For National Women’s Health Week last year, this blog focused on the need for progress in a variety of areas in which women have unmet medical needs. Last year’s post mentioned the need for progress in noninvasive diagnostics and therapeutics for osteoporosis, female sexual dysfunction, endometriosis, bacterial vaginosis and uterine fibroids. This year we want to note progress in prevention of HPV infections and to highlight the need to address two other infectious conditions.
Progress in HPV Prevention
The intervening year has brought notable progress in some areas, including a continued reduction in prevalence of HPV infections. Progress is evident in the markedly lower HPV prevalence is younger age cohorts with higher HPV vaccination rates, with more recent data snapshots likely to show even greater reductions in HPV prevalence.
This is likely because of increasingly widespread health insurance coverage of preventive services such as the HPV vaccine. If the trend to wider access to the HPV vaccine continues, many women will be spared future medical procedures such as colposcopy. Even more important, some women who otherwise might have developed cervical cancer will not. Let us hope that healthcare policy makers show continued appreciation for the human benefit and economic value of prevention of known oncogenic infections whenever possible.
Unmet Medical Needs: the Zika Virus and Mycoplasma genitalium
This year we would like to highlight the need for improvements in diagnosis, prevention and, if possible, treatment of two infectious conditions. The first is the Zika virus with its devastating combination of the potential for birth defects and transmission not only by mosquitoes but also through sexual activity. There are several FDA emergency-use authorizations for Zika diagnostics as well as candidate Zika vaccines. Let us hope to see early FDA approval of a Zika virus diagnostic and an effective Zika vaccine.
Another infectious condition raising increasing concerns is Mycoplasma genitalium (MG). This infection is associated with pelvic inflammatory disease and, although the Centers for Disease Control and Prevention classifies it as an emerging condition already demonstrates substantial resistance to antibiotics like azithromycin. Moreover, MG appears to be more prevalent in some populations than better known sexually transmitted infections such as Chlamydia trachomatis and Neisseria gonorrhea.
The Need for Routine Screening for MG, Novel Antibiotics
Given the combination of prevalence, antibiotic resistance and associated health risks that MG presents, there is a need to introduce routine screening for this pathogen among all sexually active women. In addition, just as with many other infectious conditions, there is a pressing need for novel antibiotics. Several companies have developed or are developing MG diagnostics. We hope to see screening for this pathogen incorporated into the standard of care soon.
A near-term solution to the problem of antibiotic-resistant STIs seems less likely. Discovery and development of novel antibiotics is a global health priority with no near-term solution in sight. The Pew Charitable Trusts have published a roadmap for antibiotic discovery but the rest is up to the research community and the pharma industry.