Trial finds prophylactic doxycycline doesn’t reduce STIs in cisgender women

News brief

A clinical trial in Kenya found that taking the antibiotic doxycycline after sex did not prevent sexually transmitted infections (STIs) in cisgender women, researchers reported at this week's Conference on Retroviruses and Opportunistic Infections (CROI).

The trial, conducted at a single site in Kenya by researchers with Kenya Medical Research Institute (KEMRI), the University of Washington, and Hennepin Healthcare Research Institute, enrolled 449 cisgender women who were taking daily oral HIV pre-exposure prophylaxis (PrEP) and randomized them to receive doxycycline postexposure prophylaxis (PEP) or standard of care.

Previous studies have found a high level of protection against STIs with doxycycline use among gay and bisexual men and transgender women in France and the United States, but this was the first trial to investigate doxycycline PEP in cisgender women.

Over 12 months of follow-up, the annual incidence of STIs in trial participants was 27%. A total of 109 new STIs were diagnosed, with 50 diagnosed in the doxycycline group and 59 in the standard-of-care group. Eighty-five (78%) of the new STIs were chlamydia, 35 of which were in the doxycycline group, compared with 50 in the standard-of-care group. The differences were not statistically significant.

We are committed to understanding why doxycycline PEP did not work in this population.

"The results from the study are deeply disappointing, and we are committed to understanding why doxycycline PEP did not work in this population and also determining the next steps for how to identify prevention tools that will work for and can be used by women," Elizabeth Bukusi, MD, PhD, MPH, principal investigator of the trial and senior principal clinical research scientist at KEMRI, said in a press release.

The investigators say self-reported adherence was high but imperfect and that the frequency and timing of doxycycline use among trial participants is still being investigated. They also suggested that anatomic differences could play a role.

Bacterial STIs in women can increase the risk of pelvic inflammatory disease, chronic pain, infertility, pregnancy complications, and HIV.

COVID-related separations denied many newborns contact with their moms

News brief

Mom in mask nursing babySeparating COVID-infected mothers from their newborns resulted in low rates of breastfeeding and skin-to-skin contact during the peak of the pandemic, finds a multinational study published today in eClinicalMedicine.

Led by researchers from Murdoch Children's Research Institute in Australia, the study involved 692 mother-newborn pairs at 13 neonatal intensive care units (NICUs) in 10 countries from Mar 10, 2020, to Oct 20, 2021. All mothers and 27 of the infants (4%) tested positive for COVID-19, and 14 (52%) of the infected infants had no symptoms.

Participating countries were involved in the EPICENTRE trial and were located in Europe, the Middle East, and North and South America.

Policies eased as pandemic progressed

Most NICUs had policies that encouraged breastfeeding and close contact between mothers and babies. Nearly half of the newborns (46%) stayed in the same room as their mothers, a practice that rose from 23% in March to June 2020 to 74% in January to March 2021.

Of the 369 separated newborns, 93% had no physical contact with their mother before separation, 86% were asymptomatic, and most cases were mild. More than half of infants (53%) received breastmilk, climbing from 23% in March to June 2020 to 70% in January to March 2021. Separations were most common with mothers who had COVID-19 symptoms at delivery.

Encouragingly, clinicians did gradually adapt to allow more family-centred care as the pandemic progressed, particularly the use of breastmilk.

"Almost half of all newborns in the trial were denied early and close contact with their mother, demonstrating how hard it was to balance infection control measures with mother-baby bonding recommendations, especially in the first year of the pandemic," senior author D.G. Tingay, MBBS, PhD, said in a Murdoch news release.

"Encouragingly, clinicians did gradually adapt to allow more family-centred care as the pandemic progressed, particularly the use of breastmilk," he added.

Lead author Georgie Dowse said breastmilk supports infant growth and development and can help protect against conditions like asthma, obesity, type 1 diabetes, and sudden infant death syndrome. "Skin-to-skin contact helps babies adjust to life outside the womb and supports mothers to initiate breastfeeding and develop close, loving relationships with their baby," she said.

Brain changes may be linked to anxiety, depression in long COVID

News brief

Older depressed womanPeople who have long COVID and experience anxiety and depression following a mild infection may have brain changes that affect its structure and function, Brazilian researchers reported yesterday at the American Academy of Neurology (AAN) annual meeting in Boston.

The team, from the University of Campinas in Sao Paulo, assessed 254 people who had mild COVID 3 months earlier. Of the group, 102 (40.2%) had both anxiety and depression symptoms, and 152 (59.8%) had no symptoms. The participants, with an average age of 41, also underwent brain scans. The researchers compared the scans with those of 148 people who had not been sick with COVID-19.

Shrinkage in limbic region

Long-COVID patients who had anxiety and depression had shrinkage in the brain's limbic area, which is involved in memory and emotional processing. However, the brain scans of COVID patient who had no anxiety and depression, as well as those who didn't experience COVID, revealed no signs of shrinkage.

Testing with software that tracks brain activity of the three groups found that the COVID patients with anxiety and depression had widespread functional changes in all 12 networks. COVID patients who didn't experience anxiety and depression had changes in 5 networks.

We need to be exploring holistic treatments even for people mildly affected by COVID-19.

Clarissa Yasuda, MD, PhD, with the University of Campinas, said in an AAN press release that the preliminary results suggest severe pattern changes that could affect how the brain communicates, as well as its structure, in those who have anxiety and depression alongside long COVID.

"The magnitude of these changes suggests that they could lead to problems with memory and thinking skills, so we need to be exploring holistic treatments even for people mildly affected by COVID-19." The team pointed out that a study limitation is that anxiety and depression symptoms were self-reported, so some participants could have misjudged their symptoms.

Bacterial vaccines network gets funding boost

News brief

The Bacterial Vaccines Network (BactiVac) announced today that it has received £1 million ($1.2 million US) from UK-based charitable organization Wellcome to accelerate the development of bacterial vaccines.

Based at the University of Birmingham, BactiVac brings together more than 1,400 members in the academic, industry, and policy sectors from 78 countries to advance the development of vaccines targeting the bacterial pathogens of global importance. Over half of its members are from low- and middle-income countries (LMICs), which have been disproportionately affected by bacterial infections and antimicrobial resistance (AMR).

Since its founding in 2017, the network has focused on raising awareness of the need for bacterial vaccines, promoting interaction and collaboration among members, and providing catalyst funding for new research projects. BactiVac Co-director Adam Cunningham, PhD, said in a press release that the funding will enable the network to build on those efforts over the next 4 years.

BactiVac will continue to support its membership to develop new vaccines, particularly those that are relevant to LMICs.

"We are grateful to Wellcome for their generous support and for sharing BactiVac’s vision that bacterial vaccines have a critical role to play in reducing bacterial infections and the threat of AMR," he said. "In this exciting new phase, BactiVac will continue to support its membership to develop new vaccines, particularly those that are relevant to LMICs." 

In a July 2022 report, the World Health Organization said that with the current antibiotic pipeline relatively short on new candidates, vaccines have become a "highly attractive" tool that could help curb AMR by reducing the incidence of bacterial infections and reducing the overall use and misuse of antibiotics.

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