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.

Prevention of recurrence of bacterial vaginosis using lactobacilli-containing vaginal tablets among women with HIV: a randomized, placebo-controlled, double-blinded phase IV trial.

OBJECTIVES: The effectiveness of lactobacilli-containing vaginal tablets (VT) in bacterial vaginosis (BV) recurrence prevention among women infected with HIV treated with standard oral metronidazole in Pune, India was studied. METHODS: Women infected with HIV with confirmed BV diagnosis (Nugent score ≥7 and Amsel criteria >3) were enrolled in a 12-month, double-blind, randomized, placebo-controlled, phase IV study between 2018 and 2021. After a standard course of oral metronidazole for 7 days (400 mg three times a day), women were randomly assigned to either lactobacilli-containing or placebo VT arms to receive VTs for 4 months. BV recurrence was assessed after the initial cure from BV. RESULTS: Of the 464 women infected with HIV, 80 women with confirmed BV were enrolled. The retention was affected due to the COVID-19 pandemic (6-month retention rates 78%). The cure was seen in 85% and 93.5% of participants from the treatment and placebo arms, respectively, after four VT cycles. BV recurrence was seen in 41.4% and 44.8% in the treatment and placebo arm, respectively, with no significant difference in the two groups. CONCLUSION: The lactobacilli-containing VT was acceptable and safe; however, the addition of VT over standard oral metronidazole did not show any additional benefit in the prevention of BV recurrence in women infected with HIV, indicating the need for long-term randomized trials among them. Registered at Clinical Trials Registry- India, (CTRI) Number: CTRI/2018/04/013298.