Technology Enhanced Community Health Nursing to Reduce Recurrent STIs after PID

摘要 盆腔炎（PID）是一种常见的，严重的生殖系统疾病， 严重的不良生殖健康后果，如宫外孕、输卵管不孕、慢性盆腔炎、 疼痛，并显著降低受影响患者的健康相关生活质量。技术增强 社区卫生（TECH）护理研究进一步表明，与 PID比疾病控制和预防中心（CDC）的治疗指南更复杂 表明，使妇女没有足够的治疗生殖支原体（MG）和毛滴虫 迷走神经（TV）。CDC推荐用于综合征PID管理的广谱抗生素包括 次优的原因是：1）MG通常对多西环素（标准疗法）和大环内酯类药物（如 阿奇霉素（替代疗法）和2）甲硝唑（对TV有效）是标准PID的可选添加剂 诊断时不一致的治疗。此外，CDC未正式考虑MG 性传播感染治疗指南直到2015年才发布，测试只能在大型研究实验室进行， 缺乏随机试验的数据限制了CDC建议的范围。最后，虽然有 在美国没有针对MG和TV的公共卫生控制项目， MG和TV与女性生殖道持续炎症相关， 由于阴道微生物群的不健康变化而导致的继发性性病和艾滋病毒感染。本次竞赛的目标是 更新应用是利用新的STI诊断（新的MG大环内酯耐药性测试和TV 测试）与我们证明有能力接触脆弱的青年，以治疗青少年和年轻的成年妇女 根据他们的实际诊断，而不是次优综合征， 管理我们将增加阴道标本的基因组分析，以评估五种基因的组成变化。 阴道乳酸杆菌群落状态类型与最佳阴道健康相关， 细胞因子反应，以确定是否为现场治疗定制了精确护理（ESP-PN）方案， STI结果减少了活动性阴道感染的炎症反应。我们假设 进一步重新包装我们以前成功的BN-N干预方案，并将实验室科学转化为 精准医疗，我们将进一步降低复发感染的风险，恢复PID的阴道健康- 受影响的患者，并增加新的知识，推进公共卫生控制的性传播感染，并有可能 减少城市青年PID后观察到的STI差异。

Abstract Pelvic Inflammatory Disease (PID) is a common, serious reproductive disorder that is associated with significant adverse reproductive health outcomes such as ectopic pregnancy, tubal infertility, chronic pelvic pain, and significant reductions in health related quality of life for affected patients. The Technology Enhanced Community Health (TECH) Nursing Study has further demonstrated that the biological milieu associated with PID is more complicated than the Centers for Disease Control and Prevention (CDC) treatment guidance indicates, leaving women without adequate treatment for Mycoplasma genitalium (MG) and Trichomonas vaginalis (TV). The broad-spectrum antibiotics recommended by the CDC for syndromic PID management are suboptimal because: 1) MG is often resistant to doxycycline (standard therapy) and macrolides such as Azithromycin (alternative therapy) and 2) metronidazole (effective for TV) is an optional add-on to standard PID treatment that is inconsistently prescribed at diagnosis. Further MG was not officially considered in CDC STI treatment guidelines until release until 2015, testing is only available in large research laboratories, and the paucity of data from randomized trials limits the scope of the CDC's recommendations. Finally, while there are no public health control programs in the United States for MG and TV, recurrent and persistent infection with MG and TV is associated with ongoing inflammation in the female genital tract and increased risk for secondary STI and HIV infection due to unhealthy shifts in vagina microbiota. The goals of this competitive renewal application are to leverage novel STI diagnostics (new MG macrolide resistance testing and TV testing) with our demonstrated ability to reach vulnerable youth to treat adolescents and young adult women with mild-moderate PID with precision based on their actual diagnoses rather than suboptimal syndromic management. We will add genomic analysis of vaginal specimens to assess compositional changes in the five vaginal Lactobacilli community state types associated with optimal vaginal health and measure the vaginal cytokine response to determine if TECH-precision-nursing (TECH-PN) protocols for field treatment tailored to STI results reduces the inflammatory response observed with active vaginal infections. We hypothesize that by further repackaging our previous successful TECH-N intervention protocol and translating bench science into precision healthcare, we will further reduce the risk of recurrent infection, restore vaginal health for PID- affected patients, and add new knowledge that advances public health control of STIs and has the potential to reduce the observed STI disparities after PID in urban youth.