Lindsey Carr

 on menstrual health have led to much vaccine hesitancy. While its effects weren’t studied in the initial Pfizer/BioNTech, Moderna, and Johnson & Johnson clinical trials, recent research delivers reassuring results.

A retrospective cohort analysis found that slight, temporary changes in menstrual cycles may occur after COVID-19 vaccination but return to normal after 2 postvaccine cycles.1

Investigators conducted a retrospective cohort analysis of nearly 4000 vaccinated and unvaccinated women, examining 6 cycles of menstrual data using the US Food and Drug Administration-approved fertility app 

Data were used from women in the United States aged 18 to 45. All women reported normal cycle lengths (24 to 38 days), and investigators included data of the vaccinated group for 3 consecutive cycles before the first vaccine dose, followed by vaccine dose cycles (cycles 4-6). Data for the unvaccinated group included 6 cycles in a similar period. They included women in the United States aged 18 to 45 with normal cycle lengths of 24 to 38 days over the course of 3 consecutive cycles.

Of the 3959 women, 2403 were vaccinated and 1556 were not. Most of the vaccinated women received the Pfizer/BioNTech vaccine (55%), followed by Moderna (35%) and Johnson & Johnson/Janssen (7%).

After adjusting for confounders, investigators reported that all women experienced small variations in cycle length, regardless of vaccination status. As for the vaccinated group, the difference in cycle length was less than 1 day when compared with the unvaccinated group. A small group of women who received both vaccine doses in the same cycle had their period for an average of 2 days longer than the unvaccinated group, but this alteration diminished after 2 postvaccine cycles.

Investigators found no change in menses length between or within the 2 groups.

These results are useful for ob-gyns because, even though a 1-day change is not clinically significant, a cycle change of any kind may cause concern or raise hopes of patients avoiding or planning for pregnancy.

This article was originally published by sister publication Contemporary OB/GYN.

Edelman A, Boniface ER, Benhar E, et al. Association between menstrual cycle length and coronavirus disease 2019 (COVID-19) vaccination: a U.S. cohort. 

 Published online January 5, 2022. doi:10.1097/AOG.0000000000004695

Articles

A new study showed that COVID-19 vaccinations may temporarily cause changes to the timing of menstruation. 

What does the COVID-19 vaccine do to the menstrual cycle?

The device can detect 3 of the most common sexually transmitted infections (STIs)—

The US Food and Drug Administration also granted a waiver under the Clinical Laboratory Improvement Amendments of 1988 (CLIA), allowing any health care setting with a CLIA Certificate of waiver to administer the test during the patient’s appointments. This eliminates the need to send samples to a laboratory and reduces the time needed to obtain the results. It also may be useful in areas with limited access to testing.

“Without an accurate test result, we are fighting blind, often prescribing STI treatments before we have a clear diagnosis, which can lead to delayed or ineffective treatment and to the emergence of antibiotic-resistant microbes, Gary Choolnik, MD, an infectious disease expert, Visby Medicals’ Chief Medical Officer, and Professor of Medicine at Stanford University said in a recent 

This article was originally published by Contemporary OB/GYN.

The US Food and Drug Administration has issued 501(k) clearance for Visby Medical’s Sexual Health Click Test, a single-use, instrument-free polymerase chain reaction diagnostic test for sexually transmitted infections.

Visby Medical ™ handheld STI testing device gets approval

“With rising rates of STIs, appropriate treatment is essential,” said 

 Editor in Chief, Catherine Y. Spong, MD.

The CDC continues to recommend routine screenings for common STIs for all sexually active adolescents and young adults. The guidelines also recommend opt-out screening for chlamydia and gonorrhea for female adolescent and young adult patients, which could increase screening significantly, save costs, and identify STIs among youths who do not wish to disclose their sexual activity.

The new guidelines also include a change to doxycycline as the first treatment for chlamydia in place of azithromycin. Specifically, they recommend doxycycline 100 milligrams (mg) orally twice a day for seven days as first-line chlamydia infection treatment. For doxycycline allergy or pregnancy patients, alternatives include azithromycin 1 gram (g) orally in a single dose or levofloxacin 500 mg orally once daily for seven days.

Antibiotic resistance complicates gonorrhea treatment. The recommended treatment for cervical, urethral, and rectal gonorrhea is intramuscular ceftriaxone 500 mg in a single dose. For patients over 150 kilograms (kg), the ceftriaxone dose should be increased to 1 g. If ceftriaxone is unavailable, alternatives include intramuscular gentamicin 240 mg in a single dose 

azithromycin 2 g orally in a single dose; or cefixime 800 mg orally in a single dose.

If chlamydial co-infection cannot be excluded, doxycycline 100 mg orally twice daily for seven days should be added.

The new guidelines for trichomoniasis treatment are metronidazole 500 mg orally twice daily for seven days.

This article was originally published on Contemporary OB/GYN.

The Centers for Disease Control and Prevention (CDC) updated its guidelines for the treatment of sexually transmitted infections (STIs), notably for Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, and pelvic inflammatory disease.

CDC updates guidelines for diagnosing and treating STIs

was developed by ACOG’s Immunization, Infectious Disease, and Public Health Preparedness Expert Work Group in collaboration with 

; Richard Beigi, MD; Denise J. Jamieson, MD, MPH; Brenna L. Hughes, MD, MSc; Geeta Swamy, MD; Linda O’Neal Eckert, MD; Mark Turrentine, MD; and Sarah Carroll, MPH. The Practice Advisory will reflect any changes as more data are collected about the vaccines and their use in specific populations.

ACOG recommends that pregnant individuals have access to COVID-19 vaccines.

COVID-19 vaccines should be offered to lactating individuals.

Individuals considering a COVID-19 vaccine should have access to available information about the safety and efficacy of the vaccine, including information about data that are not available.

A discussion with their health care provider can help them make an informed decision.

the risk and potential severity of maternal disease, including the effects of disease on the fetus and newborn

the safety of the vaccine for the pregnant patient and the fetus.

While a conversation with a clinician may be helpful, it should not be required prior to vaccination, as this may cause unnecessary barriers to access.

Pregnancy testing should not be a requirement prior to receiving any EUA-approved COVID-19 vaccine.

Unfounded claims linking COVID-19 vaccines to infertility have been scientifically disproven. ACOG recommends vaccination for all eligible people who may consider future pregnancy.

Women under age 50 including those who are pregnant can receive any FDA-authorized COVID-19 vaccine available to them. However, they should be aware of the rare risk of TTS (thrombosis with thrombocytopenia syndrome) after receipt of the Janssen COVID-19 vaccine and that other FDA-authorized COVID-19 vaccines are available (i.e., mRNA vaccines)

Available data suggest that symptomatic pregnant patients with COVID-19 are at an increased risk of more severe illness than nonpregnant patients.

The absolute risk for severe COVID-19 is low; however, data suggest an increased risk of ICU admission, need for medical ventilatory support (ECMO) and death reported in pregnant women with symptomatic COVID-19 infection when compared to symptomatic non-pregnant women. The 

Centers for Disease Control and Prevention

 has listed pregnancy as a risk factor for severe COVID-19 infection.

American College of Obstetricians and Gynecologists. Practice Advisory: Vaccinating Pregnant and Lactating Patients Against COVID-19. Revised April 28, 2021. Accessed May 20, 2021. 

https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2020/12/vaccinating-pregnant-and-lactating-patients-against-covid-19

Centers for Disease Control and Prevention. Vaccination of pregnant or lactating people. Revised May 14, 2021. Accessed May 20, 2021.

https://www.cdc.gov/vaccines/covid-19/info-by-product/clinical-considerations.html#pregnant

A recently updated Practice Advisory from the American College of Obstetricians and Gynecologists (ACOG) provides an overview of the latest guidance for COVID-19 vaccination in pregnant and lactating patients. 

Lindsey Carr

Articles

What does the COVID-19 vaccine do to the menstrual cycle?

Visby Medical ™ handheld STI testing device gets approval

CDC updates guidelines for diagnosing and treating STIs

ACOG advisory offers latest info for COVID-19 vaccine use in pregnant and lactating patients