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)
By Hope Kirwan | WPR A parasitic infection linked to imported produce is popping up in Wisconsin again this summer. @media ( min-width: 250px ){.newspack_global_ad.scaip-1{min-height: 100px;}}@media ( min-width: 300px ){.newspack_global_ad.scaip-1{min-height: 100px;}}@media ( min-width: 728px ){.newspack_global_ad.scaip-1{min-height: 90px;}} There have been 40 cases of cyclosporiasis reported to the state Department of Health Services since June 1. Sign up for our free newsletters to receive morning and afternoon local news directly to your inbox. The intestinal illness is caused by a parasite that comes from people ingesting food or water contaminated with feces. The parasite is commonly found in tropical regions, and cases in the United States usually come from produce imported from affected countries. According to the Centers for Disease Control and Prevention, it takes about a week for symptoms to begin after being infected. These include watery diarrhea, cramping and fatigue, and can last for several weeks to more than a month. @media ( min-width: 250px ){.newspack_global_ad.scaip-2{min-height: 100px;}}@media ( min-width: 300px ){.newspack_global_ad.scaip-2{min-height: 100px;}}@media ( min-width: 728px ){.newspack_global_ad.scaip-2{min-height: 90px;}} Dr. Kim Zelton, foodborne illness epidemiologist for DHS, said this year’s numbers are typical for the state. “It really varies from year to year depending on if we have any kind of outbreaks associated with some produce imported to Wisconsin or not,” she said. “For years that we identify outbreaks, (the total) can get very high.” Wisconsin and Minnesota saw an outbreak of cyclosporiasis in 2018 linked to Del Monte vegetable trays sold at Kwik Trip stores. @media ( min-width: 250px ){.newspack_global_ad.scaip-3{min-height: 100px;}}@media ( min-width: 300px ){.newspack_global_ad.scaip-3{min-height: 100px;}}@media ( min-width: 728px ){.newspack_global_ad.scaip-3{min-height: 90px;}} Zelton said DHS does not know at this point whether this year’s infections came from one widely distributed food or if it’s from a variety of items. She said it’s also possible that residents consumed contaminated food in another state. The CDC has confirmed 581 cases of the illness since April across 31 states. The agency’s website said this year’s outbreak started slightly earlier than normal, but it’s too soon to tell whether that will be a lasting change. In May, federal agencies linked an outbreak of cyclosporiasis to raw broccoli in Georgia and Alabama. The CDC’s website said there is no indication that broccoli continues to be a source of illness. Zelton said cyclosporiasis tends to be a seasonal illness, with cases declining in late summer and early fall. She said it’s important for consumers to be aware that any fresh produce can carry different illnesses and that following food safety precautions is important when preparing and consuming these foods. “Things like washing their hands before and after handling raw produce, making sure to rinse that produce thoroughly under running water, using a clean produce brush on those firmer fruits and vegetables that can handle it, and then also storing your fresh produce in the refrigerator as quickly as possible and separate from things like raw meats,” she said. This story was produced by Wisconsin Public Radio and is being republished by permission. See the original story here. Support our work As an independent publication, we rely on donations to fund our journalism @media ( min-width: 300px ){.newspack_global_ad.sidebar_article-2{min-height: 100px;}}@media ( min-width: 320px ){.newspack_global_ad.sidebar_article-2{min-height: 100px;}}@media ( min-width: 728px ){.newspack_global_ad.sidebar_article-2{min-height: 90px;}}
The city is seeing a spike in cases of conjunctivitis, fungal infections and vector-borne diseases, Health Minister Saurabh Bharadwaj said on Tuesday, adding that hospitals in Delhi have been alerted about the same. He attributed the rise in the cases to the high humidity levels. The Municipal Corporation of Delhi (MCD) on Tuesday issued guidelines asking teachers to be vigilant in recognising symptoms of conjunctivitis after some teachers reported a spike in such cases in the municipal-run schools. The symptoms may include redness in the eyes, excessive tearing, itchiness, and eye. Teachers have also been asked to encourage students to practice good hygiene habits, and refrain students from touching eyes, face, or common surfaces with unwashed hands. According to an MCD report, over 180 cases of dengue were reported in the city as of Tuesday, exceeding an all-time high in five years from January 1 to July 22. The report also recorded 61 cases of malaria and 14 of chikungunya. COMMents SHARE Copy link Email Facebook Twitter Telegram LinkedIn WhatsApp Reddit Related Topics Delhi / health / malaria / disease / school
By Corinne Saunders | Outer Banks Voice on July 25, 2023 Mike Gard. Nags Head resident Michael “Mike” Gard, 71, a fondly remembered local business owner and avid waterman, died unexpectedly on July 21, following infection of a cut he got while handling a crab pot in the sound five days earlier. While Dare County Health and Human Services (DHHS) Director Sheila Davies said she could not confirm that the deceased individual was Gard for privacy reasons, the DHHS said it was made aware of a confirmed Vibrio bacteria case on July 20 and was notified of that person’s death on July 24—something that tracks with the Gard death and timeline. The DHHS confirmed that another Vibrio case was reported July 25, although at this time, there is no fatality involved. As a result of these cases, Davies said her department was issuing a media release “on recreational water illnesses and preventative measures individuals can take to help prevent illness.” (How to Enjoy Water Activities Safely to Prevent Illness) Gard’s family and friends discussed the tragedy with the Voice. “The outcome they gave us was he had a very weak heart and it wasn’t able to compete with the infection,” said Kenny Gard, Mike Gard’s younger brother. “He’d had a stent in his heart since 2019.” “If he was young and had a strong heart, I think he would have made it,” said Gard’s girlfriend Elaine Piddington. “It’s like a bad dream, it truly is, the worst dream I’ve had.” “It made all his friends just stunned,” added Ronny Bennett. He’d regularly hunted and fished with Mike Gard, owner of Honey-Do Handyman Services, whom he called “a jack of all trades.” Bennett and Mike Gard’s close friend Ted Moseley reported that the doctors said Gard had necrotizing fasciitis. That is “a severe infection in which the flesh around an open wound dies,” according to the Centers for Disease Control and Prevention (CDC) website. Gard’s friends and family said they were not sure of the name of the bacteria that caused his infection. Several bacteria species can cause necrotizing fasciitis, including Vibrio. Over the past six years, only seven other Vibrio cases have been confirmed in Dare County, with another three “probable” cases. Monday’s reported case is the only fatality, according to Davies. Vibrio is common in seawater, especially in warm, brackish waters, and Vibrio cases are expected every summer, Davies added. “The majority of Vibrio infections occur from eating raw or undercooked shellfish, particularly oysters,” she said. “Certain Vibrio species can also cause a skin infection when an open wound is exposed to salt water or brackish water.” Vibrio is a required reportable disease in North Carolina, meaning it is tracked statewide, but community notification is not required nor common practice, Davies said in an email. Following Gard’s death, Moseley posted a notice on Facebook about the bacteria from the sound causing his death “because I thought people ought to know about it.” Several other friends and family members had also posted on social media, first asking for prayers for his recovery and then announcing his death. According to Piddington, she and Gard were moving her five crab pots from one location to another in Buzzard Bay—part of the Albemarle Sound—south of Colington Island, on Sunday, July 16. Gard scratched himself with a crab pot while putting it in the boat. About an hour later, well after the cut stopped bleeding, the two swam for a few minutes in the sound. They went home, showered and went to bed. Piddington recounted that on Monday, Gard went to work, but didn’t feel well. He opted to wait to see a doctor, but when Piddington saw him that evening, she said he was “shaking like a leaf” and “from the ankle to the knee, it was red.” She sent a photo to his heart doctor and to his niece, who is an EMT. The niece asked when his last tetanus shot was, and he didn’t know, so she told him to go get one. Piddington took him to Outer Banks Health around 11:30 p.m., where he received a tetanus shot and antibiotics. Tuesday morning, Piddington woke up around 6 a.m. and Gard was not doing well. Following an ambulance ride to Outer Banks Health, he was flown to the hospital in Greenville around 8:45 a.m. “I got a call from the doctor saying, ‘Come on up,’” Kenny Gard recalled, and he went to Greenville on Tuesday afternoon. The chaplain told him that his brother was coherent when he first arrived, but within 30 minutes, “he went into septic shock…and never came out of it.” Following an unsuccessful surgery, Mike Gard was taken off life support on Friday morning, July 21, and passed away just hours later, around noon. Kenny Gard said that 20-some years ago, he’d contracted two bacterial infections within a six month-period from being in the sound with scratches on his legs, with a very different outcome from his brother’s. “Certainly we all miss him, and it’s hard to grasp how quickly it went and happened,” he noted. As a child, Moseley vacationed in his aunt’s beach house on Soundside Road in Nags Head, which was the street where Gard grew up. They played together in the sound, and after high school, Moseley moved to the Outer Banks. “We did everything together, fished and hunted…we’ve taken some camping trips down to Cape Lookout,” he said. Piddington said that her husband died of cancer eight years ago, and “I’d finally found love” with Gard. “We had only been together 10 weeks, but…it was like I knew him all my life kind of thing. It was the best 10 weeks of my life.”
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
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
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,
