Discussion
urinary tract infection
STIS, SECONDARY, REPRODUCTIVE TRACT INFECTION, URINARY TRACT INFECTION
In this prospective analysis nested within a cluster randomized controlled trial, we observed via ITT analysis that secondary schoolgirls allocated to schools receiving the menstrual cup with BV and STI testing and treatment had a 26% lower odds of BV, 37% increased odds of having optimal VMB CST (CST-I), and 3.95% increased relative abundance of Destabilization of the vaginal microbiome composition during menses is well documented, with increases in Poor-quality MHM products have been associated with reproductive tract infections. The mechanisms are biological and behavioral. Unsanitary cloths, disposable pads used beyond their recommended time, or reusable pads that are not sufficiently washed and dried are associated with increased reports of vaginal discharge, reproductive tract infections, and urinary tract infection symptoms [The COVID-19 pandemic caused the 24-month endline visit to be delayed, thus introducing potential confounding and bias. We observed substantial increases in BV and STI at the 30-month visit (i.e., including time during the COVID-19 pandemic), and we also observed meaningful and statistically significant benefits conferred to VMB composition and against BV occurrence through 18 months of follow-up time, occurring completely prior to the COVID-19 pandemic. The effect sizes were similar between data including the 30-month visit and data excluding the 30-month visit, suggesting lack of confounding. After trial end, all participants have received menstrual cups and follow-up is ongoing to 72 months. This extended follow-up will enable us to observe whether the changes associated with menstrual cups vary by changes in sexual activity (such as number of sexual partners, condom use, and coerced and transactional sex) and a greater cumulative incidence and prevalence of past STIs and BV.