Increased reproductive tract infections among secondary school girls during the COVID-19 pandemic: associations with pandemic related stress, mental health, and domestic safety (preprint)

Background: Kenya, like many countries, shuttered schools during COVID–19, with subsequent increases in poor mental health, sexual activity, and pregnancy. We sought to understand how the COVID–19 pandemic may mediate risk of reproductive tract infections. We hypothesized that greater COVID–19 related stress would mediate risk via mental health, feeling safe inside the home, and sexual exposure, given the pandemic mitigation–related impacts of school closures on these factors. Methods: We analyzed data from a cohort of 436 girls enrolled in secondary school in rural western Kenya. Baseline, 6–, 12–, and 18– month study visits occurred April 2018 – December 2019 (pre–COVID), and 30–, 36–, and 48– month study visits occurred September 2020 – July 2022 (COVID period). At study visits, participants self–completed a survey for sociodemographics and sexual practices, and provided self–collected vaginal swabs for Bacterial vaginosis (BV) testing, with STI testing at annual visits. COVID–related stress was measured with a standardized scale and dichotomized at highest quartile. Mixed effects modeling quantified how BV and STI changed over time, and longitudinal mediation analysis quantified how the relationship between COVID–19 stress and increased BV was mediated. Findings: BV and STI prevalence increased from 12.1% and 10.7% pre–COVID to 24.5% and 18.1% during COVID, respectively. This equated to a 26% (95% CI 1.00 – 1.59) and 36% (95% CI 0.98 – 1.88) increased relative prevalence of BV and STIs, respectively, in the COVID–19 period compared to pre–COVID, adjusted for numerous sociodemographic and behavioral factors. Higher COVID–related stress was associated with elevated depressive symptoms and feeling less safe inside the home, which were each associated with increased likelihood of having a boyfriend. In longitudinal mediation analyses, the direct effect of COVID–related stress on BV was small and non–significant, indicating increased BV was due to the constellation of factors that were impacted during the COVID pandemic. Conclusions: In this cohort of adolescent girls, BV and STIs increased following COVID–related school closures. These results highlight modifiable factors to help maintain sexual and reproductive health resiliency, such as anticipating and mitigating mental health impacts, domestic safety concerns, and maintaining sexual health services to prevent and treat reproductive tract infections.

Is this Herpes or Syphilis?: Latent Dirichlet Allocation Analysis of Sexually Transmitted Disease-Related Reddit Posts During the COVID-19 Pandemic (preprint)

BackgroundSexually Transmitted Diseases (STDs) are common and costly, impacting approximately one in five people annually. Reddit, the sixth most used internet site in the world, is a user-generated social media discussion platform that may be useful in monitoring discussion about STD symptoms and exposure. ObjectiveThis study sought to define and identify patterns and insights into STD related discussions on Reddit over the course of the COVID-19 pandemic. MethodsWe extracted posts from Reddit from March 2019 through July 2021. We used a machine learning text mining method, Latent Dirichlet Allocation (LDA), to conduct a text analysis to identify the most common topics discussed in the Reddit posts. We then used word clouds, qualitative topic labelling, and spline regression to characterize the content and distribution of topics observed. ResultsOur extraction resulted in 24,311 total posts. LDA Coding showed that with 8 topics for each time period we achieved high coherence values (pre-COVID=0.41, pre-vaccine=0.42; post-vaccine=0.44). While most topic categories remained the same over time, the relative proportion of topics changed and new topics emerged. Spline regression revealed some key terms had variability in the percentage of posts that coincided with COVID-19 pre- and post-periods, while others were uniform across the study periods. ConclusionsOur studys use of Reddit is a novel way to gain insights into STD symptoms experienced, potential exposures, testing decisions, common questions, and behavior patterns (e.g., during lock down periods). For example, reduction in STD screening may result in observed negative health outcomes due to missed cases, which also impacts onward transmission. As Reddit use is anonymous, users may discuss sensitive topics with greater detail, and more freely than in clinical encounters. Data from anonymous Reddit posts may be leveraged to enhance understanding of the distribution of disease and need for targeted outreach/screening programs. This study demonstrates Reddit has feasibility and utility to enhance understanding of sexual behaviors, STD experiences, and needed health engagement with the public.