{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T12:27:13Z","timestamp":1793104033274,"version":"4.5.0"},"reference-count":61,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T00:00:00Z","timestamp":1778198400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["R01-HD093780"],"award-info":[{"award-number":["R01-HD093780"]}],"id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000865","name":"Gates Foundation","doi-asserted-by":"publisher","award":["INV-076401"],"award-info":[{"award-number":["INV-076401"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]},{"name":"the Joint Global Health Trials Initiative (UK-Medical Research Council\/ Department for International Development\/ Wellcome Trust\/Department of Health and Social Care","award":["MR\/N006046\/1"],"award-info":[{"award-number":["MR\/N006046\/1"]}]}],"content-domain":{"domain":["gatesopenresearch.org"],"crossmark-restriction":false},"short-container-title":["Gates Open Res"],"abstract":"<ns5:p>\n                    Background Menstrual cups are increasingly promoted in low-resource settings as long-lasting and cost-effective menstrual hygiene solutions. However, no studies have been done among cup users to characterize the bacterial communities found on cups with long-term use when stored. This study sought to comprehensively characterize the bacterial surface profile of the menstrual cup, identify factors associated with putative pathogens, and quantify the vaginal microbiome as potential source for menstrual cup bacterial communities. Methods Over 30 months of follow-up, 369 menstrual cup samples were collected from 172 secondary schoolgirls participating in a randomized controlled trial in western Kenya. Samples were obtained from cups brought to school by girls during study visits. Menstrual cup and vaginal microbiomes were assessed using 16S rRNA gene amplicon sequencing. Mixed effects models were applied to identify factors associated with putative pathogens (\n                    <ns5:italic>Escherichia coli<\/ns5:italic>\n                    ,\n                    <ns5:italic>Staphylococcus aureus<\/ns5:italic>\n                    , coliform bacteria), and factors associated with vaginal microbiome as potential source environment to bacterial surface profile of the menstrual cup, estimated via fast expectation-maximization for microbial source tracking (FEAST). Results Menstrual cup bacterial surface profile composition was primarily comprised of soil and water bacteria. However, taxa specific to the vaginal microbiome (e.g.,\n                    <ns5:italic>Lactobacillus crispatus<\/ns5:italic>\n                    ,\n                    <ns5:italic>L. iners<\/ns5:italic>\n                    , and\n                    <ns5:italic>Gardnerella vaginalis<\/ns5:italic>\n                    ) were also recovered from cups. The mean relative abundance (presence) of\n                    <ns5:italic>E. coli<\/ns5:italic>\n                    and\n                    <ns5:italic>S. aureus<\/ns5:italic>\n                    was 0.09% (36%) and 0.36% (24%), respectively, with higher relative abundance among participants with HSV-2 or non-optimal vaginal community state type 4. Damaged cups were also associated with higher relative abundance of putative pathogens, while antibiotic use was inversely associated with\n                    <ns5:italic>E. coli.<\/ns5:italic>\n                    On average, 25.1% of cup microbiota originated from the vagina, with lower contributions among older participants and those with damaged cups. No serious adverse events related to the menstrual cup were observed in the cohort. Conclusions Interventions focused on improved cleaning and storage tools and methods, and access to clean water and sanitation infrastructure are required to maximize safety of menstrual cup use in low-resource settings.\n                  <\/ns5:p>","DOI":"10.12688\/gatesopenres.16380.1","type":"journal-article","created":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T10:49:08Z","timestamp":1783594148000},"page":"25","update-policy":"https:\/\/doi.org\/10.12688\/gatesopenres.crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Characterizing the bacterial surface profiles of menstrual cups and their association with user characteristics and vaginal microbiomes in an adolescent cohort from western Kenya"],"prefix":"10.12688","volume":"10","author":[{"given":"Garazi","family":"Zulaika","sequence":"first","affiliation":[{"name":"Liverpool England Liverpool School of Tropical Medicine Department of Clinical Sciences"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Nordgren","sequence":"additional","affiliation":[{"name":"Chicago Illinois University of Chicago"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Walter","family":"Agingu","sequence":"additional","affiliation":[{"name":"Kisumu Nyanza Reproductive Health Society"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adit","family":"Chaudhary","sequence":"additional","affiliation":[{"name":"Chicago Illinois Rush University Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ezekiel","family":"Dibondo","sequence":"additional","affiliation":[{"name":"Kisumu Nyanza Reproductive Health Society"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patriciah","family":"Wambua","sequence":"additional","affiliation":[{"name":"Kisumu Nyanza Reproductive Health Society"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna Maria","family":"van Eijk","sequence":"additional","affiliation":[{"name":"Liverpool England Liverpool School of Tropical Medicine Department of Clinical Sciences"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Rusie","sequence":"additional","affiliation":[{"name":"Chicago Illinois Rush University Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ankur","family":"Naqib","sequence":"additional","affiliation":[{"name":"Chicago Illinois Rush University Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fredrick","family":"Otieno","sequence":"additional","affiliation":[{"name":"Kisumu Nyanza Reproductive Health Society"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Penelope A.","family":"Phillips-Howard","sequence":"additional","affiliation":[{"name":"Liverpool England Liverpool School of Tropical Medicine Department of Clinical Sciences"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Supriya D.","family":"Mehta","sequence":"additional","affiliation":[{"name":"Chicago Illinois Rush University College of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2560","published-online":{"date-parts":[[2026,5,8]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"e376-e393","DOI":"10.1016\/S2468-2667(19)30111-2","article-title":"Menstrual cup use, leakage, acceptability, safety, and availability: a systematic review and meta-analysis.","volume":"4","author":"A Van Eijk","year":"2019","journal-title":"Lancet Public Health."},{"key":"ref2","doi-asserted-by":"publisher","first-page":"104339","DOI":"10.1016\/j.ebiom.2022.104339","article-title":"Safety assessment scheme for menstrual cups and application for the evaluation of a menstrual cup comprised of medical grade silicone.","volume":"86","author":"V Sica","year":"2022","journal-title":"EBioMedicine."},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.29690","article-title":"Study of adaptability and efficacy of menstrual cups in managing menstrual health and hygiene: a descriptive longitudinal study.","volume":"14","author":"R Singh","year":"2022","journal-title":"Cureus."},{"key":"ref4","doi-asserted-by":"publisher","first-page":"3045-3053","DOI":"10.18203\/2320-1770.ijrcog20172932","article-title":"Study of adaptability and efficacy of menstrual cup in managing menstrual health and hygiene.","volume":"6","author":"C Kakani","year":"2017","journal-title":"Int. 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The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.","order":0,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}