Sex Transm Infect
· 2026 Jun · PMID 42236154
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Congenital syphilis (CS) has been rapidly re-emerging as a public health crisis across North America. The present standard of care treatment for CS involves a 10-day hospitalisation for intravenous penicillin G, which is...Congenital syphilis (CS) has been rapidly re-emerging as a public health crisis across North America. The present standard of care treatment for CS involves a 10-day hospitalisation for intravenous penicillin G, which is costly for healthcare systems and families. Given these costs and the frequency of their application, the purpose of this study was to locate the evidence upon which the standard of care for CS has been founded and to assess its quality.A search of Embase and MEDLINE was conducted, and a total of 398 publications were evaluated for inclusion in this study. 54 publications met the inclusion criteria. Quality of data was appraised using the Oxford Centre for Evidence-Based Medicine (OCEBM) levels of evidence 2011 and the American Academy of Family Physicians grades of strength of recommendation taxonomy (SORT). Levels of evidence in OCEBM 2011 are assigned a number from 1 (highest quality) to 5 (weakest). The strength of recommendations in SORT is assigned a letter from A (strongest recommendation) to C (weakest). Level 5 evidence and grade C recommendations were the most abundant results in this study. Additionally, the most common treatment regimens reported were intramuscular penicillin administration, in doses of 50 000-75 000 units/kg, for a duration of 10-14 days. Systematic statistical analyses could not be applied to the results due to inconsistency and arbitrary changes of treatment within the individual constituent studies. The results affirmed a gap in high-quality primary evidence behind the treatment of CS. Supporting literature is based on expert opinion, consensus and non-randomised studies. Overall, this project underscores the need for high-quality randomised controlled trials to understand the limitations of the current standard of care and to confirm the need for a 10-day course of intravenous penicillin G in hospital.
Manguro GO, Ray J, Schocken C
… +7 more, Were DK, Omballa VO, Johnson CC, Dziva Chikwari C, Footman A, Newman LM, Peters RPH
Sex Transm Infect
· 2026 Jun · PMID 42236153
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INTRODUCTION: Syndromic management remains the primary approach for identifying and treating sexually transmitted infections (STIs) in low-resource settings. While faster and inexpensive, it leads to overtreatment, under...INTRODUCTION: Syndromic management remains the primary approach for identifying and treating sexually transmitted infections (STIs) in low-resource settings. While faster and inexpensive, it leads to overtreatment, undertreatment and missed opportunities for surveillance. Recent advances in point-of-care (POC) diagnostic technologies for and other STIs present new opportunities to improve STI management. METHODS: In September 2024, the Gates Foundation convened a 3-day expert meeting in Nairobi, Kenya, bringing together 44 global and national experts in STI diagnostic development, implementation research, policy, regulatory affairs and clinical practice. The objective was to identify priorities and strategies for advancing the introduction and scale-up of STI POC testing in low-resource settings with a focus on sub-Saharan Africa. RESULTS: Participants identified opportunities and barriers for introducing STI POC testing at various levels: individual client, health service delivery, national and global. At the individual client level, recommendations to optimise testing uptake included identifying and piloting strategies to improve knowledge about STIs and testing as well as addressing barriers to testing. At the health service delivery level, recommendations were to optimise clinical workflows, consider testing outside traditional health facilities (including private pharmacies), encourage self-collection and improve partner notification. At the national level, recommendations included updating treatment guidelines to incorporate diagnostic testing, strengthening laboratory quality assurance for STI tests and advocating for the public health importance of STIs, which remain underprioritised. This also involves building political commitment. At the global level, recommendations included harmonising regulatory requirements across regions, leveraging WHO prequalification processes, and expanding manufacturing capacity through technology transfer. CONCLUSIONS: Effective introduction of STI POC diagnostics in low-resource settings will require coordinated efforts across global and national levels. Successful introduction, while ensuring equitable access, will accelerate access to quality STI care, reduce antimicrobial resistance and improve STI control outcomes.
Boswell E, Webster BL, Cooper JM
… +1 more, Reboud J
Sex Transm Infect
· 2026 May · PMID 42209291
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BACKGROUND: High-risk human papillomavirus (HR-HPV) causes around 95% of cervical cancers. People in low-resource settings are more frequently affected, primarily due to lack of access to screening and vaccinations. Poin...BACKGROUND: High-risk human papillomavirus (HR-HPV) causes around 95% of cervical cancers. People in low-resource settings are more frequently affected, primarily due to lack of access to screening and vaccinations. Point-of-care screening tests using DNA-based isothermal amplification are being developed to address this, but few are tested in real-world scenarios, a critical step in evaluating their future utility. OBJECTIVES: This scoping review aimed to summarise and contextualise studies developing point-of-care HR-HPV screening tests evaluated in real-world scenarios, defined as using low-resource sample preparation methods on >30 clinical samples. METHODS: A scoping review of studies in Web of Science and PubMed identified isothermal amplification screening tests meeting this definition. Their alignment with the WHO's target product profile (TPP) for point-of-care tests was assessed. RESULTS: Only 13 studies-7% of total studies addressing DNA-based HPV isothermal amplification in our search-were tested in real-world scenarios. Atila's ScreenFire and AmpFire platforms were the only platforms taken to mid-stage validation.Of these 13 studies, 12 used a combination of lysis buffer and heat for the sample preparation (1 used magnetic beads); 5 used samples from low-resource locations (8 used samples from high-resource locations); 3 used at least some vaginal or cervicovaginal samples, as recommended by the WHO (9 used cervical, 1 did not specify); and 1 used samples taken immediately (9 used stored clinical samples, 3 did not specify). Only four studies addressed three or more out of seven criteria in relation to the TPP for HR-HPV point-of-care tests. CONCLUSION: To facilitate agreement with the TPP, we recommend that future studies aim to test their systems with freshly obtained vaginal swabs. The use of cervical swabs and preconcentration steps should be accounted for in analysis. Samples from low-resource populations should be used in mid-stage validation.
Keane A, Lyons F, Smith CJ
… +3 more, Caixeta D, Molina JM, Villa G
Sex Transm Infect
· 2026 May · PMID 42135198
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OBJECTIVES: Doxycycline post-exposure prophylaxis (doxyPEP) has been shown to reduce syphilis and chlamydia incidence among gay, bisexual and other men who have sex with men (gbMSM) and transgender women (TGW). However,...OBJECTIVES: Doxycycline post-exposure prophylaxis (doxyPEP) has been shown to reduce syphilis and chlamydia incidence among gay, bisexual and other men who have sex with men (gbMSM) and transgender women (TGW). However, evidence among other populations remains limited. This study aimed to assess knowledge, attitudes, willingness and use of doxyPEP among sexual health clinic attendees and healthcare workers in Dublin. METHODS: Data were collected via two anonymous surveys in two sexual health services for service users and healthcare workers. Surveys were collected between January and March 2024. Logistic regression analyses explored factors associated with willingness to use doxyPEP. RESULTS: Among 378 clinic attendees (median age 32), 72% (272/378) identified as gbMSM, TGW, non-binary or gender fluid; 17% (64/378) cisgender women and 11% (42/378) heterosexual men. Overall, 62% (235/378) expressed willingness to use doxyPEP, with higher willingness observed in the gbMSM, TGW, non-binary and gender fluid group (70%, 190/272). This group also reported the highest level of knowledge of doxyPEP compared with other groups: 107/272 (39.3%). After adjustment, logistic regression analyses revealed that individuals with prior sexually transmitted infection (STI) diagnoses were more willing to use doxyPEP (adjusted OR (aOR) per number of STI diagnosed 2.00, 95% CI 1.28 to 3.03, p=0.002). 9% (35/378) reported doxyPEP use in the past 1 year. Among 52 healthcare workers, 81% (42/52) were aware of doxyPEP studies, 62% (32/52) believed it could reduce STIs, but 89% (46/52) had concerns, primarily around antimicrobial resistance. CONCLUSIONS: This is the first study evaluating doxyPEP attitudes in Ireland. Willingness to use doxyPEP was high among individuals at greatest STI risk, supporting its potential for targeted implementation. There was also interest among cisgender women and heterosexual men. However, clinician concerns about antimicrobial resistance remain a barrier. These findings highlight the need for national guidelines, ongoing surveillance and research, including among heterosexual men and cisgender women, to inform equitable and safe doxyPEP prescription.
Ludwick T, Cardwell ET, Vo TD
… +6 more, Ware L, Quinn P, Chow EPF, Grace D, Hocking JS, Kong FYS
Sex Transm Infect
· 2026 May · PMID 42082360
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OBJECTIVES: Many countries recommend 3-monthly chlamydia/gonorrhoea screening for gay, bisexual and other men who have sex with men (GBMSM). Evidence about the limited impact of frequent, asymptomatic gonorrhoea/chlamydi...OBJECTIVES: Many countries recommend 3-monthly chlamydia/gonorrhoea screening for gay, bisexual and other men who have sex with men (GBMSM). Evidence about the limited impact of frequent, asymptomatic gonorrhoea/chlamydia screening on population prevalence, coupled with concerns about overburdened health services and antimicrobial resistance (from frequent treatment), calls into question current approaches to asymptomatic screening. We explored sexual health professionals/experts' arguments in favour/against reducing asymptomatic screening using Polis (www.Pol.is), an online, crowdsourcing tool for understanding what large groups think. METHODS: Recruited via global peak bodies/networks, 99 individuals in the field of sexually transmitted infections (STIs) (43.4 % clinicians, 35.4% researchers) primarily from Australasia (41.4%), UK/Europe (29.3%) and North America (22.2%) participated. Ninety-one statements were submitted in favour/against reduced screening for GBMSM (eg, 'Bisexual men who don't test regularly risk putting women at risk'). Participants voted on submitted statements (agree/disagree/pass). Statements with ≥80% agreement were considered as 'strong' support, 70%-79% 'moderate' and ≤69% 'mixed'. Statements were grouped using content analysis to assess support for clusters of related statements. RESULTS: There was 'mixed support' for statements on: (1) the impact of screening in reducing prevalence; (2) whether asymptomatic infections pose clinical harm/necessitate treatment; and (3) risk of antimicrobial resistance. Statements advocating for 6-monthly screening received 'moderate support', with arguments centring on resource use. Participants 'strongly supported' the need for community engagement and maintaining frequent HIV/syphilis screening. CONCLUSIONS: While there were mixed opinions about relative utility, risks and harms of reducing chlamydia/gonorrhoea screening for GBMSM, arguments relating to resource constraints may provide common ground for policy changes.
Erly S, Hyzer S, Strick LB
… +3 more, Pezo-Salazar A, Senter Z, Jack HE
Sex Transm Infect
· 2026 May · PMID 42082359
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OBJECTIVE: The syphilis epidemic in the USA has expanded dramatically into new populations, but the overlap with prison populations is unknown. The objective of this analysis was to describe trends in syphilis diagnosis...OBJECTIVE: The syphilis epidemic in the USA has expanded dramatically into new populations, but the overlap with prison populations is unknown. The objective of this analysis was to describe trends in syphilis diagnosis among people incarcerated and released from a state prison system. METHODS: This was a cohort study of people released from prison in Washington state between 2010 and 2022. Linking prison rosters to Washington surveillance data, we calculated the rate of syphilis diagnosis between 2013 and 2023 when individuals were inside and outside of prison and compared it to the general population of Washington state. FINDINGS: The rate of syphilis diagnosis increased substantially both in prison (36 per 100 000 person-years in 2013 to 274 in 2022, rate ratio vs general population 1.3 in 2013 to 2.1 in 2023) and out of prison (8 in 2013 to 887 in 2023, rate ratio vs general population 0.3 in 2013 to 6.4 in 2023) over time. INTERPRETATION: From 2013 to 2023, the rate of syphilis diagnosis among those incarcerated in prison in Washington changed from similar to the general population to being significantly greater. Opt-out syphilis testing and treatment in prisons should be included in prison guidelines and accreditation standards.
Gupta S, Papp-Green M, Eisenberg M
… +2 more, Mahn J, Hecht J
Sex Transm Infect
· 2026 May · PMID 42082358
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OBJECTIVES: We evaluated the uptake of an at-home syphilis testing option through TakeMeHome, a free HIV/STI self-testing programme, and assessed the correlates of selecting the new testing option in this cross-sectional...OBJECTIVES: We evaluated the uptake of an at-home syphilis testing option through TakeMeHome, a free HIV/STI self-testing programme, and assessed the correlates of selecting the new testing option in this cross-sectional evaluation. METHODS: Data consisted of self-test orders placed between January and July 2025 in jurisdictions that introduced an at-home syphilis self-testing option through TakeMeHome and previously did not offer STI testing through the programme. Poisson regression models with robust standard errors were used to estimate the associations between participant race/ethnicity, gender identity, last HIV/STI test date, status as a previous TakeMeHome tester, and age and the outcome of ordering an add-on at-home syphilis test. RESULTS: In jurisdictions that did not previously offer an STI testing option, 1234 at-home tests were ordered over the follow-up period, with 907 (74%) orders for an at-home HIV test with an at-home syphilis test. Cisgender women were more likely to be interested in and eligible for the syphilis test compared with cisgender men, after adjustment for race/ethnicity, last HIV/STI test date, being a previous TakeMeHome tester, jurisdiction and age (adjusted PR: 1.22, 95% CI 1.13 to 1.33, p<0.0005). CONCLUSIONS: There was high interest in and uptake of the new at-home syphilis testing option in jurisdictions that previously did not offer at-home STI testing through TakeMeHome.
OBJECTIVE: To evaluate the efficacy of pristinamycin in treating infection among patients who experienced failure of resistance-guided treatment regimens. METHODS: This observational study reviewed pharmaceutical and cl...OBJECTIVE: To evaluate the efficacy of pristinamycin in treating infection among patients who experienced failure of resistance-guided treatment regimens. METHODS: This observational study reviewed pharmaceutical and clinical records of patients who received pristinamycin via the named-patient mechanism at a London sexual health service between October 2019 and February 2025. Eligible participants had documented clinical and/or microbiological failure following resistance-guided therapy. Data collected included demographics, sexuality, infection site, macrolide resistance results, prior antibiotic exposure and tetracycline pretreatment. The primary outcome was microbiological cure, defined as a negative test-of-cure ≥4 weeks post treatment. The secondary outcome was clinical cure, defined as resolution of symptoms in the absence of a confirmatory test. We compared proportions with Fisher's exact test for 2×2 comparisons and a single global χ test for multicategory comparisons, reporting relative risks with 95% CIs. RESULTS: Sixty-eight patients were identified; 87% were male, 57% were men who have sex with men, and the mean age was 37 years. Nearly all (97%) had macrolide-resistant infections. Most (81%) had previously received moxifloxacin and the median number of prior antimicrobial courses was three. Microbiological cure was achieved in 71% (48/68; 95% CI 58% to 81%) and clinical cure in 76% (52/68; 95% CI 65% to 86%). When stratified by the use or non-use of tetracycline pretreatment and by the indication for the test, no statistically significant difference in either microbiological or clinical cure was observed. CONCLUSIONS: Pristinamycin achieved microbiological and clinical cure rates of 71-76% in patients with macrolide-resistant infection. These findings align with previously published observational data, supporting pristinamycin as an effective and tolerable third-line treatment option following macrolide-based and quinolone-based regimen failure. Development of standardised algorithms is warranted to optimise management of resistant infection.
OBJECTIVES: The demand for point-of-care testing (POCT) increased exponentially during the COVID-19 pandemic, providing a convenient and accessible method of virus detection outside of traditional laboratory settings. As...OBJECTIVES: The demand for point-of-care testing (POCT) increased exponentially during the COVID-19 pandemic, providing a convenient and accessible method of virus detection outside of traditional laboratory settings. As high rates of sexually transmitted infections (STIs) remain a prominent public health concern, POCT for STI detection may offer an option that reduces key barriers to care such as stigma and limited clinic hours. The aim of this narrative review is to identify key facilitators, barriers and gaps related to the acceptability and implementation of STI POCT from patient perspectives in non-traditional settings. METHODS: To conduct this narrative review, a comprehensive literature search was conducted using PubMed, Embase and Scopus to identify relevant studies published between 1 January 2015 and May 2025, focusing on patient perspectives and contextual determinants of POCT implementation for (CT) and (NG). Search terms included free-text keywords (such as "point of care") and indexed terms (such as (MeSH)). Findings were contextualised based on patient perspective data and implementation into non-traditional settings. RESULTS: 40 studies were included in the narrative review, reflecting geographical regions where POCT implementation has been prioritised. Study designs and implementation environments varied. POCT for CT/NG screening generally reported high diagnostic accuracy and reliability as well as increased uptake and high acceptability across settings. Availability, perceived convenience and increased autonomy significantly influenced POCT uptake and implementation among patients. Implementation facilitators included ease of device usage, minimal training and improved quality of care. Implementation barriers primarily focused on logistics, workflow and cost. CONCLUSIONS: Community-engaged approaches to designing and implementing STI POC tests in non-traditional settings are necessary to better understand specific needs. High patient satisfaction, device acceptability and improved health outcomes place STI POCT as a promising avenue for strengthening public health efforts against the STI epidemic.
Verheyden M, Surmont M, Goossens M
… +6 more, Mostmans Y, Kindt S, Brunetta JM, Sahebali S, Gutermuth J, Allard SD
Sex Transm Infect
· 2026 Mar · PMID 41895851
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BACKGROUND: Men who have sex with men using pre-exposure prophylaxis (MSM-PrEP) represent an emerging population at high risk for anal human papillomavirus (HPV)-related disease. However, screening strategies and evidenc...BACKGROUND: Men who have sex with men using pre-exposure prophylaxis (MSM-PrEP) represent an emerging population at high risk for anal human papillomavirus (HPV)-related disease. However, screening strategies and evidence have primarily focused on MSM living with HIV. We compared the burden of high-risk anal HPV (HR-HPV) infection, abnormal cytology and associated risk factors between MSM using PrEP and MSM living with HIV. METHODS: In this cross-sectional study, MSM attending a Belgian HIV/PrEP clinic between 2020 and 2023 were recruited. A total of 303 participants were enrolled; 298 had analysable HPV and/or cytology results (148 MSM-PrEP and 150 MSM living with HIV). Participants completed a questionnaire, and anal swabs were collected for cytology and HPV genotyping. Multivariable logistic regression was used to identify factors associated with HR-HPV infection and abnormal cytology. RESULTS: HR-HPV was detected in 74.3% of MSM-PrEP and 75.8% of MSM living with HIV (p=0.79). Abnormal cytology (≥atypical squamous cells of undetermined significance) was present in 53.5% and 56.8%, respectively (p=0.66). Chemsex was independently associated with a higher likelihood of HR-HPV infection (adjusted OR 2.67; 95% CI 1.25 to 5.70). HPV vaccination initiated after sexual debut was associated with a lower prevalence of HR-HPV (adjusted OR 0.37; 95% CI 0.16 to 0.82), although this analysis was exploratory. CONCLUSIONS: MSM using PrEP showed a burden of HR-HPV infection and abnormal anal cytology comparable to that observed in MSM living with HIV. These findings suggest that MSM-PrEP constitutes a high-risk group that may warrant reconsideration of current anal cancer screening strategies. The potential protective effect of postsexual-debut HPV vaccination merits further investigation.
Rossotti R, Bianchi A, Tavelli A
… +9 more, Caruso E, Vinti P, Soria AG, De Bona A, Muccini C, Moschese D, Cingolani A, Cernuschi M, d'Arminio Monforte A
Sex Transm Infect
· 2026 Mar · PMID 41876220
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OBJECTIVES: Long-acting injectable cabotegravir (LACAB) has proven to be superior to oral pre-exposure prophylaxis (PrEP); however, it represents an issue for PrEP management, given the relevant burden on clinic workload...OBJECTIVES: Long-acting injectable cabotegravir (LACAB) has proven to be superior to oral pre-exposure prophylaxis (PrEP); however, it represents an issue for PrEP management, given the relevant burden on clinic workload. This study aimed to describe (1) the proportion of users requiring LACAB for medical issues, (2) the proportion of users who wish to switch to LACAB and (3) the factors associated with prioritising LACAB based on a combination of medical and psychological needs. METHODS: Toxicity, adherence and efficacy issues were evaluated in PrEP users attending a community-based service. The same population underwent an online survey to measure their desire for and reasons for switching to LACAB. An adjusted model was developed to identify variables associated with both medical needs and interest in LACAB. RESULTS: A total of 1056 individuals were assessed for LACAB medical needs, and 27.8% were eligible, primarily due to adherence issues. Of the 419 survey respondents, 74.9% expressed interest in LACAB. Age older than 25 years, use of any other concomitant medication and reporting sexual encounters without PrEP or condom use were associated with both the medical need for LACAB and interest in this new preventive strategy. CONCLUSIONS: The need for and desire to use LACAB are significant. The health system needs to be implemented to address the issues posed by this novel approach.
Hove T, Chabata ST, Makamba M
… +12 more, Fearon E, Jones HS, Matambanadzo P, Chinozvina T, Maguma J, Takaruza A, Dirawo J, Mugurungi O, Yekeye R, Hargreaves JR, Steen R, Cowan FM
Sex Transm Infect
· 2026 Mar · PMID 41876219
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BACKGROUND: Female sex workers (FSWs) in Zimbabwe, where sexually transmitted infections (STIs) are managed syndromically, are at high risk of STIs and HIV. METHODS: We conducted a respondent-driven sampling (RDS) survey...BACKGROUND: Female sex workers (FSWs) in Zimbabwe, where sexually transmitted infections (STIs) are managed syndromically, are at high risk of STIs and HIV. METHODS: We conducted a respondent-driven sampling (RDS) survey to assess the prevalence, engagement in HIV care and factors associated with STIs among FSWs in two cities of Zimbabwe. Participants self-completed an audio computer-assisted self-interview. Participants were offered HIV testing, and if positive, were tested for HIV viral load. Additionally, 45% were randomly selected and screened for syphilis, gonorrhoea (GC), chlamydia (CT) and trichomonas (TV). RDS-II weighted HIV and STI prevalence and 95% CIs were calculated. The HIV treatment cascade was determined for FSWs living with HIV. Factors associated with having at least one STI (GC/CT/TV) were determined using modified Poisson regression. RESULTS: We recruited 3006 FSWs from Harare and Bulawayo. HIV prevalence was 41.3% (95% CI 38.1% to 44.6%). Among FSWs living with HIV, 83.4% (95% CI 79.0% to 87.0%) reported being aware of their status. Of those aware, 97.3% (95% CI 94.4% to 98.8%) reported being on antiretroviral therapy (ART), and of those on ART, 93.1% (95% CI 89.3% to 95.7%) were virally suppressed. Overall, 90.1% (95% CI 86.6% to 92.7%) of FSWs living with HIV were virally suppressed. The prevalence of active syphilis was 4.4% (95% CI 3.2% to 6.0%), gonorrhoea was 13.4% (95% CI 11.3% to 15.9%), CT was 20.7% (95% CI 18.2% to 23.5%) and TV was 23.7% (95% CI 21.0% to 26.6%). Of the 598 FSWs with a current STI, 52.4% (95% CI 47.4% to 57.3%) did not have HIV infection. Factors associated with increased relative risk of having at least one STI, after adjusting for age and city, included being divorced/separated, living with HIV and reporting STI symptoms in the past year. CONCLUSION: While there have been huge gains in identifying and treating FSWs living with HIV, many STIs remain undetected, and a significant proportion of HIV-negative FSWs are affected by these infections, suggesting an urgent need for improved STI management including access to cheap point of care diagnostics.