Sexually Transmitted Infections[JOURNAL]
Sun
200 papers
'Bish bash bosh': the experiences of men who have sex with men providing self-taken oropharyngeal, rectal, meatal and first-catch urine specimens, and pooling genital and extragenital specimens for and detection.
Richardson D, Wallace H, Wilson J
Sex Transm Infect · 2026 May · PMID 41545058 · Publisher ↗
OBJECTIVE: This qualitative analysis aimed to explore the experiences of men who have sex with men (MSM) providing self-taken oropharyngeal, rectal, meatal and urine specimens, and pooling genital and extragenital specim...
OBJECTIVE: This qualitative analysis aimed to explore the experiences of men who have sex with men (MSM) providing self-taken oropharyngeal, rectal, meatal and urine specimens, and pooling genital and extragenital specimens for and nucleic acid amplification testing (NAAT). METHOD: MSM participants from the MYSTIC study consented to participate in an online focus group. They were encouraged to share and discuss their experiences of self-taken oropharyngeal, rectal, meatal and urine specimens, and the pooling of specimens. The focus group was recorded and transcribed. Thematic analysis, using a framework approach, generated themes and highlighted their experiences. RESULTS: Seven MSM, with experience of providing self-taken specimens for gonorrhoea and chlamydia testing, consented and contributed to a focus group in April 2024. They described difficulties they experienced in producing and handling urine specimens. They had concerns about urine spilling, but believed it was more accurate than meatal specimens. They described learning how to take oropharyngeal specimens, including being shown by clinicians and using a mirror. They were unsure how deep, and for how long, to take rectal specimens, and whether the swab should be twisted. They described feeling embarrassed at providing faecally contaminated specimens. They found the meatal specimens easy to perform but were concerned whether they were taking the specimen correctly. Overall, MSM preferred meatal specimens over urine and were willing to compensate some test accuracy for meatal specimens rather than urine. Some found the pooling complicated and were concerned about having an adequate environment to do this in correctly; conversely, some found this easy and quicker. CONCLUSION: These data provide insight into the experiences of MSM providing self-taken samples and pooling them for gonorrhoea and chlamydia testing. Interestingly, MSM preferred self-taken meatal swabs to urine and would accept a slight reduction in diagnostic sensitivity with this specimen.
Diarrhoea as a frequent adverse event after intramuscular ertapenem treatment for uncomplicated : a secondary analysis from the NABOGO trial.
Teker B, Schim van der Loeff M, Boyd A … +4 more , Mathot R, van Dam A, de Vries H, Jongen VW
Sex Transm Infect · 2026 Jan · PMID 41545057 · Publisher ↗
OBJECTIVES: The New AntiBiotic treatment Options for uncomplicated GOnorrhoea trial compared the efficacy of gentamicin, ertapenem and fosfomycin with ceftriaxone. Ertapenem was non-inferior to ceftriaxone for treating ,...
OBJECTIVES: The New AntiBiotic treatment Options for uncomplicated GOnorrhoea trial compared the efficacy of gentamicin, ertapenem and fosfomycin with ceftriaxone. Ertapenem was non-inferior to ceftriaxone for treating , but participants receiving ertapenem commonly reported having diarrhoea. We assessed diarrhoea trajectories, estimated the probability of remaining with diarrhoea over time and identified determinants of diarrhoea. METHODS: Participants were randomly assigned (1:1:1:1) to receive intramuscular 5 mg/kg gentamicin (maximum 400 mg), intramuscular 1000 mg ertapenem, oral 6 g fosfomycin or intramuscular 500 mg ceftriaxone (control group). Following antibiotic treatment, participants self-reported adverse events, including diarrhoea, in a paper diary until 30 days after treatment. In this secondary analysis, we assessed the frequency of diarrhoea in each study arm. Kaplan-Meier methods were used to estimate the probability of remaining with diarrhoea over time in each study arm. Determinants of diarrhoea in the ertapenem arm were assessed using relative risk regression. RESULTS: Among 343 participants randomised, 2/102 (2.0%) in the gentamicin arm, 49/97 (50.5%) in the ertapenem arm, 32/37 (86.5%) in the fosfomycin arm and 11/103 (10.7%) in the ceftriaxone arm reported diarrhoea. Median duration of diarrhoea varied between 1 and 2 days across arms. In the ertapenem arm, only having an anal and/or anal infection (prevalence ratio=2.29, 95% CI 1.04 to 5.02) was associated with increased diarrhoea risk. CONCLUSIONS: Ertapenem was associated with high frequency of diarrhoea, which was mostly short-lived. Continued evaluation of the tolerability of ertapenem could help increase acceptability of this potential second-line treatment against . TRIAL REGISTRATION NUMBER: NCT03294395.
Role of long-acting injectables in perinatally acquired HIV, with persistent viraemia and non-nucleoside reverse transcriptase inhibitor resistance.
Grant A, Keegan S, Kulasegaram R
Sex Transm Infect · 2026 Feb · PMID 41545056 · Publisher ↗
This case describes successful management of a man with perinatally acquired HIV complicated by incomplete adherence, multidrug-resistant HIV and opportunistic infections-cryptococcal meningitis and mycobacterium avium i...
This case describes successful management of a man with perinatally acquired HIV complicated by incomplete adherence, multidrug-resistant HIV and opportunistic infections-cryptococcal meningitis and mycobacterium avium intracellulare. Initial treatment included antifungal and antimycobacterials with oral antiretroviral therapy (ART), but persistent high HIV viral load (>100 000 copies/mL) prompted initiation of long-acting injectable ART (LAI-ART) with cabotegravir and rilpivirine combined with adjunct oral nucleoside reverse transcriptase inhibitor therapy (emtricitabine/tenofovir). This combination is expected to have reduced antiviral activity secondary to resistant mutations; notably, high-level resistance to emtricitabine and intermediate resistance to rilpivirine. To attenuate further resistance, 4-weekly dosing of LAI-ART was used. This regimen led to viral suppression within 4 weeks, which remains suppressed (>1 year) and successful immune reconstitution (CD4 cell count of 209 cells/µL/18.7%), despite challenges with adherence to oral medications. This case highlights the feasibility and effectiveness of LAI-ART in managing complex resistance and adherence in perinatally acquired HIV.
Changes in hepatitis C virus-related sexual and drug use behaviours among men who have sex with men between 2021 and 2024: results from the Dutch NoMoreC project.
Hage K, Boyd A, Davidovich U … +5 more , Prinsenberg T, van der Valk M, Schinkel J, Zantkuijl P, Prins M
Sex Transm Infect · 2026 Feb · PMID 41545055 · Publisher ↗
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Point-of-care testing to strengthen sexually transmitted infection case management in resource-constrained settings.
Peters RPH, Manguro G, Ong'wen PA … +7 more , Mdingi MM, Applegate TL, Stuart R, Harding-Esch EM, Manabe YC, Ndowa F, Van Der Pol B
Sex Transm Infect · 2026 Jan · PMID 41535122 · Full text
Syndromic management remains the standard approach for sexually transmitted infection (STI) care in many low-resource settings. Recent advances in point-of-care (POC) diagnostic testing offer the opportunity to improve S...
Syndromic management remains the standard approach for sexually transmitted infection (STI) care in many low-resource settings. Recent advances in point-of-care (POC) diagnostic testing offer the opportunity to improve STI case management by enabling targeted treatment, reducing unnecessary antibiotic use, and strengthening partner services. This educational article summarizes key insights from a symposium organised by the World Health Organization and Gates Foundation at the STI & HIV World Congress 2025. Evidence from modeling studies in Zimbabwe and South Africa demonstrates significant reductions in overtreatment and population-level STI burden with POC test integration. Acceptability among end-users and providers is high, contingent on rapid, confidential testing linked to same-day treatment. The article reviews the current landscape of STI POC tests, including WHO’s REASSURED criteria and target product profiles, and discusses regulatory progress and technical specifications for prequalification. Implementation strategies emphasize integration into existing health services, capacity building, stakeholder engagement and importance of robust quality assurance processes. While cost-effectiveness data remain limited, strategic investment and policy development are essential to scale up STI POC testing. With growing technological feasibility and public health urgency, POC testing represents a paradigm shift in STI management, offering a pathway to more effective, equitable, and sustainable care in resource-constrained settings.
Awareness, attitudes and early use of doxycycline prophylaxis among gbMSM in Ireland: findings from a 2025 community-based cross-sectional survey.
Gilmore J, Field DJ, Kelly H … +4 more , Lawlor R, Noone C, Traeger M, White J
Sex Transm Infect · 2026 Jan · PMID 41535121 · Publisher ↗
BACKGROUND: Bacterial sexually transmitted infections (STIs) remain a growing public health challenge globally, with gay, bisexual and other men who have sex with men (gbMSM) disproportionately affected. Doxycycline post...
BACKGROUND: Bacterial sexually transmitted infections (STIs) remain a growing public health challenge globally, with gay, bisexual and other men who have sex with men (gbMSM) disproportionately affected. Doxycycline postexposure prophylaxis (DoxyPEP) has been shown in clinical trials to reduce syphilis and chlamydia, and has been incorporated into US and UK guidelines. However, community-level data in many European countries remain scarce. This study aimed to assess awareness, attitudes and early use of DoxyPEP among gbMSM in Ireland. METHODS: An anonymous, cross-sectional online survey was conducted between May and June 2025. Eligible participants were aged ≥18 years, identified as male (cis or trans) or non-binary/gender diverse and reported sex with a man in the past 12 months. The questionnaire covered demographics, sexual behaviours, STI/HIV history, awareness and use of antibiotics for STI prevention and attitudinal measures. Descriptive statistics summarised findings, and logistic regression identified predictors of DoxyPEP use. RESULTS: A total of 149 participants completed the survey, with a mean age of 36.4 years (range: 22-67); 92.6% were cisgender men and 86.6% identified as gay. Awareness of antibiotic STI prophylaxis was high (83.2%), and 69.1% expressed strong interest in future use. Over one-quarter (29.5%) reported DoxyPEP use in the past 12 months, almost exclusively at the recommended 200 mg dose. DoxyPEP use was associated with previous HIV PEP use (adjusted OR (AOR) 3.02 s, 95% CI 1.35 to 6.73) and group sex (AOR 3.27, 95% CI 1.26 to 8.59). Most participants reported sourcing antibiotics informally, including online or through friends. Antimicrobial resistance was the most common concern reported (69.8%). CONCLUSION: Despite the absence of national guidelines on the use of DoxyPEP for STI prevention, over one-quarter of participants reported using DoxyPEP, with high awareness and demand for structured access. These findings highlight the urgency for evidence-based, internationally aligned policies that ensure safe and equitable delivery, integrated within sexual health services and underpinned by antimicrobial stewardship.
Management of asymptomatic bacterial STIs and doxycycline postexposure prophylaxis: consensus statement of the Italian Society of Infectious and Tropical Diseases.
Nozza S, Vinti P, Giacomelli A … +8 more , Mazzotta V, Moschese D, Raccagni AR, Rossotti R, Russo A, Mussini C, Parrella R, Italian Society of Infectious and Tropical Diseases (SIMIT)
Sex Transm Infect · 2026 Feb · PMID 41526162 · Publisher ↗
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Consensus for integrating the point-of-care Genital Inflammation Test (GIFT) into sexually transmitted infection management guidelines: results from a two-round modified Delphi survey.
Kpokiri E, Francis S, Mackworth-Young CR … +5 more , Crucitti T, Wijgert JHHMV, Masson L, Passmore JA, Harding-Esch EM
Sex Transm Infect · 2026 Jan · PMID 41513452 · Publisher ↗
BACKGROUND: Sexually transmitted infections (STIs) and bacterial vaginosis (BV) are frequently asymptomatic in women, causing genital inflammation and increasing transmission and acquisition of HIV. The Genital Inflammat...
BACKGROUND: Sexually transmitted infections (STIs) and bacterial vaginosis (BV) are frequently asymptomatic in women, causing genital inflammation and increasing transmission and acquisition of HIV. The Genital Inflammation Test (GIFT) is a novel, point-of-care (POC) device under development for detecting genital inflammation in women. We aimed to obtain consensus to inform the integration of GIFT into STI management guidelines. METHODS: We employed a Delphi technique through two rounds of online surveys. Respondents included service providers, health programmers, researchers and policy makers. Round one questions generated ideas, and round two built consensus on strategies from round one. Survey sections included participant demographics and test implementation, integration into current guidelines and purpose. The round two survey employed a five-point Likert scale from strongly agree to strongly disagree. Consensus was reached if ≥70% of participants selected strongly agreed or agreed. RESULTS: We received 28 responses in the first round and 68 in the second. In both rounds, participants were healthcare providers (41%) or researchers (26%), residing in Africa (57%), Europe (21%) and America (10%). Most participants agreed that GIFT should be used as a screening tool to be followed by confirmatory STI testing before treatment: 75% (round 1), 69% (round 2). There was consensus that populations that would benefit most from GIFT would be young asymptomatic women (16-24 years) in high HIV prevalence settings and high-risk women of any age, such as female sex workers and those with multiple partners. Attributes of GIFT ranked as most important included ease-of-use, stability at room temperature and high diagnostic accuracy. Barriers were test stock-outs, complexity of use and high cost. CONCLUSION: While Delphi consensus was for GIFT as a POC screening tool, factors such as supply chain, storage and stakeholder engagement are crucial for its integration into STI management guidelines.
Recommendations for developing asynchronous online consultations for chlamydia treatment for underserved populations: a Behaviour Change Wheel analysis.
Estcourt CS, McLeod J, Flowers P … +9 more , MacDonald J, Mapp F, Saunders J, Woode Owusu M, McInnes-Dean A, Gallego Márquez N, Blandford A, Sonnenberg P, Gibbs J
Sex Transm Infect · 2026 Jan · PMID 41506900 · Publisher ↗
INTRODUCTION: People from underserved groups experience disproportionately poor sexual health and challenges accessing care. Asynchronous online consultations (a user completes a health questionnaire online, which is rev...
INTRODUCTION: People from underserved groups experience disproportionately poor sexual health and challenges accessing care. Asynchronous online consultations (a user completes a health questionnaire online, which is reviewed by a clinician) are being used within sexual healthcare to prescribe chlamydia treatment. Users require sufficient health and digital literacy to access online services and use them safely. METHODS: We used the PROGRESS-Plus (PROGRESS: Place of Residence, Race/Ethnicity, Occupation, Gender/Sex, Religion, Education, Socio-economic Status, Social Network; Plus: e.g., Age, Sexual Orientation, Disability) framework to guide purposive recruitment of 35 participants from diverse underserved groups, from community settings and sexual health services in contrasting areas of the UK (15 October 2021-18 March 2022). We conducted qualitative semistructured interviews and thematic analyses to derive key barriers and facilitators to using asynchronous online consultations. We applied the Behaviour Change Wheel to specify recommendations to address them. RESULTS: Over half of participants were from the most deprived areas and 40% were from minoritised ethnic groups. Key barriers included: lack of familiarity with online healthcare; perceived need to see a healthcare professional in person; privacy concerns; concerns about difficulty interpreting the questions; discomfort answering personal questions online. Key facilitators included: familiarity with online consultations; perceived low sexually transmitted infection risk; perceived increase in convenience, control and privacy; simple wording and design; and support while completing them. Recommendations included: increasing awareness and familiarity by promoting them offline and online and providing demonstrations and instructions on how to use them; encouraging people to choose them by highlighting available support, equivalence to in-person consultations and privacy and convenience; and reducing attrition by using simple wording and design, providing additional explanations and offering audio and visual alternatives to text. CONCLUSIONS: Incorporating these evidence-based, theoretically informed recommendations could widen access to underserved groups and increase the usability and safety of asynchronous online consultations for chlamydia treatment. Recommendations are likely to benefit all users and could be of use across health more broadly.
Oral and anal shedding of in patients with syphilis in the DOXYVAC cohort.
Salle R, Grange PA, Ouattara M … +6 more , Assoumou L, Leducq V, Benhaddou N, Ghosn J, Molina JM, Dupin N
Sex Transm Infect · 2026 Jan · PMID 41494955 · Publisher ↗
OBJECTIVES: The incidence of syphilis, caused by (TP), has increased significantly in recent years in Western countries, particularly among men who have sex with men (MSM). Recent data suggest that ongoing transmission...
OBJECTIVES: The incidence of syphilis, caused by (TP), has increased significantly in recent years in Western countries, particularly among men who have sex with men (MSM). Recent data suggest that ongoing transmission may be facilitated by undetected mucosal excretion of TP. This study focuses on patients who had incident syphilis during the DOXYVAC study in order to evaluate oral and anal excretion of TP by molecular biology before, during and after infection. METHODS: During the DOXYVAC study, incident syphilis was defined as new TP haemagglutinations assay positivity or increased Venereal Disease Research Laboratory (VDRL) titres. Quantitative PCR tests were performed on stored oral and anal samples from the visit preceding the diagnosis, the diagnostic visit of syphilitic infection and the follow-up visit. For each TP-positive PCR sample, detection of 23S ribosomal RNA (rRNA) (azithromycin resistance) and 16S rRNA (doxycycline resistance) mutations was performed. RESULTS: Among the 556 participants, 44 cases of incident syphilis occurred in 43 patients. 11 patients (25%) had at least one PCR-positive site, including nine patients in the non-postexposure prophylaxis (PEP) group and two in the doxycycline PEP group. Eight patients had positive TP PCRs at diagnosis, two before diagnosis and one after. A total of eight anal samples and six oral samples tested positive. PCR-positive patients were more likely to be VDRL-positive with higher titres, suggesting more active infection. No mutations associated with doxycycline resistance were detected, while 75% patients had azithromycin-resistant TP strains. CONCLUSIONS: This study shows that a significant proportion of patients have oral or anal TP excretion, sometimes several months before serological diagnosis, suggesting potential early asymptomatic transmission. The integration of the TP PCR assay into routine screening of high-risk MSM could enable earlier detection and treatment of these patients. The absence of doxycycline resistance is reassuring, but continued monitoring remains essential.
Foundations for progress: insights from the PrEP Impact Trial supporting change to PrEP delivery and implementation in England.
Ogaz D, Mitchell H, Chiavenna C … +14 more , Cartier A, Bell J, Golombek R, Charlett A, Jaffer S, Harris R, Diamente V, Mohammed H, Ward CJ, McSorley J, Gill ON, Sullivan A, Saunders J, Impact Study Group
Sex Transm Infect · 2025 Dec · PMID 41469202 · Publisher ↗
OBJECTIVES: The HIV pre-exposure prophylaxis (PrEP) Impact Trial demonstrated the feasibility and effectiveness of PrEP in England, providing critical evidence to inform national commissioning. Using trial data, we asses...
OBJECTIVES: The HIV pre-exposure prophylaxis (PrEP) Impact Trial demonstrated the feasibility and effectiveness of PrEP in England, providing critical evidence to inform national commissioning. Using trial data, we assess regional variation in delivery and examine how service provision differences impacted outcomes across the PrEP Prevention Care Continuum (PPCC) (ie, those at risk of HIV acquisition, those eligible for PrEP, PrEP uptake and coverage). METHODS: We assessed PPCC outcomes among HIV-negative men who have sex with men (MSM) attending trial sexual health services (SHS) from October 2017 to February 2020. Outcomes were stratified by SHS region (London, Outside London) and MSM throughput, defined as the mean annual number of MSM attendees, to approximate differences in service structure and provision based on attendee composition. HIV incidence per 100 person-years was calculated for SHS in and outside of London, restricted to those with ≥2 visits during the study period. RESULTS: Across 157 trial SHS, 165 270 MSM attended during the study period, of whom 20 349 were enrolled in the trial. HIV incidence was calculated among 102 842 MSM, including 17 770 trial participants. PrEP uptake ranged from 42% to 92%, and coverage from 16% to 31%, varying by MSM throughput strata and consistently higher among London SHS. HIV incidence was significantly lower in trial participants (London: 0.07 (95% CI 0.04 to 0.14); Outside London: 0.22 (0.13 to 0.36)) versus non-trial attendees (London: 0.98 (0.88 to 1.10); Outside London: 0.93 (0.82 to 1.04)). CONCLUSIONS: This analysis supports ongoing enhancements to PrEP delivery across England. Findings highlight the success of varied service models, including those not traditionally focused on MSM populations. High HIV seroconversions among individuals without clear markers of risk for HIV acquisition support the need for broader, less restrictive PrEP access, aligned with recent updates to national guidance. To evaluate the long-term impact of PrEP on HIV and sexually transmitted infection (STI) incidence, consistent, high-quality data reporting to national surveillance remains essential.
High prevalence and incidence of curable sexually transmitted infections among young women using oral HIV pre-exposure prophylaxis in sub-Saharan Africa: results from the INSIGHT Cohort study.
Mukui I, Peacock S, Donnell D … +19 more , Gati-Mirembe B, Krows M, Bukusi EA, Imaan L, Kotze P, Gill KM, Macdonald P, Louw C, Jaggernath M, Marais A, Peters RPH, Delany-Moretlwe S, Ward A, du Preez P, Kasaro M, Gandhi M, Heffron R, Celum C, INSIGHT Study Team
Sex Transm Infect · 2025 Dec · PMID 41448908 · Publisher ↗
BACKGROUND: HIV pre-exposure prophylaxis (PrEP) programmes in Africa reach young women at risk of sexually transmitted infections (STIs). We evaluated curable STI prevalence, incidence and risk factors among women initia...
BACKGROUND: HIV pre-exposure prophylaxis (PrEP) programmes in Africa reach young women at risk of sexually transmitted infections (STIs). We evaluated curable STI prevalence, incidence and risk factors among women initiating PrEP. METHODS: From August to December 2022, sexually active women aged 16-30 years from 15 South African sites, and one site each in Eswatini, Kenya, Malawi, Uganda and Zambia were enrolled into the INSIGHT cohort and offered oral emtricitabine/tenofovir PrEP with follow-up at 1, 3 and 6 months. At each visit, STI symptoms were assessed and treatment provided based on syndromic management or diagnostic testing. Diagnostic tests included nucleic acid amplification for and , the rapid OSOM for at enrolment and month 6, and serological testing for syphilis at enrolment using rapid plasma reagin with confirmatory particle agglutination. Prevalence and incidence of each STI were calculated, and predictors assessed using multivariable regression. RESULTS: Of 3087 participants offered daily oral PrEP with a median age of 23 (IQR 21-27), 3011 had STI results and 30.9% had one or more STIs, with 15.7% reporting symptoms. The prevalence of , , and syphilis was 20.8%, 6.8%, 6.0% and 4.4%, respectively. The incidence of one or more STIs (, or ) was 49.3/100 person-years (95% CI 45.3 to 53.4) with 12.7% reporting symptoms. The incidence of was 30.6/100 person-years (95% CI 27.5 to 33.7), 10.8/100 person-years (95% CI 9.0 to 12.6) and 11.5/100 person-years (95% CI 9.7 to 13.4). An incident STI diagnosis was associated with low alcohol use (adjusted incidence rate ratio (aIRR) 1.3; 95% CI 1.0 to 1.6) and moderate alcohol use (aIRR 1.4; 95% CI 1.1 to 1.8), and having an STI diagnosed at enrolment (aIRR 1.8; 95% CI 1.5 to 2.1). CONCLUSION: The high prevalence and incidence of STIs among African women initiating PrEP, most of whom did not report symptoms, highlights the need for aetiologic testing to detect STIs, guide treatment and reduce reproductive health sequelae and risk of transmission. TRIAL REGISTRATION NUMBER: clinicaltrials.gov NCT05746065.
Extragenital chancre mimicking breast cancer and oropharyngeal secondary syphilis in a heterosexual couple: an unusual clinical pairing.
Almarzooqi K, Borg E, Almeheri N … +4 more , Muscat J, Ceci M, Abdilla A, Padovese V
Sex Transm Infect · 2025 Dec · PMID 41443777 · Publisher ↗
Syphilis is a sexually transmitted infection caused by It progresses through three clinical stages and shows various oral symptoms, mainly during the secondary stage. The disease can resemble other common oral mucosal c...
Syphilis is a sexually transmitted infection caused by It progresses through three clinical stages and shows various oral symptoms, mainly during the secondary stage. The disease can resemble other common oral mucosal conditions, such as infections with nonspecific pharyngitis, tonsillitis and laryngitis, as well as neoplastic and immune-mediated ulcers. This report discusses a heterosexual couple with rare manifestations of primary and secondary syphilis involving oropharyngeal lesions and an extragenital chancre, highlighting the diagnostic challenge and the importance of clinical awareness for early detection and treatment.
Prevalence and co-occurrence of sexually transmitted infections among heterosexual couples in southern Uganda: a population-based study.
Moffa MA, Peer AD, Tobian A … +14 more , Feng X, Mpagazi J, Manabe YC, Gaydos CA, Kennedy CE, Ssekubugu R, Reynolds S, Jackson J, Kigozi G, Chang LW, Quinn T, Kagaayi J, Grabowski MK, Galiwango RM
Sex Transm Infect · 2025 Dec · PMID 41386965 · Publisher ↗
OBJECTIVE: Partner-level sexually transmitted infection (STI) data from eastern Africa are rare, despite high STI burden. To address this gap, we examined STI prevalence and clustering among cohabiting couples in two hig...
OBJECTIVE: Partner-level sexually transmitted infection (STI) data from eastern Africa are rare, despite high STI burden. To address this gap, we examined STI prevalence and clustering among cohabiting couples in two high HIV-burden Ugandan communities, representing the largest population-based, couple-level STI study in the region. METHODS: We analysed data from the Sexually Transmitted Infection Prevalence Study (STIPS), a cross-sectional, population-based study in southern Uganda which tested participants for chlamydia, gonorrhoea, trichomonas, syphilis, high-titre syphilis and herpes simplex virus-2 (HSV-2). We restricted the present analysis to STIPS participants in a cohabiting sexual relationship. Poisson regression with robust standard errors was used to estimate prevalence ratios (PRs) and corresponding 95% confidence intervals (CIs) of all STIs by partner's infection status. RESULTS: Among 423 cohabiting heterosexual couples, at least one partner tested positive for a curable STI (chlamydia, gonorrhoea, trichomonas or high-titre syphilis) in 37% of couples. STIs were strongly clustered within partner dyads. For example, female participants with male partners with gonorrhoea had increased prevalence of not only gonorrhoea (PR 10.4, 95% CI 6.4 to 16.8) but also HIV (PR 2.2, 95% CI 1.5 to 3.2), chlamydia (PR 2.5, 95% CI 1.1 to 5.7), trichomonas (PR 2.4, 95% CI 1.2 to 4.7) and HSV-2 (PR 1.3, 95% CI 1.1 to 1.7). CONCLUSION: Partners of individuals with an STI are more likely to have a curable STI, which may be the same or may be a different pathogen; broad screening of partners could be essential to curbing transmission and preventing reinfection. Comprehensive couple-based approaches, including partner notification, treatment and counselling strategies, are critical for reducing STI disease burden.
Impact of reduced chlamydia testing on STI testing and provider preferences in the Netherlands: an experimental vignette study.
van Bergen IJW, Heijne JCM, de Bruin M … +1 more , van Wees DA
Sex Transm Infect · 2025 Dec · PMID 41381200 · Publisher ↗
OBJECTIVES: The restrictive chlamydia testing guidelines for asymptomatic individuals at Dutch sexual health centres (SHCs) since January 2025 may influence perceptions and attitudes towards testing for sexually transmit...
OBJECTIVES: The restrictive chlamydia testing guidelines for asymptomatic individuals at Dutch sexual health centres (SHCs) since January 2025 may influence perceptions and attitudes towards testing for sexually transmitted infections (STIs). This study aimed to assess the potential impact of this guideline change on STI testing preferences among young people and to examine determinants and underlying motivations of these preferences. METHODS: Heterosexuals aged 16-34 in the Netherlands, recruited via social media and SHCs, completed an online survey (April-June 2024). STI testing preferences (SHCs, general practitioners (GPs), commercial self-sampling tests or not testing) before and after the anticipated guideline change were assessed in a hypothetical scenario involving condomless sex with a new partner without having STI-related symptoms after. Participants initially preferring SHCs were grouped according to post-change preferences. We used logistic regression to identify factors associated with preferences and thematic analysis to explore motivations. RESULTS: Of 1179 participants, 68% (95% CI 65% to 71%) initially preferred SHCs as a testing provider. After the guideline change, among this group, 24.2% (95% CI 21% to 27%) still preferred SHCs, 51.5% (95% CI 48% to 55%) switched to a preference for testing at GPs, 18% (95% CI 16% to 21%) to self-sampling and 6.2% (95% CI 5% to 8%) opted out. Switching to GPs was associated with younger age and high self-efficacy and control beliefs; choosing self-sampling with older age (>24) and university education; and opting out with inconsistent condom use and low health goals compared with preferring SHCs. Motivations included test costs, symptom absence and perceived chlamydia prevalence. CONCLUSION: Changing chlamydia testing guidelines at SHCs may cause a shift in testing preferences to GPs or self-sampling and may discourage some from testing. These findings underscore the need for targeted communication and ongoing monitoring of STI testing behaviour to maintain STI testing uptake and are relevant for countries facing similar changes to chlamydia testing guidelines.
Evaluation of a free mail-in opt-out STI testing programme on 3-month rescreening rates in reproductive health centres.
Small SL, Emery JF, Hart V … +2 more , Tarmey OA, de Jager E
Sex Transm Infect · 2026 May · PMID 41365629 · Full text
OBJECTIVES: The Centers for Disease Control guidelines recommend rescreening for chlamydia, gonorrhoea and trichomoniasis 3 months after treatment to detect reinfection. This intervention aimed to improve rescreening rat...
OBJECTIVES: The Centers for Disease Control guidelines recommend rescreening for chlamydia, gonorrhoea and trichomoniasis 3 months after treatment to detect reinfection. This intervention aimed to improve rescreening rates by removing multiple logistical and financial barriers to rescreening within our influence for the greatest possible effect. METHODS: For 1 year (2022, n=837), free (to the patient) rescreen tests were automatically mailed to all patients in 21 health centres 3 months after they were treated for chlamydia, gonorrhoea and/or trichomoniasis, unless they opted out or were rescreened sooner. Patients returned the completed mail-in self-collection kit in a prepaid envelope within 2-4 weeks. Rescreening rates were compared with a control period (2019, n=1743). RESULTS: A total of 2580 rescreen opportunities (intervention=837, control=1743) were tracked for rescreening. The median age was 23, 66% were female, 80% were white and 79% tested positive for chlamydia. The intervention increased rescreening rates from 22% to 26%, which was not statistically significant after adjustment (OR 1.20, 95% CI 0.98 to 1.48, p=0.08). CONCLUSIONS: A 4% increase in rescreening rates did not justify programme continuation. While rescreening has been an important public health strategy to reduce sexually transmitted infections (STIs), this programme reveals that high rates of rescreening may not be possible. Recommending rescreening and making it free, convenient and automatic is not enough. Without new ideas and approaches to tackling this public health problem, STI reinfection and resulting reproductive health complications will persist.
Sexually transmitted infections after implementation of doxycycline postexposure prophylaxis.
Scott HM, Roman J, Spinelli M … +4 more , Bena J, Torres T, Glidden D, Buchbinder S
Sex Transm Infect · 2025 Dec · PMID 41339087 · Publisher ↗
OBJECTIVES: Doxycycline as bacterial sexually transmitted infection (STI) postexposure prophylaxis (DoxyPEP) has shown high efficacy in clinical trials. We evaluated the impact of DoxyPEP on chlamydia (CT), gonorrhoea (G...
OBJECTIVES: Doxycycline as bacterial sexually transmitted infection (STI) postexposure prophylaxis (DoxyPEP) has shown high efficacy in clinical trials. We evaluated the impact of DoxyPEP on chlamydia (CT), gonorrhoea (GC) and syphilis incidence among pre-exposure prophylaxis (PrEP) users in a sexual health clinic in San Francisco, California, USA. METHODS: DoxyPEP was offered to all PrEP clients at routine clinical visits starting on 30 November 2022. We included PrEP clients who received DoxyPEP (DoxyPEP users) or never initiated DoxyPEP (non-DoxyPEP users). Among DoxyPEP users, the 'pre-DoxyPEP' period was from 1 June 2022 until DoxyPEP initiation, and the 'post-DoxyPEP' period started after DoxyPEP initiation through 7 September 2023. STI testing included three sites-GC, CT and early syphilis testing. STI incidence rate ratios (IRRs) per quarter were evaluated using a pre-analysis, post-analysis and a controlled interrupted time series (CITS) analysis, with mixed-effects Poisson regression used to evaluate intervention effects. RESULTS: Among 3081 PrEP clients, 1209 (39%) initiated DoxyPEP. During the pre-DoxyPEP period, any STI, CT, GC and syphilis mean quarterly positivity was 18.1%, 9.2%, 8.1% and 2.2% among DoxyPEP users and 7%, 3.2%, 3% and 0.7% among non-DoxyPEP users, respectively. In pre-implementation and post-implementation analysis of DoxyPEP users, DoxyPEP was associated with lower STI incidence for any STI (IRR 0.42, 95% CI 0.24 to 0.74, p=0.003), CT (IRR 0.33, 95% CI 0.23 to 0.46, p<0.001) and syphilis (IRR 0.22, 95% CI 0.07 to 0.54, p=0.001), but not GC (IRR 0.89, 95% CI 0.69 to 1.15, p=0.383). In a CITS analysis, DoxyPEP was associated with a significant decline in any STI incidence (0.67, 95% CI 0.46 to 0.96, p<0.030). CONCLUSIONS: Observed DoxyPEP uptake reflected strong demand among PrEP users when offered in a clinical setting. Overall, STI incidence declined rapidly after implementation, demonstrating the high impact of this intervention in a real-world setting. Continued evaluation of uptake, adherence and impact on bacterial STIs will be essential as DoxyPEP implementation expands.
Annual HIV incidence among gay, bisexual and other men who have sex with men in England, 2014 to 2023: a prospective cohort analysis using national surveillance data.
Ratna N, Harrison C, Kolawole T … +6 more , Bell E, Ogaz D, Brown A, Saunders J, Djuretic T, Mohammed H
Sex Transm Infect · 2025 Dec · PMID 41339086 · Publisher ↗
OBJECTIVES: Following the fall in new HIV diagnoses in gay, bisexual and other men who have sex with men (GBMSM) since 2015, the English government published an HIV Action Plan in 2021 committing to end HIV transmission...
OBJECTIVES: Following the fall in new HIV diagnoses in gay, bisexual and other men who have sex with men (GBMSM) since 2015, the English government published an HIV Action Plan in 2021 committing to end HIV transmission by 2030. Underlying HIV transmission and access to testing influence diagnosis trends and may not reflect incidence as people could be living with undiagnosed HIV for many years. We derived HIV incidence by clinical risk markers and pre-exposure prophylaxis (PrEP) use. METHODS: Using GUMCAD STI surveillance data between 2014/2015 and 2022/2023, we calculated yearly HIV incidence among HIV-negative GBMSM attending sexual health services (SHS) in England with at least two HIV tests within 365 days ('repeat testers'). Annual incidence was stratified by clinical risk markers: bacterial sexually transmitted infection (STI) history and recent HIV test (from the previous year). Incidence was further stratified by PrEP use in 2022/2023. RESULTS: The number of HIV-negative GBMSM attending SHS in England increased by 34% from 111 977 in 2014/2015 to 1 49 904 in 2022/2023, of whom repeat testers were 34% (37 576) in 2014/2015 and 38% (56 896) in 2022/2023. HIV incidence reduced by 93% overall (1.77/100 person-years (py) (95 CI 1.61 to 1.94) in 2014/2015 to 0.12/100 py (0.09 to 0.16) in 2022/2023). Incidence was reduced by at least 89% in all groups irrespective of clinical risk markers: with bacterial sexually transmitted infection (STI) history (3.68/100 py (3.17 to 4.27) to 0.26/100 py (0.18 to 0.38)); the subset with a rectal bacterial infection (5.18/100 py (4.13 to 6.49) to 0.58/100 py (0.36 to 0.93)) and with a recent HIV test (1.93/100 py (1.66 to 2.24) to 0.08/100 py (0.05 to 0.13)). In 2022/2023, using PrEP reduced HIV incidence by 86% (using PrEP: 0.05/100 py (0.03 to 0.08)) vs not using PrEP: 0.36/100 py (0.26 to 0.50)). CONCLUSION: There was a sustained and large decline in HIV incidence among GBMSM, while incidence remains highest among those with a recent bacterial STI history. This analysis further highlights the real-world impact of PrEP and highlights the importance of equitable provision of HIV combination prevention interventions.
Evaluation of chlamydia trachomatis prevalence in male sexual partners: a hospital-based cross-sectional study in Shaoxing, China.
Guan J, Feng J, Ding J … +1 more , Zhu L
Sex Transm Infect · 2025 Dec · PMID 41339085 · Publisher ↗
OBJECTIVES: Genital () is the most prevalent bacterial sexually transmitted infection globally, with partner notification being a major challenge. This study combined partner notification and self-sampling to assess the...
OBJECTIVES: Genital () is the most prevalent bacterial sexually transmitted infection globally, with partner notification being a major challenge. This study combined partner notification and self-sampling to assess the prevalence among sexual partners and assessed the association between partner positivity and age, symptoms and clinical department. METHODS: Conducted at Shaoxing Maternal and Child Health Hospital from 18 October 2023 to 29 April 2025, the cross-sectional study involved notifying 1543 women diagnosed with to return for treatment. The hospital provided self-sampling test kits, free testing and treatment services for their male partners. We analysed the links between partner positivity and the age, symptoms and clinical departments of the diagnosed women. RESULTS: 1191 women returned to the clinic and received treatment, and 599 urine kits were distributed, 504 were returned, yielding an 84.1% return rate (504/599). Among the returned specimens, 220 (43.9%, 220/501, with three specimens excluded due to incomplete data) tested positive for . Women aged 16-25 with a diagnosis had the highest partner positivity rate at 53.5% (83/155), which is 3.17 times higher than those aged 41 and older (OR=3.17, 95% CI 1.52 to 6.59). The 26-40 age group had the second-highest rate at 41.5% (125/301), nearly double that of the 41+ age group (OR=1.95, 95%CI 0.97 to 3.93). The symptomatic status and the recruitment clinics of women diagnosed with did not significantly affect partner positivity rates. CONCLUSIONS: The prevalence of infection was prevalent among partners of infected individuals, particularly those under 25 years of age, indicating a need for targeted interventions within this demographic.
Acceptance and prescription of doxycycline post-exposure prophylaxis (doxy-PEP) among Brazilian physicians: results from a national online survey.
Passarelli VC, de Paula Vasconcelos R, Secco Torres Silva M … +10 more , Goldemberg F, Veras MA, Barberia L, Brant JL, Gaspar PC, Cole MJ, Fifer H, Hughes G, Costa SF, ResIST-Brasil
Sex Transm Infect · 2025 Dec · PMID 41326210 · Publisher ↗
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