O04.1 The Impact of the Coronavirus Disease (COVID-19) on the Health and Social Needs of Sex Workers in Singapore

Abstract

Background In a recent PID treatment trial, MG was recovered significantly less from women treated with a regimen that included metronidazole. Our objective was to determine if cervical MG at randomization and following treatment correlated with vaginal dysbiosis. Methods This is a secondary analysis of the ACE Trial, a randomized trial comparing single dose ceftriaxone and two weeks of doxycycline, with either metronidazole 500 mg PO BID or placebo for 2 weeks. At enrollment and at 30 days following treatment, vaginal samples were evaluated for BV by Nugent criteria, and quantitative PCR was performed for anaerobic organisms. Endocervical swabs were tested for MG by NAAT. Results At randomization, MG infection was detected in 41/ 233 (18%) women, but detection at follow-up differed for those who received metronidazole [4/94 (4%)] vs placebo [14/ 99 (14%), p<0.05]. Women having MG at baseline had higher concentrations of four microbes (Gardnerella vaginalis, Atopobium vaginae, Megasphaera lornae, Prevotella timonensis) compared to women without cervical MG (P<0.05 for each), and each of these microorganisms was associated with cervical MG after treatment (P<0.05 for each). Although BV by Nugent criteria was not significantly associated with MG at randomization, women without BV following PID treatment were less likely to have MG infection than women with BV (4% vs 18%, p<0.01). Conclusion MG infection following PID is uncommon among women treated with metronidazole along with ceftriaxone and doxycycline, despite limited activity of this regimen against MG. MG infection was associated with vaginal dysbiosis, as defined by higher densities of BV-associated bacteria. These results suggest that a PID regimen with oral metronidazole and eradication of BV pathogens might be key to eliminating MG in women. Whether women diagnosed with PID should be tested for MG and treated with targeted therapy if positive remains uncertain.