Inflammation, Vaginal Microbiota, and STI/HIV Risk

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Adolescents and young adults (AYA) aged 15-24 years acquire half of the 20 million new sexually transmitted infections (STI) annually in the U.S. Mycoplasma genitalium (MG) is emerging as a new and important STI. Untreated STIs can lead to reproductive harm like preterm delivery, pelvic inflammatory disease, infertility, ectopic pregnancy, chronic pelvic pain, and increased susceptibility to HIV. HIV susceptibility is increased because some STIs breach the protective mucosal barrier, promote inflammation, and recruit immune cells (HIV target cells) into the genital tract. However, there are conflicting data about the relationship between MG and these inflammatory reproductive tract syndromes. In addition, our parent study found that 25% of participants who tested positive for an STI or bacterial vaginosis did not have a treating provider. Despite available clinical services, some urban residents report lack of transportation, clinic hours, and difficulty navigating the healthcare system as factors associated with not accessing care. Digital technology (e.g. internet, telehealth) offers the opportunity to increase access to STI prevention services. This innovative supplement seeks to expand the parent study to better understand the role of MG in female genital tract inflammation, and to use telehealth to engage AYAs who are not accessing traditional brick-and-mortar care. We propose the following aims: Aim 1: To measure the prevalence of MG and determine its association with inflammation; Aim 2: To determine the uptake, acceptability, and feasibility of using telehealth visits to counsel and treat those who test positive for MG; and Aim 3: To measure the uptake of 3-month retesting using an online home-based STI website. This supplement addresses a significant gap in our knowledge of MG, the critical need to better understand the interaction among vaginal microbiota, STIs, and inflammation that potentially conspire to increase HIV susceptibility in AYAs, and how a telehealth approach may reach vulnerable female AYAs who might not otherwise receive care. In the absence of such knowledge and novel strategies to engage this vulnerable population, STIs will continue to rise in the U.S. and threaten the reproductive health of AYAs.