title: Periodic Presumptive Treatment for Vaginal Infections May Reduce the Incidence of Sexually Transmitted Bacterial Infections.
abstract: Bacterial vaginosis (BV) may increase women's susceptibility to sexually transmitted infections (STIs). In a randomized trial of periodic presumptive treatment (PPT) to reduce vaginal infections, we observed a significant reduction in BV. We further assessed the intervention effect on incident Chlamydia trachomatis, Neisseria gonorrhoeae, and Mycoplasma genitalium infection.
  
  
  
  Nonpregnant, human immunodeficiency virus-uninfected women from the United States and Kenya received intravaginal metronidazole (750 mg) plus miconazole (200 mg) or placebo for 5 consecutive nights each month for 12 months. Genital fluid specimens were collected every other month. Poisson regression models were used to assess the intervention effect on STI acquisition.
  
  
  
  Of 234 women enrolled, 221 had specimens available for analysis. Incidence of any bacterial STI (C. trachomatis, N. gonorrhoeae, or M. genitalium infection) was lower in the intervention arm, compared with the placebo arm (incidence rate ratio [IRR], 0.54; 95% confidence interval [CI], .32-.91). When assessed individually, reductions in STI incidences were similar but not statistically significant (IRRs, 0.50 [95% confidence interval {CI}, .20-1.23] for C. trachomatis infection, 0.56 [95% CI, .19-1.67] for N. gonorrhoeae infection, and 0.66 [95% CI, .38-1.15] for M. genitalium infection).
  
  
  
  In addition to reducing BV, this PPT intervention may also reduce the risk of bacterial STI among women. Because BV is highly prevalent, often persists, and frequently recurs after treatment, interventions that reduce BV over extended periods could play a role in decreasing STI incidence globally.
authors.affiliation: Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center Department of Global Health.
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Balkus
authors.affiliation: Department of Global Health Department of Epidemiology.
authors.forename: Lisa E
authors.initials: LE
authors.lastname: Manhart
authors.affiliation: Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock.
authors.forename: Jeannette
authors.initials: J
authors.lastname: Lee
authors.affiliation: Department of Medical Microbiology.
authors.forename: Omu
authors.initials: O
authors.lastname: Anzala
authors.affiliation: University of Nairobi Institute for Tropical and Infectious Diseases, University of Nairobi, Kenya.
authors.forename: Joshua
authors.initials: J
authors.lastname: Kimani
authors.affiliation: Department of Medicine, University of Alabama at Birmingham.
authors.forename: Jane
authors.initials: J
authors.lastname: Schwebke
authors.affiliation: University of Nairobi Institute for Tropical and Infectious Diseases, University of Nairobi, Kenya.
authors.forename: Juma
authors.initials: J
authors.lastname: Shafi
authors.affiliation: Department of Medicine, University of Alabama at Birmingham.
authors.forename: Charles
authors.initials: C
authors.lastname: Rivers
authors.affiliation: University of Nairobi Institute for Tropical and Infectious Diseases, University of Nairobi, Kenya.
authors.forename: Emanuel
authors.initials: E
authors.lastname: Kabare
authors.affiliation: Department of Global Health Department of Medicine, University of Washington, Seattle University of Nairobi Institute for Tropical and Infectious Diseases, University of Nairobi, Kenya.
authors.forename: R
authors.initials: R
authors.lastname: Scott McClelland
mesh_terms: D000328:Adult; D000890:Anti-Infective Agents / Q000008:administration & dosage*; D002690:Chlamydia Infections / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D002692:Chlamydia trachomatis / Q000187:drug effects; D004359:Drug Therapy, Combination; D005260:Female; D006069:Gonorrhea / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D007630:Kenya / Q000453:epidemiology; D008795:Metronidazole / Q000008:administration & dosage; D008825:Miconazole / Q000008:administration & dosage; D009175:Mycoplasma Infections / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D045704:Mycoplasma genitalium / Q000187:drug effects; D009344:Neisseria gonorrhoeae / Q000187:drug effects; D065129:Pre-Exposure Prophylaxis; D012749:Sexually Transmitted Diseases / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D016585:Vaginosis, Bacterial / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D055815:Young Adult
chemical_list: D000890:Anti-Infective Agents; D008795:Metronidazole; D008825:Miconazole
keywords: Chlamydia trachomatis; Mycoplasma genitalium; Neisseria gonorrhoeae; bacterial vaginosis; periodic presumptive treatment; vaginal health interventions