Why we're so bad at treating vaginal infections

Also: What to know about the drug pricing reform deal in Congress [View in browser](    [❤️]( August 9, 2022 Hi CommonHealth reader, I recently [reported]( that Massachusetts General Hospital performed the country’s first vaginal fluid transplants this summer. It was a story that surprised me at each turn in the reporting process. Researchers are studying the transplants in an effort to find better treatments for bacterial vaginosis (BV), a condition that occurs when the natural bacteria in the vagina are out of whack. And for starters, its prevalence was astounding: At any given moment, one in three women in the United States has BV. Next, I was shocked by the gravity of the consequences: For people with symptoms — often discharge and odor — it can have a serious impact on their relationships and intimacy. And while the majority of people with BV don't report symptoms, they still face the same serious health implications. BV has been linked to a higher risk of HIV, HPV, preterm birth and perhaps infertility. Finally, the lack of treatment options was baffling: For roughly 40 years, the recommendation has been antibiotics. But even after taking antibiotics, there is a 40-60% chance BV will return within a month. That's where vaginal fluid transplants could help. The procedure is simple. It uses a menstrual cup to collect fluid from a healthy vagina and an eyedropper to put it into an unhealthy one. Caroline Mitchell, who is spearheading the transplant study and directs MGH’s Vulvovaginal Disorders Program, told me the hope is to provide a breakthrough toward long-term treatments. But something kept bugging me. I wanted to know: How did the situation get this bad? Why don’t we have better treatments already? Mitchell said the answer is twofold. First, she told me, human vaginas are unique. Ideally, they are dominated by just one type of extraordinary bacteria: Lactobacillus crispatus, which has a unique superpower that seems to make the vagina particularly acidic and reduces inflammation. HIV even moves more slowly in such an acidic environment. No other animal in the animal kingdom has vaginas dominated by lactobacillus. Not mice. Not baboons. Not chimpanzees. "That makes making progress in this field very difficult because you can't try a new therapy in an animal model the way you can for things that treat gut microbiome dysfunction or skin microbiome dysfunction," said Mitchell. The second thing Mitchell pointed to is a long-term lack of investment in women’s health — particularly in women’s sexual wellbeing. She said when you juxtapose conditions that primarily affect men with those that primarily affect women, the ones that impact men get significantly more research funding. “In an era where we're sequencing people's tumors so we can give individual chemotherapy to people, we still don't know why people get vaginal infections," she said. "It is incredibly frustrating.” The field has a long way to go, but she’s hopeful the vaginal fluid transplants will be one step in the right direction. Gabrielle Emanuel Health reporter [Follow]( Support the news  This Week's Must Reads [To solve the mystery of long COVID, researchers look to an older disease]( The symptoms of long COVID appear almost identical to a condition known for decades: myalgic encephalomyelitis/chronic fatigue syndrome. Understanding the connections between the two could be key to helping people suffering from both. [Read more.]( [To solve the mystery of long COVID, researchers look to an older disease]( The symptoms of long COVID appear almost identical to a condition known for decades: myalgic encephalomyelitis/chronic fatigue syndrome. Understanding the connections between the two could be key to helping people suffering from both. [Read more.]( [Congress is about to act on drug price reform. Here's what you need to know]( A deal in Congress would help deliver on a long-time promise: to make prescription drugs more affordable. It also includes a $2,000 cap on out-of-pocket expenses for Medicare patients. [Read more.]( [Congress is about to act on drug price reform. Here's what you need to know]( A deal in Congress would help deliver on a long-time promise: to make prescription drugs more affordable. It also includes a $2,000 cap on out-of-pocket expenses for Medicare patients. [Read more.]( [A 'staggering' number of people couldn't get care during the pandemic, poll finds]( Insured or not, one in five said they couldn't get treated for serious illness, while preventive and elective procedures were neglected. Disruptions in care hit Black and Native Americans the hardest. [Read more.]( [A 'staggering' number of people couldn't get care during the pandemic, poll finds]( Insured or not, one in five said they couldn't get treated for serious illness, while preventive and elective procedures were neglected. Disruptions in care hit Black and Native Americans the hardest. [Read more.]( [Little has been done to correct problems at Bridgewater State Hospital, report finds]( The report found both the Department of Correction and its medical provider, Wellpath, violated laws requiring appropriate medical care and documentation when force is used. [Read more.]( [Little has been done to correct problems at Bridgewater State Hospital, report finds]( The report found both the Department of Correction and its medical provider, Wellpath, violated laws requiring appropriate medical care and documentation when force is used. [Read more.]( [Behind the new study changing how doctors view depression]( You’ve seen the pharma ads saying depression may be caused by a chemical imbalance in the brain. But for years, doctors have known that's not entirely true. A big new study confirms that, and it’s come as a shock to patients. [Read more.]( [Behind the new study changing how doctors view depression]( You’ve seen the pharma ads saying depression may be caused by a chemical imbalance in the brain. But for years, doctors have known that's not entirely true. A big new study confirms that, and it’s come as a shock to patients. [Read more.]( What We're Reading 📚 The pigs were cold and dead for an hour. Then, scientists at Yale pumped a concoction of nutrients, drugs and nerve blockers into them — and dead cells began to show signs of life. While death is traditionally considered the ultimate irreversible condition, a[new study]( out this week in Nature raises questions about that basic assumption (and, of course, serious ethical questions). Even the researchers behind the study said they were surprised by what they saw. Though the pigs did not fully come back to life, their seemingly dead cells did. Organs like the heart, liver, kidneys and brain even regained function. “Everything we restored was incredible to us,” Dr. David Andrijevic, one of the authors of the paper, [told The New York Times]( week. Others not connected to the study called it “unbelievable, mind blowing” and said their “[eyes went wide]( While this concoction is a far way off from being used in humans, the researchers say they hope that one day it will increase the supply of organs that can be transplanted by allowing doctors more time to collect them from people after they die. They also hope it might help patients after a significant heart attack or a stroke. " I do feel like I've come back, basically, from being dead each time" —  Dr. Liisa Selin, of UMass Chan Medical School, about having [myalgic encephalomyelitis/chronic fatigue syndrome]( ICYMI [Report recommends blood tests, medical monitoring for people exposed to toxic PFAS chemicals]( The report linked PFAS exposure to kidney cancer in adults, as well as decreased immune response in adults and children. The toxins have contaminated drinking water supplies in many Massachusetts communities. [Read more.]( [Report recommends blood tests, medical monitoring for people exposed to toxic PFAS chemicals]( The report linked PFAS exposure to kidney cancer in adults, as well as decreased immune response in adults and children. The toxins have contaminated drinking water supplies in many Massachusetts communities. [Read more.]( 🧠💥 Did you know...💥🧠 In an effort to escape the heat, veterinarians in Japan [have teamed up with a clothing maker to create wearable fans for pets]( According to Reuters, the idea is that the fans help cats and dogs manage since they can’t get rid of their fur in heat waves. (The photos are also very cute.) 😎 Forward to a friend. They can sign up [here](. 📣 Give us your feedback: newsletters@wbur.org 📧 Get more WBUR stories sent to your inbox. [Check out all of our newsletter offerings.]( Support the news     Want to change how you receive these emails? Stop getting this newsletter by [updating your preferences.](  I don't want to hear from WBUR anymore. Unsubscribe from all WBUR editorial newsletters [here.](  Interested in learning more about corporate sponsorship? [Click here.]( Copyright © 2022 WBUR-FM, All rights reserved.