosis is the best opportunity for effective treatment, and prevention of health complications and further transmission. Visit your GP or local health centre for a physical exam and STI screening or alternatively, order an at-home testing kit online. Be mindful to avoid judgemental language when talking to a partner about their STI diagnosis. Aliona Hradovskaya/Shutterstock Depending on the complexity of the testing required, you may have a number of days to wait for your results. Since STIs spread by skin-to-skin contact or through transmission of bodily fluids, it’s best to abstain from sex while you await results. If you do decide to have sex, it’s advisable to use a physical barrier such as a condom or dental dam to protect your partner. When used correctly and consistently, condoms offer one of the most effective methods of protection against STIs, including HIV. Make this an opportunity Low health literacy can often instil unnecessary fear in circumstances like these. Whether it’s you or your partner who have an STI – or both – use this opportunity to do some research on sexual health. Educating yourself on suitable contraceptive methods, vaccines, signs and symptoms of STIs and the benefits of regular STI check-ups is vital to keeping yourself and others safe when sexually active. Focus on evidence-based advice from trusted sources such as the US Centers for Disease Control and Prevention, the World Health Organization, and the NHS, where you can find up-to-date fact sheets on STI symptoms and treatment guidelines. If we think back to the height of the pandemic, disclosure of a positive COVID test was often associated with fear of judgement, social exclusion, discrimination and blame – much like an STI disclosure. However, as the pandemic progressed, so too did attitudes. The COVID pandemic has also shown us the crucial role of early detection, rapid testing, and importantly, public health communication and education. All of these lessons should be applied to the global fight against STI transmission. Stigma, embarrassment, guilt, taboo and shame are words still too often associated with STIs. Overcoming STI stigma, much like COVID stigma, requires education, improving access to STI testing and treatment, and the

Doctors had to remove half of my SKULL after a harmless sinus infection spread to my brain – these are strange symptoms that could be overlooked By Cassidy Morrison Senior Health Reporter For Dailymail.Com Updated: 12:33 EDT, 25 July 2023

Abstract Background Nonhygienic products for managing menstruation are reported to cause reproductive tract infections. Menstrual cups are a potential solution. We assessed whether menstrual cups would reduce bacterial vaginosis (BV), vaginal microbiome (VMB), and sexually transmitted infections (STIs) as studies have not evaluated this. Methods and findings A cluster randomized controlled trial was performed in 96 Kenyan secondary schools, randomized (1:1:1:1) to control, menstrual cup, cash transfer, or menstrual cup plus cash transfer. This substudy assessing the impact of menstrual cups on BV, VMB, and STIs, included 6 schools from the control (3) and menstrual cup only (3) groups, both receiving BV and STI testing and treatment at each visit. Self-collected vaginal swabs were used to measure VMB (16S rRNA gene amplicon sequencing), BV (Nugent score), and STIs. STIs were a composite of Chlamydia trachomatis and Neisseria gonorrhoeae (nucleic acid amplification test) and Trichomonas vaginalis (rapid immunochromatographic assay). Participants were not masked and were followed for 30 months. The primary outcome was diagnosis of BV; secondary outcomes were VMB and STIs. Intention-to-treat blinded analyses used mixed effects generalized linear regressions, with random effects term for school. The study was conducted between May 2, 2018, and February 7, 2021. A total of 436 participants were included: 213 cup, 223 control. There were 289 BV diagnoses: 162 among control participants and 127 among intervention participants (odds ratio 0.76 [95% CI 0.59 to 0.98]; p = 0.038). The occurrence of Lactobacillus crispatus–dominated VMB was higher among cup group participants (odds ratio 1.37 [95% CI 1.06 to 1.75]), as was the mean relative abundance of L. crispatus (3.95% [95% CI 1.92 to 5.99]). There was no effect of intervention on STIs (relative risk 0.82 [95% CI 0.50 to 1.35]). The primary limitations of this study were insufficient power for subgroup analyses, and generalizability of findings to nonschool and other global settings. Conclusions Menstrual cups with BV and STI testing and treatment benefitted adolescent schoolgirls through lower occurrence of BV and higher L. crispatus compared with only BV and STI testing and treatment during the 30 months of a cluster randomized menstrual cup intervention. Author summary Why was this study done? Many girls in low- and middle-income countries are unable to adequately manage their menses and can suffer reproductive tract infections resulting from use of inappropriate materials. Reusable menstrual cups are medical grade silicone bell-shaped chambers that are inserted into the vagina to capture menstrual blood. Menstrual cups are safe and have not been associated with changes in vaginal pH or microflora. It is not known whether menstrual cups could lead to improvements in reproductive tract health. What did the researchers do and find? We assessed the impact of menstrual cups on the vaginal microbiome (VMB), bacterial vaginosis (BV), and sexually transmitted infections (STIs) in 436 secondary schoolgirls in western Kenya. During the 30-month cluster randomized controlled trial, BV and VMB composition were assessed every 6 months, and STIs (gonorrhea, chlamydia, and trichomoniasis) were assessed annually, with testing and treatment for BV and STIs for intervention and control participants regardless of symptoms. Among the intervention group, in crude analyses, the occurrence of BV was 24% lower than control participants, while the proportion of Lactobacillus crispatus–dominated community state type was 37% higher. What do these findings mean? Other studies have found that menstrual cups are a safe and cost-effective tool for menstrual hygiene management. These results provide evidence they can promote an optimal VMB and reduce BV for adolescent girls. Further research should investigate the constitution of the VMB and incidence of BV and STIs in different age groups and populations using menstrual cups. Citation: Mehta SD, Zulaika G, Agingu W, Nyothach E, Bhaumik R, Green SJ, et al. (2023) Analysis of bacterial vaginosis, the vaginal microbiome, and sexually transmitted infections following the provision of menstrual cups in Kenyan schools: Results of a nested study within a cluster randomized controlled trial. PLoS Med 20(7): e1004258. https://doi.org/10.1371/journal.pmed.1004258 Academic Editor: Sarah J. Stock, The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, UNITED KINGDOM Received: November 4, 2022; Accepted: June 7, 2023; Published: July 25, 2023 Copyright: © 2023 Mehta et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability: Raw sequence data (FASTQ files) were deposited in the National Center for Biotechnology Information (NCBI) Sequence Read Archive (SRA), under BioProject identifier PRJNA746243. This study was conducted with approval from the Kenya Medical Research Institute (KEMRI) Scientific and Ethics Review Unit (SERU), which requires that data be released from any KEMRI-based Kenyan studies (including de-identified data) only after their written approval for additional analyses. In accordance, data for this study will be available upon request, after obtaining written approval for the proposed analysis from the KEMRI SERU. Their application forms and guidelines can be accessed at https://www.kemri.org/seru-overview. To request these data, please contact the KEMRI SERU at [email protected]. Funding: This study was supported by the National Institutes of Health Eunice Shriver National Institute of Child Health and Human Development (R01-HD093780 to SDM), and the Joint Global Health Trials Initiative (UK-Medical Research Council/ Department for International Development/ Wellcome Trust/Department of Health and Social Care; MR/N006046/1 to PPH). The funders had no role in the design of the study, the collection, analysis, and interpretation of data, or in writing the manuscript. Competing interests: The authors have declared that no competing interests exist. Abbreviations: BIOM, biological observation matrix; BV, bacterial vaginosis; CaCHe, Cups and Community Health; CCT, conditional cash transfer; COVID-19, Coronavirus Disease 2019; CST, community state type; CT, Chlamydia trachomatis; GLMM, generalized linear mixed model; GRC, Genome Research Core; HDSS, health and demographic surveillance system; ITT, intention to treat; MHM, menstrual hygiene management; NG, Neisseria gonorrhoeae; OR, odds ratio; RR, relative risk; SES, socioeconomic status; SSA, sub-Saharan Africa; STI, sexually transmitted infection; TV, Trichomonas vaginalis; VALENCIA, VAginaL community state typE Nearest CentroId classifier; VMB, vaginal microbiome; WASH, water,