Pitt-Kendall R, Cole MJ, Sunthararajah S
… +9 more, Millward J, Charles H, Mohammed H, Viviani L, Phillips D, Phillips M, Fifer H, Sinka K, Alexander S
Sex Transm Infect
· 2026 Mar · PMID 41850778
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OBJECTIVES: Following the global mpox outbreak in 2022, cases have continued to occur in England at a low but persistent rate. Differences in access or application of testing along with widespread roll-out of vaccination...OBJECTIVES: Following the global mpox outbreak in 2022, cases have continued to occur in England at a low but persistent rate. Differences in access or application of testing along with widespread roll-out of vaccination (which may affect the clinical presentation of infection) may lead to under-detection of cases. We sought to investigate the prevalence of potentially undiagnosed clade IIb mpox using residual samples from men tested for suspected lymphogranuloma venereum (LGV) or syphilis infection. METHODS: Anonymised, residual DNA extracts from specimens (including urogenital swabs, rectal swabs and ulcer swabs) from men referred to the national UK Health Security Agency Sexually Transmitted Infections Reference Laboratory between 1 October and 30 November 2024 (inclusive), for LGV or syphilis detection, were tested using a dual-clade monkeypox virus (MPXV) real-time PCR. RESULTS: A total of 1043 (805/1043, 77.2% requested for LGV; 238/1043, 22.8% requested for syphilis) anonymised DNA extracts were tested for MPXV. Four (4/1043, 0.38%; 95% CI 0.1 to 0.9) extracts tested positive for mpox, 3/805 (0.37%; 95% CI 0.08 to 1.09) were from LGV referrals and 1/238 (0.42%; 95% CI 0.01 to 2.32) was from a syphilis referral. Clade typing was successful for ¾ mpox-positive samples, all were clade II. CONCLUSIONS: This study identified a small number of mpox cases in England that may not have been detected using the standard diagnostic and clinical pathways. This study represents proof of concept for rapid assessment of the scale of missed cases and could be repeated should shifts in epidemiology suggest an increase in undiagnosed cases.
Majaha M, Mwaturura T, Machinga F
… +3 more, Samatanga B, Kranzer K, Dziva Chikwari C
Sex Transm Infect
· 2026 Mar · PMID 41802838
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BACKGROUND: Gaps in sexually transmitted infection (STI) diagnosis hinder effective STI control particularly in low-resource settings where syndromic management is often the standard of care. Rapid and affordable point-o...BACKGROUND: Gaps in sexually transmitted infection (STI) diagnosis hinder effective STI control particularly in low-resource settings where syndromic management is often the standard of care. Rapid and affordable point-of-care (POC) diagnostics for STIs such as ) and ) are needed. This study evaluated the diagnostic performance of Eazyplex (a point-of-care test (POCT)) to screen CT and NG among sexually active women in Zimbabwe. METHODS: We enrolled 220 sexually active women aged 18-35 (median 28 years) years attending a family planning clinic in Zimbabwe. Samples collected from vaginal swabs were tested for CT and NG using Eazyplex, GeneXpert and PRESTO CT/NG. Diagnostic performance metrics (sensitivity, specificity, positive predictive value and negative predictive value) were calculated against GeneXpert, PRESTO CT/NG and a GeneXpert+PRESTO CT/NG combined reference standard. For the combined reference standard, a participant was categorised as having a positive result for CT or NG if either of the two tests yielded a positive result. RESULTS: Overall, Eazyplex reported high specificity and low sensitivity. CT results demonstrated sensitivities of 60.9%, 76.2% and 64.0% compared with GeneXpert, PRESTO CT/NG and GeneXpert+PRESTO CT/NG combined, respectively. NG results demonstrated sensitivities of 57.1%, 66.7% and 66.7% compared with GeneXpert, PRESTO CT/NG and GeneXpert+PRESTO CT/NG combined, respectively. All results had specificity ≥98.5%. CONCLUSION: Eazyplex was highly specific but moderately sensitive in detecting and . While not suitable as a standalone screening tool, its rapid turnaround gives it potential for use as near POCT in low-resource settings.
McHugh MP, Goldstein E, Cairns F
… +8 more, Calder C, Cotton S, Falconer K, Malloy B, Renwick L, Scott A, Gunson RN, Templeton KE
Sex Transm Infect
· 2026 Mar · PMID 41786583
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OBJECTIVES: Rapid and accurate detection of antimicrobial resistance in is key for appropriate treatment of gonorrhoea. Nucleic acid amplification tests are increasingly available for the detection of and antimicrobial...OBJECTIVES: Rapid and accurate detection of antimicrobial resistance in is key for appropriate treatment of gonorrhoea. Nucleic acid amplification tests are increasingly available for the detection of and antimicrobial resistance markers from clinical samples. This study evaluated the Allplex NG & DR assay for the detection of and resistance markers against ciprofloxacin ( S91F) and azithromycin (23S rRNA A2059C and C2611T). METHODS: This was a retrospective diagnostic accuracy study performed in two centres. We evaluated assay inclusivity with a panel of laboratory strains, specificity with 35 . negative clinical samples and sensitivity with 82 . positive samples with a matched culture isolate to allow comparison of resistance calls. The Alinity STI assay was considered gold standard for detection, and agar incorporation minimum inhibitory concentration testing of isolates was considered gold standard for resistance calling. Comparisons were also made to the GC assay which detects and the S91F ciprofloxacin resistance marker. RESULTS: The Allplex NG & DR assay performed well in the inclusivity panel and had high sensitivity and specificity for the detection of in clinical samples (98.8% and 100%, respectively). For resistance detection, sensitivity and specificity were >97%. The Allplex NG & DR assay generated one ciprofloxacin resistance marker false negative due to the presence of the S91I mutation. Two azithromycin resistance marker false positive calls were identified due to the presence of the 23S rRNA C2611T mutation in phenotypically sensitive cases. CONCLUSIONS: Our retrospective study shows the Allplex NG & DR assay performed well in the detection of and associated azithromycin and ciprofloxacin resistance mutations.
Rodríguez Sauceda KL, de Loredo N, Montoya Conesa FJ
… +3 more, Rodríguez Ruiz MJ, De Lazzari E, Laguno Centeno M
Sex Transm Infect
· 2026 Mar · PMID 41781275
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INTRODUCTION: Acute hepatitis C (AHC) has emerged as a relevant sexually transmitted infection (STI) among men who have sex with men (MSM), particularly linked to condomless anal practices and chemsex. Data on AHC in HIV...INTRODUCTION: Acute hepatitis C (AHC) has emerged as a relevant sexually transmitted infection (STI) among men who have sex with men (MSM), particularly linked to condomless anal practices and chemsex. Data on AHC in HIV pre-exposure prophylaxis (PrEP) users in our setting are scarce. METHODS: We conducted a descriptive case series study of AHC events identified within a PrEP user cohort followed between November 2019 and February 2025 at Hospital Clínic de Barcelona. Cases of AHC were identified, and their socio-demographic, clinical and behavioural profiles were described. RESULTS: A total of 2003 individuals were enrolled in the PrEP programme during this period. The cohort was predominantly composed of cisgender MSM (96%), with a median age of 32 years, and 46% were born in Spain. Regarding sexual practices and substance use, 59% reported drug use, 82% of whom practised chemsex. Additionally, group sex and condomless anal sex were reported in 59% and 61% of participants, respectively. At baseline, 26% of patients tested positive for (CT) or (NG). Seven individuals (0.35%) had hepatitis C virus (HCV)-antibody positive with undetectable viraemia.During follow-up, 11 cases of AHC were diagnosed, yielding an incidence of 0.34 cases per 100 person-years (95% CI 0.17 to 0.61). All cases occurred in cisgender MSM, of whom 75% reported chemsex, 80% condomless group sex and 1 injecting drug use. STI coinfection was observed in 73% of AHC cases: 4 CT, 3 NG and 2 . Antiviral HCV treatment was effective in all cases, with no reinfections reported. CONCLUSION: The incidence of AHC among PrEP users is not negligible and most cases reported substance use and sexual practices such as condomless sex and group sex. These findings highlight the need to reinforce systematic screening in this key population and adopt a multidisciplinary approach for an effective response.
Sutton C, Bradshaw CS, Plummer EL
… +3 more, Chow EPF, Fairley CK, Vodstrcil LA
Sex Transm Infect
· 2026 Feb · PMID 41708324
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OBJECTIVES: Recurrence of bacterial vaginosis (BV) and vulvovaginal candidiasis (VVC) following recommended treatment is common. We aimed to determine the factors associated with BV and VVC and recurrent infections to in...OBJECTIVES: Recurrence of bacterial vaginosis (BV) and vulvovaginal candidiasis (VVC) following recommended treatment is common. We aimed to determine the factors associated with BV and VVC and recurrent infections to inform management strategies. METHODS: We conducted a retrospective study of BV and VVC infections and recurrence among female Melbourne Sexual Health Centre attendees from 1 January 2012 to 31 December 2021. The proportion with BV and VVC at their first annual test within a calendar year was calculated with 95% CIs. Factors associated with BV or VVC were determined using logistic regression, and factors associated with recurrence (>1 diagnosis within 12 months) were assessed using Poisson regression, accounting for multiple visits. RESULTS: Of 50 245 attendees, 9343/29 990 (31%) had BV and 8528/30 210 (28%) had VVC at their first annual test; positivity of both increased over time. Women had higher odds of BV if they had >1 male or one or more female partner(s) in the prior 3 months (adjusted OR (aOR)=1.29; 95% CI 1.21 to 1.39; aOR=1.69; 95% CI 1.49 to 1.92, respectively), and lower odds if they used hormonal contraception (aOR=0.73; 95% CI 0.68 to 0.79). Women had higher odds of VVC if they reported >1 male partner in the prior 3 months (aOR=1.11; 95% CI 1.04 to 1.19). The recurrence rate of BV was 22/100 person-years (PY), and risk of BV recurrence was higher among sex workers (adjusted recurrence rate ratio (aRRR)=2.02; 95% CI 1.71 to 2.39), women with a regular sexual partner (RSP; aRRR=1.32; 95% CI 1.16 to 1.50) and intrauterine device (IUD) users (aRRR=1.29; 95% CI 1.07 to 1.56). The recurrence rate of VVC was 17/100 PY, and the risk of recurrence was higher among sex workers (aRRR=2.00; 95% CI 1.55 to 2.59) and those with an RSP (aRRR=1.25; 95% CI 1.06 to 1.46). CONCLUSIONS: BV and VVC rates and recurrence were high among attendees. Both infections were associated with risk factors that support sexual transmissibility of each, while only BV recurrence was associated with IUD use, supporting existing data that IUDs increase a woman's risk of acquisition and persistence of a suboptimal vaginal microbiota. These data highlight the importance of considering an individual's partners and contraceptive use when managing these infections.
White A, Villa G, Crowley V
… +6 more, Murphy D, Quinn L, O'Sullivan C, Courtney G, Griffin B, Devitt E
Sex Transm Infect
· 2026 Mar · PMID 41698829
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OBJECTIVE: Clinical guidelines recommend monitoring of serum creatinine concentrations in users of tenofovir disoproxil/emtricitabine for HIV pre-exposure prophylaxis (PrEP) due to its potential nephrotoxicity. Cystatin...OBJECTIVE: Clinical guidelines recommend monitoring of serum creatinine concentrations in users of tenofovir disoproxil/emtricitabine for HIV pre-exposure prophylaxis (PrEP) due to its potential nephrotoxicity. Cystatin C might aid clinicians in determining whether creatinine elevations reflect true kidney injury. We reviewed the use of Cystatin C in our practice. METHODS: Clinic records from Gay Men's Health Service were reviewed until March 2024, and those from St. James's Hospital were reviewed until October 2024, specifically for patients who had a cystatin C test requested due to concerns regarding their renal function. Descriptive statistics were used to analyse the data. RESULTS: Seventy PrEP users, with a median age of 39 years (IQR 34-45), were included. Data on body mass index (BMI) and blood pressure were available in 57/70 (81.4%) and 41/70 (58.6%), respectively; 37/57 (64.9%) had a BMI≥ 25 kg/m and 14/41 (34.1%) had hypertension. Protein supplements, creatine and anabolic agents were used by 43/70 (61.4%), 29/70 (41.4%) and 11/70 (15.7%), respectively. Recreational drugs were used by 17/70 (24.3%).The median cystatin C was 0.87 mg/L (IQR 0.81-0.99); 21/70 (30%) had a result above the upper limit of normality. At this time, the median creatinine was 106.5 µmol/L (97-114). An estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m according to Modification of Diet in Renal Disease, Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) (2021), CKD-EPI creatinine-cystatin (2021) and CKD-EPI cystatin C (2012) was found in 11/70 (15.7%), 1/70 (1.4%), 0/70 (0%) and 1/70 (1.4%), respectively. Median eGFR was 67 (61-74), 78 (70-86), 90.5 (82-96), 102.5 (84-111) mL/min/1.73m, respectively. Urinary protein-to-creatinine ratio was <15 mg/mmol in 65/70 (92.9%), and nobody had significant proteinuria of >50 mg/mmol. CONCLUSION: In this review, the addition of cystatin C to calculate eGFR lessened concerns regarding renal dysfunction, facilitating safe ongoing PrEP prescribing and potentially avoiding unnecessary referral to nephrology services.
Wu S, Huang Y, Luo L
… +4 more, Deng J, Wang Y, Ye F, Li D
Sex Transm Infect
· 2026 Feb · PMID 41679954
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OBJECTIVES: With the increasing incidence and persistent prevalence of syphilis, it is necessary to reevaluate the clinical utility of three syphilis algorithms. METHODS: Cases with concurrent -electrochemiluminescence i...OBJECTIVES: With the increasing incidence and persistent prevalence of syphilis, it is necessary to reevaluate the clinical utility of three syphilis algorithms. METHODS: Cases with concurrent -electrochemiluminescence immunoassay (TP-ECLIA), particle agglutination (TPPA) and toluidine red unheated serum test (TRUST) results from a large hospital in China were collected. The diagnostic performance of three syphilis algorithms-the traditional algorithm (start with TRUST and confirmation by TPPA), reverse algorithm 1 (start with TP-ECLIA and confirmation by TRUST with TPPA for TRUST-negative cases) and reverse algorithm 2 (start with TP-ECLIA and confirmation by TPPA with TRUST for TPPA-positive cases)-was evaluated using kappa coefficient analysis and Bayesian latent class model (BLCM), along with assessing their capabilities, discrepancies and limitations in identifying discordant results for antibodies. RESULTS: High agreement was observed between the two reverse algorithms. BLCM revealed sensitivities of 49.1%, 98.9% and 98.5% and specificities of 99.6%, 99.2% and 100.0% for the traditional algorithm, reverse algorithm 1 and reverse algorithm 2. The traditional algorithm identified 11 biological false-positive cases but missed 1177 TPPA/TRUST syphilis diagnoses. Discordant treponemal test results (TP-ECLIA/TPPA) were common (18.2%) and associated with significantly lower TP-ECLIA cut-off index values. The reverse algorithm 1 identified 500 treponemal test-discordant cases, while the reverse algorithm 2 identified 517 cases. Besides, 17 discordant cases were identified among untested components of the algorithms. CONCLUSIONS: The reverse algorithm 2 is recommended, as the confirmation of TP-ECLIA by TPPA reduces the underdiagnosis of previously treated syphilis compared with the traditional algorithm and compensates for the limited specificity of TP-ECLIA, thereby representing an improvement over reverse algorithm 1.
Demirbas ND, Gul O, Atasoy Tahtasakal C
… +4 more, Ozgur U, Derin O, Oncul A, Yildiz Sevgi D
Sex Transm Infect
· 2026 Feb · PMID 41672776
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BACKGROUND: Late presentation remains a major public health issue in Türkiye, where up to 50% of newly diagnosed patients present with advanced immunosuppression. AIMS: To determine the prevalence and correlates of misse...BACKGROUND: Late presentation remains a major public health issue in Türkiye, where up to 50% of newly diagnosed patients present with advanced immunosuppression. AIMS: To determine the prevalence and correlates of missed opportunities for HIV testing among newly diagnosed adults in Türkiye, where delayed diagnosis remains a major public health concern. METHODS: This cross-sectional study was conducted between September 2023 and September 2024 at a tertiary HIV centre in İstanbul, Türkiye. Eligible participants were adults (≥18 years) newly diagnosed with HIV within the past 6 months. Demographic characteristics, healthcare encounters and indicator conditions in the preceding 3 years were collected through interviews and medical-record review. The primary outcome was missed opportunities for HIV testing, defined as healthcare encounters in which a behavioural or clinical indicator was disclosed but no test was offered. Univariable and multivariable logistic regression analyses were performed. RESULTS: Among 142 participants (median age 34 years, 94% male), 32 (22.5%; 32/142) experienced at least one missed opportunity for HIV testing. Among the 55 individuals who disclosed a behavioural or clinical HIV-related indicator during a healthcare encounter, 32 (58.2%; 32/55) were not offered testing. In the univariable analysis, patients with missed opportunities had higher HIV RNA levels and lower CD4 counts at diagnosis, and those with CD4 <200 cells/mm³ had significantly higher odds of being in the missed-opportunity group (OR 13.4, 95% CI 4.76 to 41.4). In the multivariable analysis, employment status remained independently protective, with employed individuals significantly less likely to experience missed opportunities (adjusted OR 0.17, 95% CI 0.05 to 0.55). Notably, testing was offered in only 60% of encounters involving sexually transmitted infections. CONCLUSIONS: Missed opportunities remain a substantial barrier to early HIV diagnosis in Türkiye. Expanding provider-initiated testing, implementing indicator-condition-guided protocols and strengthening provider-patient communication are essential to improve timely detection.
Harrison C, Harryman L, Stockwell S
… +12 more, Family H, Kesten JM, Denford S, Scott J, Sabin C, Copping J, Saunders J, Hamilton-Shaw R, Symonds N, Dick OB, Tarmey E, Horwood J
Sex Transm Infect
· 2026 Feb · PMID 41672775
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OBJECTIVES: To develop and pilot a community pharmacy pre-exposure prophylaxis (PrEP) awareness-raising and referral pathway, informed by a literature review and interviews with pharmacists and community members. METHODS...OBJECTIVES: To develop and pilot a community pharmacy pre-exposure prophylaxis (PrEP) awareness-raising and referral pathway, informed by a literature review and interviews with pharmacists and community members. METHODS: Using the person-based approach and the Capability, Opportunity, Motivation-Behaviour change (COM-B) model, the pilot aimed to improve HIV/PrEP knowledge/capability and motivation through pharmacist and community awareness-raising. Opportunity was addressed by integrating PrEP consultations into pharmacy services and offering sexually transmitted infection (STI), HIV and kidney function home self-sampling kits. Financial incentives aimed at motivating pharmacists. Pharmacists initiated PrEP discussions and provided self-sampling kits. Individuals interested in starting PrEP were referred to the sexual health clinic, completed the tests and posted them to the clinic for processing. Clinic staff then confirmed PrEP eligibility and prescribed PrEP remotely. National Health Service (NHS) policy restrictions on pharmacies stocking NHS-procured PrEP informed the delivery model. The pilot evaluation focused on staff training impact, number/type of consultations and acceptability and feasibility for staff and community members. RESULTS: The pilot was conducted in five pharmacies across Bristol, North Somerset and South Gloucestershire from October 2024 to April 2025. A total of 55 individuals (aged 18-69 years, n=23 male, n=31 female, n=1 transgender) were made aware of PrEP and offered a referral for PrEP. Visit reasons included emergency contraception (n=14), PrEP (n=14) and opioid substitution therapy (n=11). Twenty-eight community members expressed interest in PrEP; 22 accepted a self-sampling kit, nine returned it and four were prescribed PrEP. Pharmacists and community members viewed the service positively. Barriers included pharmacists' initial lack of confidence initiating PrEP discussions and limited public awareness of PrEP availability in pharmacies. CONCLUSION: Community pharmacies represent a promising site for a PrEP awareness-raising and referral pathway. Successful scale-up requires pharmacist training, public health education and structural and policy changes to support accessible PrEP provision beyond sexual health clinics to reduce inequities.
Gautam K, Paudel K, Wickersham JA
… +7 more, Altice FL, Bellia G, Jadkarim L, Liew Z, Khati A, Copenhaver M, Shrestha R
Sex Transm Infect
· 2026 Feb · PMID 41667236
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OBJECTIVE: To evaluate the feasibility and acceptability of daily oral emtricitabine/tenofovir alafenamide fumarate (FTC/TAF) as HIV pre-exposure prophylaxis (PrEP) among people who inject drugs with opioid use disorder...OBJECTIVE: To evaluate the feasibility and acceptability of daily oral emtricitabine/tenofovir alafenamide fumarate (FTC/TAF) as HIV pre-exposure prophylaxis (PrEP) among people who inject drugs with opioid use disorder (OUD). METHODS: In this single-arm, open-label observational study, 100 people who inject drugs (PWID) were enrolled to receive daily oral FTC/TAF for HIV prevention through a community-based syringe services programme. Participants were referred for laboratory testing following enrolment and received a 90-day supply of FTC/TAF at baseline, 3-month and 6-month visits. Behavioural and biomedical data were collected at each follow-up visit. Feasibility was assessed by tracking the number of individuals screened, enrolled and retained in the study. Acceptability was measured at 3 and 6 months using an adapted 10-item acceptability rating profile. Adherence, uptake and side effects were assessed via self-report, and exit interviews were conducted at follow-up visits to provide qualitative context. RESULTS: Participants had a median age of 43.5 years (IQR: 38-53), 63% were male, 52% non-Hispanic white, 37% injected daily, 67% reported condomless sex and 21% reported prior PrEP use. Although all participants were prescribed FTC/TAF, only 60 collected PrEP at least once during the study; of these, 42 collected it only once, 16 two times and two at all three time points (baseline, 3-month and 6-month). Among those on PrEP, self-reported adherence increased from 68.14% (±34.76) over 3 months to 88.37% (±21.52) over 6 months. Acceptability was high (range: 1-4): 3 months (3.20 (±0.35)) and 6 months (3.10 (±0.17)). The most frequently reported side effects were fatigue (18.4%) and nausea (17.2%). There were no HIV seroconversions. CONCLUSION: FTC/TAF PrEP was acceptable among PWID with OUD. However, feasibility challenges were due to low uptake and continuation, with only two participants completing PrEP pick-up at all follow-up visits, despite higher self-reported adherence among those retained at 6 months. TRIAL REGISTRATION NUMBER: NCT04193787.
Peters RPH, Klausner JD, Mazzola LT
… +9 more, Mdingi MM, Blumel B, Jung H, Gigi RMS, Daniels J, De Vos L, Adamson PC, Gleeson B, Ferreyra C
Sex Transm Infect
· 2026 Feb · PMID 41663243
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OBJECTIVES: infection is a global health concern. An affordable and rapid point-of-care test is essential to optimise clinical care and could be used to detect and treat asymptomatic infection. Previously, a novel later...OBJECTIVES: infection is a global health concern. An affordable and rapid point-of-care test is essential to optimise clinical care and could be used to detect and treat asymptomatic infection. Previously, a novel lateral flow assay for infection (NG LFA) met WHO test performance requirements in a symptomatic population. This study aimed to determine the performance of the NG LFA for detection of in people without symptoms. METHODS: In this cross-sectional study, we evaluated a novel lateral flow assay in urine from 500 asymptomatic men and vaginal swabs from 400 asymptomatic women in South Africa. Individuals visiting four primary healthcare facilities in the Buffalo City district, South Africa were enrolled if they were adults (18-49 years) and did not report any genitourinary symptoms, regardless of the reason for visiting the facility. First-void urine specimens and nurse-collected vaginal swabs were tested onsite with the NG-LFA and compared with the Xpert CT/NG assay. Discordant specimens were further investigated. RESULTS: Between March and July 2023, we enrolled 500 male and 400 female participants. The median age of male participants was 21 years (range: 18-49 years), and female participants, 32 years (range: 18-49 years). In urine specimens, NG-LFA sensitivity was 80.6% (Wilson 95% CI 63.7 to 90.8) and 81.8% in vaginal swab specimens (65·6-91.4). The specificity was 94.2% in urine specimens (91.8 to 96.0) and 98.1% in vaginal specimens (96.1 to 99.1). All NG-LFA positive/Xpert negative cases were negative for or other species in additional molecular testing. CONCLUSIONS: The NG LFA in vaginal swab specimens met WHO criteria for a screening test in low-resource settings. The NG LFA in male urine specimens met sensitivity criteria but did not meet the criteria for specificity.
Mdingi MM, Gigi RMS, Babalola CM
… +5 more, Taylor C, Muzny CA, Medina Marino A, Klausner JD, Peters RPH
Sex Transm Infect
· 2026 Mar · PMID 41651654
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OBJECTIVES: Sexually transmitted infections (STIs) are common in pregnant women. Effective partner treatment of women with an STI is essential to prevent reinfection. We evaluated the impact of partner notification and t...OBJECTIVES: Sexually transmitted infections (STIs) are common in pregnant women. Effective partner treatment of women with an STI is essential to prevent reinfection. We evaluated the impact of partner notification and treatment based on the occurrence of repeat STIs in pregnant women in South Africa. METHODS: We used data from one of the intervention arms in a randomised clinical trial of STI diagnostic screening strategies in pregnancy. In this cohort, women were tested at their first antenatal care visit (<27 weeks gestational age) using onsite Xpert test assays (Cepheid, Sunnyvale, California, USA) for , and . Women with a positive STI result received pathogen-directed treatment, partner notification slips, and a test-of-cure visit was scheduled 21-35 days post-treatment. At the test of cure visit, sexual behaviour and partner treatment data were collected, and STI testing was repeated. Cure was defined as a negative result at the test-of-cure visit. RESULTS: Of 754 women tested, 193 (26%) tested positive for an STI and 183 (95%) received pathogen-directed treatment. A test-of-cure visit was attended by 108/183 (59%) women within the time window. Of those, 19/108 (18%) had a positive repeat STI result. Most women attending the test-of-cure visit (95%; 103/108) reported disclosure of their STI to their partner; however, only 44% (48/108) reported that their partner received treatment. Among those who reported partner treatment, the repeat STI positivity was 4% versus 27% in those with reported untreated partners (risk ratio 0.15 with 95% CI 0.03 to 0.7). CONCLUSIONS: Reported partner treatment reduced the likelihood of a repeat positive test result in pregnant women. Strengthening partner notification and treatment is essential to prevent reinfection.
Stuart RM, Newman LM, Manguro G
… +7 more, Dziva Chikwari C, Marks M, Peters RPH, Klein D, Snyder L, Kerr C, Rao DW
Sex Transm Infect
· 2026 Feb · PMID 41644303
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BACKGROUND: Zimbabwe's national guidelines for sexually transmitted infection (STI) management recommend that high-risk women presenting with vaginal discharge syndrome (VDS) are prescribed antibiotics for gonorrhoea ( (...BACKGROUND: Zimbabwe's national guidelines for sexually transmitted infection (STI) management recommend that high-risk women presenting with vaginal discharge syndrome (VDS) are prescribed antibiotics for gonorrhoea ( (NG)), chlamydia ( (CT)), trichomoniasis ( (TV)) and bacterial vaginosis (BV). The performance of this approach depends on its clinical interpretation and implementation. Here, we investigate the potential relative impact of an NG/CT/TV point-of-care (POC) test on undertreatment, overtreatment and disease burden in the context of different implementations of syndromic management of women with VDS. METHODS: We created an agent-based model with an age- and risk-stratified sexual network and modelled co-circulation of NG, CT and TV along with HIV and BV. We estimated symptomatic proportions and care-seeking rates under three different scenarios around the implementation of treatment guidelines, corresponding to all, most or half of women being treated for NG+CT upon presentation with VDS. For each implementation scenario, we estimated disease burden and over/undertreatment rates assuming continuation of the standard of care with/without a POC NG/CT/TV test available over 2027-2040. RESULTS: Under a treat-all interpretation of the syndromic management guidelines, we estimate that 70%-80% of antibiotics for NG/CT would currently be given to women without these infections. Overtreatment would fall to less than 5% if a sensitive POC test for NG/CT/TV were available. However, if the implementation of the guidelines implies that only half of women seeking care for VDS are treated, then a POC test would also reduce undertreatment and disease burden, with >500 000 additional women correctly treated for NG and ~1.5 million correctly treated for CT and TV, and 24%/15% reductions in the number of women with NG/CT by 2040. CONCLUSION: Improved data on the functioning of syndromic management in practice would help refine the estimates of the health impact and the overall value proposition of a highly sensitive POC diagnostic for NG/CT/TV. However, even without such data, our analysis demonstrates the potential for such a diagnostic to reduce overtreatment by >90% relative to plausible assumptions regarding the standard of care.
Montaner JSG, Granich R, Williams B
… +2 more, Shangase S, Hogg RS
Sex Transm Infect
· 2026 Jan · PMID 41593005
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HIV infection is 100% fatal; however, antiretroviral therapy prevents illness, death and transmission-delaying access to treatment is a death sentence while also leading to the spread of HIV. More recently, antiretrovira...HIV infection is 100% fatal; however, antiretroviral therapy prevents illness, death and transmission-delaying access to treatment is a death sentence while also leading to the spread of HIV. More recently, antiretroviral chemoprophylaxis (commonly known as pre-exposure prophylaxis or PrEP) has been shown to prevent HIV infection among individuals at high risk. In 2003, President George W Bush established the President's Emergency Plan for AIDS Relief (PEPFAR), the largest commitment by any nation to address a single disease. Over the last two decades, PEPFAR provided antiretroviral treatment to more than 20 million people, saved over 25 million lives, enabled more than 7 million babies to be born free of HIV and helped cut new HIV infections by half in the most impacted countries. Earlier last year, the US administration drastically cut overseas development funding, severely compromising PEPFAR's ability to deliver life-saving HIV services. UNAIDS modelling shows that if the funding permanently disappears, there could be an additional 6 million HIV infections and an additional 4 million AIDS-related deaths by 2029. We urge the US administration and the G7 leadership to reflect carefully on the likely and grave consequences of dismantling one of the most successful initiatives in the history of global health.
Hanum N, Handayani M, Yuniar CT
… +8 more, Pohan MN, Putri TA, Rakhmat FF, Anggiani DS, Afriana N, Lukitosari E, Prabowo BR, Wisaksana R
Sex Transm Infect
· 2026 Jan · PMID 41558862
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OBJECTIVES: The global burden of sexually transmitted infections (STIs) presents a challenge in the context of HIV pre-exposure prophylaxis (PrEP) programmes. We aimed to determine the prevalence and incidence of bacteri...OBJECTIVES: The global burden of sexually transmitted infections (STIs) presents a challenge in the context of HIV pre-exposure prophylaxis (PrEP) programmes. We aimed to determine the prevalence and incidence of bacterial STI diagnoses and factors associated with STI incidence among key populations (KPs) initiating PrEP in Indonesia. METHODS: The Indonesia PrEP Pilot Programme (December 2021-December 2023), rolled out in 21 districts in 10 provinces, was a prospective, real-world implementation study providing oral daily or event-driven PrEP to KPs (men who have sex with men (MSM), female sex workers, transgender women and people who inject drugs). Participants at 60 healthcare facilities completed baseline and subsequent 3-monthly follow-up visits. RESULTS: A total of 4220 individuals were included in the analyses (median age 29 (IQR 25-34); 91% men, 81% MSM and 63% chose daily PrEP). The overall STI prevalence was 12.8%; it increased from baseline (10.3%) through month 12 (27.2%) (p<0.001). Among participants with no STIs at baseline (n=3787), 715 new STI diagnoses occurred over 2475 person-years (PYs); the overall incidence rate (IR) was 28.89/100 PYs (27.11-30.72). The highest IR was observed at month 3 (44.71/100 PYs; 41.53-47.93) and decreased over time. Incidence was significantly higher among MSM (age-adjusted IR ratio (aIRR) 2.31; 1.40-3.79 vs FSW), men (aIRR 1.63; 1.10-2.42 vs women), those who reported condomless sex (aIRR 1.67; 1.35-2.06), and those with more frequent sex (aIRR 1.93; 1.47-2.55). Among individuals with complete follow-up (n=464), 48% never acquired STIs during follow-up. The overall HIV incidence rate was 1.11/100 PYs (0.75-1.57); all infections occurred among non-adherent individuals. There were no associations found between HIV incidence and STI diagnoses (p=0.775). CONCLUSIONS: Among KPs using PrEP in Indonesia, the highest STI IR was observed in the early months of implementation. The findings highlight the importance of offering PrEP users regular testing and effective STI counselling.
Morena V, Gemignani N, Bottanelli M
… +5 more, Conti F, Molteni C, Valesecchi G, Pontiggia S, Piconi S
Sex Transm Infect
· 2026 Jan · PMID 41545075
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Injectable long-acting cabotegravir plus rilpivirine (CAB+RPV LA) is an effective treatment option for people living with HIV. Unlike regimens containing tenofovir with lamivudine (3TC) or emtricitabine (FTC), it lacks t...Injectable long-acting cabotegravir plus rilpivirine (CAB+RPV LA) is an effective treatment option for people living with HIV. Unlike regimens containing tenofovir with lamivudine (3TC) or emtricitabine (FTC), it lacks therapeutic activity against the hepatitis B virus, and hepatitis B vaccination is recommended for non-immune individuals. We present a case of acute hepatitis B after switching to CAB+RPV LA in a previously vaccinated individual.