Mycoplasma genitalium and Trichomonas vaginalis: addressing disparities and promoting public health control of two emerging sexually transmitted infections.

PURPOSE OF REVIEW: Mycoplasma genitalium (M. genitalium) and Trichomonas vaginalis (T. vaginalis), sexually transmitted infections that remain non-reportable in the United States, may lead to pelvic inflammatory disease (PID) and adverse pregnancy outcomes if left untreated. Prevalence estimates have highlighted socioeconomic and racial/ethnic disparities in rates of infection. This review summarizes the recent literature on M. genitalium and T. vaginalis with a focus on the epidemiology, screening, and treatment of M. genitalium and T. vaginalis. RECENT FINDINGS: The burden of T. vaginalis testing remains on women. Antimicrobial resistance is of great concern for M. genitalium. Comprehensive screening and treatment guidelines present an opportunity to address these public health concerns. SUMMARY: M. genitalium and T. vaginalis infections disproportionately affect sexual and racial/ethnic minorities and those facing socioeconomic disparities. The availability of nucleic acid amplification test testing has facilitated accurate diagnosis of both disorders. Safe and efficacious treatments are available for treatment of both disorders. Integrating macrolide resistance testing into treatment algorithms for M. genitalium and dual antibiotic therapy may prove a useful strategy for future US-based guidance. Public health reporting and increased public awareness campaigns are key next steps to addressing the observed reproductive health disparities.

Civic Engagement to Empower Young People to Impact Health and Well-Being.

Civic engagement is positively associated with important health and developmental benefits for participating adolescents and young adults. As illustrated by youth political participation, social activism, and rallies for racial justice during the COVID-19 pandemic, youth civic engagement is often inspired by and responsive to problems that are salient to a young person's lived experiences. Providers can empower youth and encourage civic engagement by eliciting issues that are important to them and directing them to community resources and opportunities for civic participation that can help them address these issues.

Urban Adolescents' and Young Adults' Decision-Making Process around Selection of Intrauterine Contraception.

STUDY OBJECTIVE: To examine adolescent and young adults' priorities, values, and preferences affecting the choice to use an intrauterine contraceptive device (IUD). DESIGN: Qualitative exploratory study with analysis done using a modified grounded theory approach. SETTING: Outpatient adolescent medicine clinic located within an academic children's hospital in the Bronx, New York. PARTICIPANTS: Twenty-seven women aged 16 to 25 years of age on the day of their IUD insertion. INTERVENTIONS AND MAIN OUTCOME MEASURES: We conducted semistructured interviews exploring participant's decision making process around selecting an IUD. We were specifically interested in elucidating factors that could potentially improve IUD counseling. RESULTS: We identified 4 broad factors affecting choice: (1) personal; (2) IUD device-specific; (3) health care provider; and (4) social network. Most of the participants perceived an ease with a user-independent method and were attracted by the high efficacy of IUDs, potential longevity of use, and the option to remove the device before its expiration. Participants described their health care provider as being the most influential individual during the IUD decision-making process via provision of reliable, accurate contraceptive information and demonstration of an actual device. Of all people in their social network, mothers played the biggest role. CONCLUSION: Adolescents and young women who choose an IUD appear to value the IUDs' efficacy and convenience, their relationship with and elements of clinicians' contraceptive counseling, and their mother's support. Our results suggest that during IUD counseling, clinicians should discuss these device-specific benefits, elicit patient questions and concerns, and use visual aids including the device itself. Incorporating the factors we found most salient into routine IUD counseling might increase the number of adolescents and young women who choose an IUD as a good fit for them.