Inflammation, Vaginal Microbiota, and STI/HIV Risk

15-24岁的青少年和年轻人（AYA）获得了2000万新移民中的一半。 性传播感染（STI）每年在美国生殖支原体（MG）是 作为一种新的、重要的科技创新。未经治疗的性传播感染会导致生殖伤害， 早产、盆腔炎、不孕症、异位妊娠、慢性盆腔疼痛、 增加了对艾滋病的易感性。艾滋病毒易感性增加，因为一些性传播感染突破 保护粘膜屏障，促进炎症，并招募免疫细胞（HIV靶细胞） 进入生殖道然而，关于MG和 这些炎症性生殖道综合征。此外，我们的研究发现， 的STI或细菌性阴道病检测呈阳性的参与者没有接受治疗 提供商尽管有临床服务，但一些城市居民报告缺乏交通工具， 门诊时间，以及难以导航医疗保健系统作为与非 获得护理。数字技术（如互联网、远程医疗）提供了增加 获得性传播感染预防服务。这种创新的补充寻求扩大家长 研究，以更好地了解MG在女性生殖道炎症中的作用，并使用 远程保健，让没有获得传统实体护理的AYAs参与进来。我们提出 以下目的：目的1：测量MG的患病率并确定其与 目的2：确定使用远程医疗的吸收、可接受性和可行性 对MG检测呈阳性的人进行咨询和治疗;目标3：测量 3-使用在线家庭STI网站进行为期一个月的重新测试。本补充说明了 我们对MG的认识存在重大差距，迫切需要更好地了解 在阴道微生物群，性传播感染和炎症中， AYAs的易感性，以及远程保健方法如何可以达到脆弱的女性AYAs， 否则可能得不到照顾。在缺乏这种知识和新的战略， 与这些弱势群体接触，性传播感染将继续在美国上升，并威胁到 青少年的生殖健康。

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.