Kaminiów K, Kotlarz A, Kiołbasa M
… +1 more, Pastuszczak M
Sex Transm Infect
· 2025 Nov · PMID 41314798
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OBJECTIVES: To determine whether intensifying therapy with three weekly doses of benzathine penicillin G (BPG) improves maternal serological response in early syphilis during pregnancy compared with the standard single d...OBJECTIVES: To determine whether intensifying therapy with three weekly doses of benzathine penicillin G (BPG) improves maternal serological response in early syphilis during pregnancy compared with the standard single dose. METHODS: In this randomised, non-blinded, single-centre study, 23 pregnant women with secondary or early latent syphilis and no previous history of the disease were enrolled. Participants were assigned to receive either a single intramuscular 2.4 million International Units (MIU) dose of BPG (n=12) or 3 weekly intramuscular doses of 2.4 MIU (n=11). Venereal Disease Research Laboratory (VDRL) titres were measured at baseline, delivery and 2 months postpartum. Serological change (ΔVDRL) was defined as the number of twofold dilution decreases between baseline and follow-up. Neonates underwent clinical and serological evaluation at birth and were followed up to 6 months. RESULTS: Median gestational age at treatment initiation was 16.5 weeks in the single-dose group and 19 weeks in the three-dose group. Baseline median VDRL titres were 1:16 and 1:8, respectively. By delivery, 60.9% of women showed no change in VDRL titre, and only a minority achieved a ≥2-dilution decrease. Two months postpartum, further declines were observed but most women still did not reach a fourfold decline. There were no significant differences in VDRL titres between groups at delivery (median 1:8 in both, p=0.66) or 2 months postpartum (median 1:4 in both, p=1.0). ΔVDRL was not associated with gestational age at treatment or treatment-to-delivery interval. All neonates were clinically healthy, had VDRL titres equal to or lower than their mothers at delivery and achieved complete seroreversion of both treponemal and non-treponemal tests by 6 months. CONCLUSIONS: This is the first randomised study evaluating intensified therapy for early syphilis in pregnancy. Three weekly BPG doses did not improve maternal serological response or neonatal outcomes compared with a single dose. These findings support current recommendations for single-dose therapy in early syphilis during pregnancy.
Krankowska DC, Mazzitelli M, Konopnicki D
… +8 more, Orviz E, Albayrak Ucak H, Protopapas K, Mortimer H, Barzizza E, Fanesi A, Gilleece Y, Aebi-Popp K
Sex Transm Infect
· 2025 Nov · PMID 41266128
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OBJECTIVE: The incidence of anal cancer (AC) is higher in women with HIV than in women without HIV due to immunosuppression and persistence of human papilloma virus (HPV). Since 2024, the International Anal Neoplasia Soc...OBJECTIVE: The incidence of anal cancer (AC) is higher in women with HIV than in women without HIV due to immunosuppression and persistence of human papilloma virus (HPV). Since 2024, the International Anal Neoplasia Society's and European AIDS Clinical Society (EACS) guidelines recommend annual AC screening of cisgender women (CW) of ≥45 years old, transgender women (TW) of ≥35 years old and women with previous vulvar high-grade squamous intraepithelial lesion (HSIL)/cancer regardless of age. This study describes current clinical practices and protocols for AC screening in women with HIV within healthcare settings across WHO European Region (WER). METHODS: Between November 2024 and January 2025, an anonymous online survey on AC screening and prevention in persons with HIV was disseminated among healthcare workers in the WER via the EACS website, social networks and e-mails. RESULTS: Among the 240 participants, 28.1% declared following national AC screening guidelines. Of those, 43.3%, 20.9% and 19.4% stated that CW, TW and women with previous vulvar HSIL/cancer, respectively, were not included in AC screening guidelines. Of those who answered the question, 37.7% respondents routinely asked CW about AC symptoms; 12.5% and 25.0% of respondents performed digital anal rectal examination annually in cis and trans gender women, respectively.Anal cytology was not routinely available in 23.2% and HPV genotyping in 20.8% of clinical settings. High-resolution anoscopy was not accessible for 37.2% of respondents and was more available in Western (68.2%) than in Central/Eastern Europe (44.6%). 26.4% of respondents did not routinely suggest HPV vaccination to adult CW. Main barriers to AC screening among women were lack of resources (47.9%), integrated resources (47.5%) and guidelines (46.6%). CONCLUSION: Women with HIV are often omitted in national guidelines and practices for AC screening in Europe. Screening methods are often not accessible. More education of healthcare workers is needed about benefits of AC screening and HPV vaccination for women with HIV.
Shimuta K, Ohama Y, Yoshida A
… +6 more, Nakayama SI, Ohnishi M, Kawahata T, Takahashi H, Akeda Y, Antibiotic-Resistant Gonorrhea Study Group
Sex Transm Infect
· 2025 Nov · PMID 41266127
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OBJECTIVES: The presence of gonococcal strains carrying the -60.001 allele has been reported worldwide. These strains can be resistant to ceftriaxone (CRO), which often leads to treatment failure. However, this strain ha...OBJECTIVES: The presence of gonococcal strains carrying the -60.001 allele has been reported worldwide. These strains can be resistant to ceftriaxone (CRO), which often leads to treatment failure. However, this strain has not been reported in Japan since 2017; therefore, its recent spread is not understood. Here, we report the emergence of CRO-resistant and the strain carrying the -60.001 allele in Japan in recent years. METHODS: strains were identified during routine surveillance in the Kyoto-Osaka area of Japan between 2018 and 2024. Antimicrobial susceptibility testing was performed using the agar dilution method. Whole-genome sequencing (WGS) was performed using the MiSeq platform. A phylogenetic tree was constructed based on the core genome using IQ-TREE V.2.0.0, with the best-fit nucleotide substitution model being selected using the Bayesian information criterion. Transformation experiments were conducted to confirm that the gDNA of the CRO-resistant strain of could generate a new CRO-resistant strain. RESULTS: Of the 1336 . strains isolated in this study, 6 were resistant to CRO. WGS revealed that one of these CRO-resistant strains, IW642, exhibited multilocus sequence type (MLST) 9903. It also carried the -60.001. A similarity analysis of the regions of IW642 and FC428 revealed complete sequence identity in the region. Through transformation experiments, we also demonstrated the ability of IW642 gDNA to produce new CRO-resistant strains of . CONCLUSIONS: An strain carrying the -60.001 allele was identified in Japan again, after not being reported since 2017. Based on a phylogenetic analysis, the strain originated from a different lineage than that of the previously dominant MLST 1903 strain in Japan. Transformation studies showed that new CRO-resistant strains could emerge from the gDNA of the MLST 9903 strain that was isolated.
Kampman CJG, Koedijk FDH, Bosma F
… +2 more, Hautvast J, Hoebe CJ
Sex Transm Infect
· 2025 Dec · PMID 41218928
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OBJECTIVES: Prevalences of (TV) in Europe are low and consequently marginally tested by Dutch sexually transmitted infections (STI) clinics. We routinely tested all patients on all anatomical sites. We aimed to assess t...OBJECTIVES: Prevalences of (TV) in Europe are low and consequently marginally tested by Dutch sexually transmitted infections (STI) clinics. We routinely tested all patients on all anatomical sites. We aimed to assess trends, prevalences among key populations and at different anatomical sites, as well as predictors of being TV positive to inform future testing practices and guideline development. METHODS: A retrospective cross-sectional study was performed between 2014 and 2022, using STI clinic data. Trends and positivity rates among key populations and anatomical locations were assessed using descriptive analyses. Sociodemographics and sexual behaviour variables were analysed to assess predictors of being TV positive, using multivariable regression analysis. RESULTS: A total of 37 577 consultations were performed in which patients were tested for TV; 16 075 among women and 21 502 among men. Overall TV positivity was 0.9% (145/16 075) among women and 0.3% (54/21 502) among men, and highest among women with a Netherlands Antillean ethnic background with 5.2% (11/212). TV positivity was lowest at the pharyngeal anatomical site (0.1%), followed by anorectal site (0.2%) and the urogenital anatomical site (0.5%).The following predictors of being TV positive were tested significant for men: being older (≥40 years, OR=5.1), having a Surinamese (OR=6.8) or Netherlands Antillean (OR=7.4) ethnic background and being gonorrhoea positive (OR=2.1). For women, the following predictors tested significant: being older (≥40 years, OR=3.3), having an Eastern European (OR=3.1), Western European (OR=2.2), Netherlands Antillean (OR=7.8) or Mid and South African (OR=4.0) ethnic background, having STI symptoms (OR=2.6) and being gonorrhoea positive (OR=2.6). CONCLUSIONS: Based on our results of 9 years of screening in an STI clinic setting, routine universal testing for TV is unnecessary. Testing patients, particularly women, is only required in symptomatic cases and might be considered in cases with an Eastern European, Netherlands Antillean or Mid and South African ethnic background.
Olatosi B, Gass SJ, Chen S
… +2 more, Yang X, Zhang J
Sex Transm Infect
· 2026 May · PMID 41203401
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BACKGROUND: Ongoing sexually transmitted infection (STI) transmission reflects inequitable access to sexual healthcare services. STI reinfection pre-HIV and post-HIV infection is a proxy measure of sexual behaviour for p...BACKGROUND: Ongoing sexually transmitted infection (STI) transmission reflects inequitable access to sexual healthcare services. STI reinfection pre-HIV and post-HIV infection is a proxy measure of sexual behaviour for people with HIV (PWH). Surveillance data show that recommended screenings are not occurring, leading to missed opportunities. Gaps exist about the true picture of STI infection and reinfection among PWH from pre-HIV to post-HIV diagnosis. To end the HIV epidemic and achieve national HIV goals of preventing new infections, synergistic STI/HIV screening is important to limit coinfection and co-transmission of other STIs and HIV. METHODS: We describe changes in STI patterns of infection among a statewide cohort of PWH (n=6896) in South Carolina pre-HIV and post-HIV diagnosis using linked HIV and STI surveillance data. We used multinomial logistic regression to examine and compare differences in pre- and post-HIV diagnosis for three STIs, namely chlamydia (CT), gonorrhoea (GC) and syphilis. RESULTS: Overall, 17.22% of PWH exhibited increasing or persistently high patterns of STI infection. Young adults (18-29) represented the largest proportion of PWH experiencing increasing (66.78%) and persistently high (80.00%) STI infection. Racial and gender minorities were disproportionately affected, with males and black individuals comprising the majority of those with increasing (males: 90.03%, black: 77.30%) and persistently high (males: 83.51%, black: 79.65%) STI infections. Post-diagnosis, syphilis remained the most prevalent STI (35.56%), chlamydia increased to 32.84% from 28.11% prediagnosis, and triple STI infection nearly doubled to 4.19%, corresponding to an approximate 200% increase relative to pre-HIV diagnosis. DISCUSSION: The persistent patterns of STIs among PWH call for a renewed focus on STI treatment and prevention as a central component for ending the HIV epidemic at the state and national levels.
Lawley KA, Copen CE, Hogben M
… +3 more, Haderxhanaj LT, Katz DA, Hamilton DT
Sex Transm Infect
· 2025 Oct · PMID 41176323
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OBJECTIVES: Chlamydia and gonorrhoea have remained the most common nationally notifiable sexually transmitted infections (STIs) in the USA, demonstrating a need for more clarity on rates of testing and diagnosis. Behavio...OBJECTIVES: Chlamydia and gonorrhoea have remained the most common nationally notifiable sexually transmitted infections (STIs) in the USA, demonstrating a need for more clarity on rates of testing and diagnosis. Behavioural changes (eg, declining condom use) may contribute to high cases, although sexual activity rates have decreased. Increased STI screening, especially among women, could also influence diagnosis rates. Research shows differences in infection rates by anatomical site (urogenital, oral, rectal) and the need for more comprehensive screening. This study aimed to explore how screening and diagnosis differ across sites in populations with exclusively opposite-sex sex partners. METHODS: This rapid review assessed the current landscape of screening and diagnosis of chlamydia and gonorrhoea in populations with opposite-sex sex partners, focusing on comparisons across anatomical sites. CENTRAL, PubMed and Embase were searched, and a risk of bias assessment was conducted to qualitatively examine potential bias across studies. RESULTS: A total of 25 studies from 2010 to 2023 were reviewed, focusing on chlamydia and gonorrhoea screening and diagnosis across urogenital, rectal and pharyngeal sites. Urogenital screening was most common, while pharyngeal screening was least common. Diagnosis rates varied. Median test positivity was 8.8% (women) and 2.1% (men) for rectal chlamydia, 2.9% (women) and 4.1% (men) for rectal gonorrhoea, 2.3% (women) and 1.1% (men) for pharyngeal chlamydia, and 2.6% (women) and 2.4% (men) for pharyngeal gonorrhoea. Women were more frequently screened for extragenital sites, rectal and pharyngeal diagnoses were more common in women, and urogenital diagnoses were slightly more common in men. Most studies found co-occurrence of infection at multiple sites or extragenital infection without urogenital infection. CONCLUSION: This review highlights the current understanding of screening and diagnosis of chlamydia and gonorrhoea among populations with exclusively opposite-sex sex partners and supports the need for increased screening, particularly of extragenital sites, to reduce transmission rates.
Eubanks A, Hoyer M, Sow A
… +11 more, Mora M, Assoumou L, Beniguel L, Ghosn J, Jones JC, Costagliola D, Spire B, Molina JM, Liegeon G, Sagaon-Teyssier L, Protière C
Sex Transm Infect
· 2025 Oct · PMID 41136209
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OBJECTIVES: Despite the wide implementation of HIV oral pre-exposure prophylaxis (oPrEP), uptake, adherence and persistence issues remain. Long-acting injectable cabotegravir (CAB-LA) is a promising new PrEP HIV preventi...OBJECTIVES: Despite the wide implementation of HIV oral pre-exposure prophylaxis (oPrEP), uptake, adherence and persistence issues remain. Long-acting injectable cabotegravir (CAB-LA) is a promising new PrEP HIV prevention option. However, little is known about oPrEP users' interest in it. We investigated men who have sex with men (MSM) oPrEP users' willingness to participate (WtP) in a CAB-LA PrEP study in France. METHODS: We designed a cross-sectional questionnaire ('NewPrEP') to evaluate attitudes to CAB-LA of daily and event-driven oPrEP users participating in the ANRS-PREVENIR cohort study (2017-2025). The outcome, WtP, was dichotomised into 'Willing' (absolutely/probably) or 'Unwilling' (probably not/absolutely not/I would like to discuss this with my doctor before making a decision). We used multivariate logistic Bayesian model averaging to estimate factors associated with WtP. RESULTS: Of the 1555 MSM followed in ANRS-PREVENIR in February 2023 with baseline data, 879 (57%) answered the NewPrEP questionnaire. Median age and follow-up time were 38 and 4.7 years, respectively; 37% and 22% were on daily- and event-driven oPrEP, respectively; 41% used a combination of both regimens. 64% had heard of CAB-LA PrEP, and 43% were WtP in a related study. Multivariate results showed that willing participants were younger and more likely to have heard of CAB-LA, to use daily oPrEP exclusively or in combination, to find it difficult to adhere to their regimen, to engage in chemsex, to trust their doctor and to be more interested in PrEP effectiveness than in the administration mode. They were less likely to perceive the obligatory 2-monthly hospital visits for CAB-LA PrEP as constraining, to be scared of injections and to fear long-acting medications. CONCLUSIONS: WtP in a CAB-LA study among MSM oPREP users was moderate but concentrated among those with the greatest need. This highlights the need to enable free distribution. Future studies should evaluate adherence and retention in long-acting iPrEP.
Kim JY, Sukhija-Cohen AC, Samidon SA
… +3 more, Robinson MB, Ordenana MJ, McGrath MR
Sex Transm Infect
· 2026 May · PMID 41136208
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OBJECTIVE: To evaluate the outcomes of a street medicine intervention offering syphilis testing and treatment to people experiencing homelessness in South Los Angeles, California-a population disproportionately affected...OBJECTIVE: To evaluate the outcomes of a street medicine intervention offering syphilis testing and treatment to people experiencing homelessness in South Los Angeles, California-a population disproportionately affected by syphilis and underserved by traditional healthcare systems. METHODS: From September 2024 to January 2025, a multidisciplinary street medicine team provided testing and treatment for syphilis during outreach visits to patients experiencing homelessness. A total of 99 patients were tested using the reverse syphilis testing algorithm. Demographic data included gender, race/ethnicity, substance use disorder, mental illness and HIV status. χ tests were used to evaluate associations between syphilis diagnosis and each demographic characteristic. RESULTS: Thirty-six (36.4%) of the 99 patients had reactive syphilis test results, with 94.4% (n=34) classified as late-stage infections. Of those diagnosed, 72.2% (n=26) were treated during follow-up visits. Statistically significant associations were found between syphilis diagnosis and gender (p=0.002), substance use disorder (p=0.008) and HIV status (p=0.020). Patients identifying as female or transgender female, and those with cooccurring substance use disorder or HIV, were more likely to be diagnosed with syphilis. CONCLUSIONS: This study demonstrates the feasibility and outcomes of delivering sexually transmitted infection care through street medicine. The high prevalence of late-stage syphilis and its syndemic overlap with substance use disorder and HIV underscores the need for low-barrier, community-based services. Street medicine interventions should be recognised and resourced as essential tools in public health responses to rising syphilis rates, particularly among unhoused populations.
Mussa A, Dugdale CM, Ryan R
… +7 more, Babalola CM, Moshashane N, Ramontshonyana K, Brooks M, Klausner JD, Morroni C, Wynn A
Sex Transm Infect
· 2025 Oct · PMID 41136207
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OBJECTIVES: We investigated the costs and cost-effectiveness of screening and treatment for and among asymptomatic pregnant women in Botswana to prevent preterm birth/low birth weight, compared with no microbiological...OBJECTIVES: We investigated the costs and cost-effectiveness of screening and treatment for and among asymptomatic pregnant women in Botswana to prevent preterm birth/low birth weight, compared with no microbiological screening. METHODS: A health systems perspective and microcosting approach were used to estimate the costs of screening, treatment and partner treatment. Cost, epidemiological and effectiveness data were collected alongside the Maduo Study, a non-randomised cluster-controlled trial in Gaborone, Botswana evaluating the effect of and screening on health outcomes among asymptomatic pregnant women and infants. We developed a decision tree to model a hypothetical cohort of 50 000 pregnant women receiving screening at first antenatal care and third trimester visits. We defined cost-effective as having an incremental cost per disability-adjusted life year (DALY) averted <$3625 (50% of Botswana's 2023 gross domestic product per capita). RESULTS: The cost per person screened was US$23.67. Additional costs of and treatment were US$3.44 and US$4.60, respectively. The total cost of implementing the intervention among 50 000 pregnant women would be US$2 363 665. Compared with the standard-of-care, we projected an incremental cost per preterm birth/low birth weight outcome averted of US$962.56. Screening and treatment for and were projected to be cost-effective with an incremental cost per DALY averted of US$580.51. However, the incremental cost-effectiveness ratio (ICER) was highly uncertain in sensitivity analyses, and assumptions about intervention effectiveness were highly influential on the ICER. CONCLUSIONS: Screening for and infections has the potential to prevent serious adverse birth outcomes that contribute to childhood mortality, morbidity and high costs to the healthcare system. Additional research on the effectiveness of screening and treatment for these infections on preventing adverse birth outcomes is necessary to provide robust evidence that can inform cost-effectiveness analyses and decision-making.
Biba U, Bui HTM, Nguyen LT
… +7 more, Dang HT, Bui TT, Nguyen TC, Dau NS, Pham LQ, Giang LM, Adamson PC
Sex Transm Infect
· 2025 Oct · PMID 41107032
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OBJECTIVES: Syphilis infections are high among men who have sex with men (MSM) on HIV pre-exposure prophylaxis (PrEP). Point-of-care (POC) testing may improve diagnosis and treatment. We performed a field evaluation of t...OBJECTIVES: Syphilis infections are high among men who have sex with men (MSM) on HIV pre-exposure prophylaxis (PrEP). Point-of-care (POC) testing may improve diagnosis and treatment. We performed a field evaluation of the Chembio dual path platform (DPP) Syphilis Screen and Confirm treponemal/non-treponemal POC test within an HIV PrEP programme in Hanoi, Vietnam. METHODS: From December 2023 to July 2024, males aged ≥16 years enrolled in the HIV PrEP programme who reported sex with men in the last year were enrolled. Specimens were tested using the Chembio DPP syphilis screen and confirm test and reference treponemal (Abbott Bioline or Determine) and non-treponemal (rapid plasma reagin (RPR)) tests. Positive per cent agreement (PPA), negative per cent agreement (NPA), positive predictive value (PPV), negative predictive value (NPV) and Cohen's kappa were calculated comparing the DPP versus reference tests. RESULTS: We enrolled 400 participants; median age was 26.4 years (IQR 22.5-30.4); one invalid test was excluded. The prevalence of a reactive treponemal test was 35.3% (141/399). For the DPP treponemal test, PPA was 75.2% (95% CI 67.2% to 82.2%), NPA was 96.9% (95% CI 94% to 98.7%), PPV was 93% (95% CI 86.8% to 96.4%), NPV was 87.7% (95% CI 83.4% to 91%), and Cohen's kappa was 0.75. For the DPP non-treponemal test, PPA was 36.5% (95% CI 23.6% to 51%), NPA was 99.4% (95% CI 97.9% to 99.9%), PPV was 90.5% (95% CI 71.1% to 97.4%), NPV was 91.3% (95% CI 88% to 93.7%), and Cohen's kappa was 0.48 (95% CI 0.33 to 0.61). For RPR titres ≥1:8, PPA and Cohen's kappa increased to 85.7% (95% CI 57.2% to 98.2%) and 0.67 (95% CI 0.47 to 0.81), respectively. CONCLUSIONS: Among MSM in an HIV PrEP programme with high syphilis prevalence, the DPP treponemal test performed well. While non-treponemal performance was lower, it was strong for RPR titres ≥1:8, suggesting it could aid in identifying high-titre syphilis infections more likely to be transmissible.
Sex Transm Infect
· 2025 Oct · PMID 41093438
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OBJECTIVES: We sought to determine positivity rates for participants in the GetaKit study who identified as asymptomatic contacts of (NG) and/or (CT). Our goal was to shed light on current discrepancies between interna...OBJECTIVES: We sought to determine positivity rates for participants in the GetaKit study who identified as asymptomatic contacts of (NG) and/or (CT). Our goal was to shed light on current discrepancies between international sexually transmitted infection (STI) guidelines, some of which recommend blanket empiric treatment for all NG and CT contacts (eg, Canadian and United States guidelines) versus others which recommend waiting for positive results (BASHH, Australian, and European). METHODS: We extracted data for the period of 1 June 2023 to 30 June 2025 from GetaKit, which is a research website through which persons in Ontario, Canada can complete an online risk assessment and obtain access to laboratory-based testing for STIs, including NG, CT, HIV, syphilis and hepatitis C. From these data, we calculated positivity rates for NG and CT and the numbers needed to treat. We also evaluated for correlations of risk factors for testing positive. RESULTS: During our 25-month study period, participants ordered NG/CT testing 12 775 times. In a total of 6.7% of these orders, participants identified as an NG and/or CT contact. Positivity rates, for all completed testing, were 1.2% (n=115 diagnoses) for NG and 4.3% (n=395 diagnoses) for CT. Positivity among asymptomatic contacts ranged from 0% for NG in heterosexual males to 30.6% for CT in females who were ≤24 years old, with most positivity rates being <20% for both infections. CONCLUSIONS: Our results suggest that blanket recommendations to treat or defer treatment seems inappropriate. More nuance is required. Empiric treatment of all NG and CT contacts will likely result in mass overuse of antibiotics. In contrast, deferring treatment seems inappropriate for asymptomatic females who are ≤24 years old and for anyone who cannot immediately obtain testing and treatment.
Osbak KK, Twisk DE, van Westreenen M
… +2 more, Klaassen C, Götz HM
Sex Transm Infect
· 2026 May · PMID 41093437
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OBJECTIVES: Effective surveillance of antimicrobial-resistant (Ng) is crucial, but culturing is labourious and costly. Focusing culturing efforts on high-yield subpopulations can enhance resource utilisation without com...OBJECTIVES: Effective surveillance of antimicrobial-resistant (Ng) is crucial, but culturing is labourious and costly. Focusing culturing efforts on high-yield subpopulations can enhance resource utilisation without compromising data quality or care. This cross-sectional retrospective study aims to pinpoint a nucleic acid amplification test (NAAT) cycle threshold (Ct) value for effective Ng surveillance culturing. METHODS: Surveillance and laboratory data from 3042 sexual health clinic clients in the Netherlands (December 2018 to October 2023) were analysed to determine correlations between Ng culture positivity and NAAT Ct value, culture timing and anatomical location. Fisher's exact χ² test assessed associations between culture recovery and time intervals between NAAT and culture collection. Receiver operator curves and Youden's J statistic were applied to determine an optimal Ct value cut-off.NAAT was performed on 6346 swabs from urogenital (urethra; 1389/vagina; 482) and extragenital (oropharynx; 2306/rectum; 2169) sites using the cobas CT/NG assay on the 6800 platform (Roche Molecular Systems). Culture plates were inoculated on the initial test day for clients treated presumptively (symptoms or notified for Ng) or during treatment consultation after positive NAAT results. RESULTS: Mean Ct values differed for positive and negative cultures (negative: Ct 33.0 (IQR 24.2-41.9); positive: Ct 25.4 (IQR 20.0-30.3); p<0.001). Oropharyngeal samples had the lowest culture positivity rate (22.0%). Culture positivity particularly declined when NAAT to culture intervals exceeded 14 days. Only 0.8% (11/1389) of urethral culture samples were positive above Ct 30. Between Ct 34 and 35, overall culture positivity dropped from 23.0% to 13.9%. A Ct value cut-off at 34 would reduce basic culturing costs by 25% while missing only 4.2% (108/2603) of positive cultures. CONCLUSIONS: Establishing an NAAT Ct value cut-off can reduce both labour and costs without compromising vital surveillance data. Assay-specific validation is recommended prior to broader application.