Hamza SA, Paolini R, Moore C
… +6 more, Unemo M, McCullough M, Hocking JS, Kahler C, Celentano A, Kong FYS
Sex Transm Infect
· 2026 May · PMID 41047234
·
Publisher ↗
OBJECTIVES: The global rise in (NG) infections, particularly oropharyngeal cases, drives treatment failures from antibiotic resistance. However, infection dynamics within oropharyngeal sites remain unclear. We developed...OBJECTIVES: The global rise in (NG) infections, particularly oropharyngeal cases, drives treatment failures from antibiotic resistance. However, infection dynamics within oropharyngeal sites remain unclear. We developed an in vitro model using three human oropharyngeal epithelial cells to investigate infection dynamics and evaluate treatment strategies. METHODS: Tonsillar, floor of mouth (FOM) and gingival cell lines were infected with NG strains: antimicrobial-susceptible FA1090 and antimicrobial-resistant WHO-R. Oral commensal served as a bacterial negative control. Infected cells were treated with antibiotics known to cure NG strains (ie, ciprofloxacin/azithromycin/ceftriaxone/cefixime) and an antimicrobial negative control that does not cure NG strains (ie, tetracycline) at 1×, 2× and 3× the minimum inhibitory concentration for 30, 60 and 120 min. Post-treatment, cells were treated with gentamicin to eliminate extracellular bacteria, lysed and internalised NG quantified. RESULTS: NG invasion for both strains was highest in tonsillar cells and lowest in FOM cells. Gingival cells only demonstrated high invasion by FA1090. Validation experiments confirmed FA1090 clearance was highest with azithromycin, ceftriaxone and ciprofloxacin, while cefixime and tetracycline showed variable efficacy. No tested antibiotics cleared WHO-R from all cell lines. Gentamicin consistently failed to clear infections. There was minimal invasion of across all cell lines. CONCLUSIONS: NG demonstrates site-specific and strain-specific invasion of oral cells, targeting tonsils and gingiva. The model's validity is supported by drug efficacy results aligning with clinical data and limited invasion by . This model provides a basis for developing a three-dimensional system to better understand oropharyngeal NG infections and identify and evaluate novel treatments.
Sex Transm Infect
· 2026 May · PMID 41047233
·
Full text
BACKGROUND: Although digital health literacy (DHL) is recognised as a determinant of access to digital sexually transmitted and blood-borne infection (STBBI) testing, empirical evidence about its contribution to access d...BACKGROUND: Although digital health literacy (DHL) is recognised as a determinant of access to digital sexually transmitted and blood-borne infection (STBBI) testing, empirical evidence about its contribution to access disparities remains limited. We applied multidimensional DHL measures to examine inequities in awareness and use of GetCheckedOnline, British Columbia's (BC) publicly funded digital STBBI testing service. METHODS: We analysed data from GetCheckedOnline's 2022 community survey of English-speaking BC residents aged ≥16 years who were sexually active in the past year. Outcomes were awareness and use of GetCheckedOnline (yes/no). DHL was measured using latent factors from the eHealth Literacy Scale: Information Navigation, Resource Appraisal and Confidence in Use. Structural equation modelling (SEM) was used to estimate associations and mediation pathways between DHL, sociodemographic characteristics and service outcomes. Model fit was assessed using standard SEM indices. RESULTS: Among 1657 respondents (mean age 33 years, SD 11.77), Information Navigation was positively associated with awareness (β=0.162, p<0.001) and use (β=0.063, p=0.020) of GetCheckedOnline. Confidence in Use was positively associated with awareness (β=0.206, p=0.014) and use (β=0.115, p=0.020). In contrast, Resource Appraisal was negatively associated with awareness (β=-0.263, p=0.006) and use (β=-0.150, p=0.010). DHL factors mediated the effects of age, income, education and digital access on both outcomes. CONCLUSIONS: DHL operates as a multidimensional and socially patterned determinant of access to digital STBBI testing services. While information navigation and confidence in use facilitate access, higher resource appraisal may reduce use, potentially reflecting concerns about service fit, privacy or trust. Findings highlight the need for digital interventions that are not only accessible but also contextually relevant, trusted and responsive to the needs of diverse users.
Swayze EJ, Liske E, DeCarr K
… +4 more, Wendel P, Swailes A, VanDillen M, Nakahara A
Sex Transm Infect
· 2026 May · PMID 41015531
·
Publisher ↗
OBJECTIVE: To identify factors associated with inadequate or no syphilis treatment during pregnancy within an urban low-income safety-net hospital. METHODS: We conducted a retrospective case control study of pregnant pat...OBJECTIVE: To identify factors associated with inadequate or no syphilis treatment during pregnancy within an urban low-income safety-net hospital. METHODS: We conducted a retrospective case control study of pregnant patients diagnosed with new syphilis infections between July 2019 and July 2024 to determine predictors of inadequate or no treatment. Treatment was considered adequate if patients received appropriate doses of intramuscular benzathine penicillin G consistent with syphilis stage. Fisher's exact test and χ test were performed for categorical variables. After adjusting for age, body mass index, substance use during pregnancy, diagnosis before 24 weeks and syphilis stage, a multivariable logistic regression was used to calculate adjusted OR (aOR) with a 95% CI. Statistical significance tests relied on a two-sided α=0.05. RESULTS: A total of 150 pregnant patients were diagnosed with syphilis; approximately 36.7% (n=55) received no or inadequate treatment. Late latent and unknown syphilis stages were predictors of inadequate syphilis treatment with the following respective aORs: aOR 4.52; 95% CI 1.10 to 18.6 and aOR 7.64; 95% CI 2.19 to 26.7. Infection diagnosis before 24 weeks' gestation (aOR 0.18; 95% CI 0.07 to 0.42) was a significant predictor of adequate treatment. Partner treatment status was unknown or none for 89.3% of patients (n=134). CONCLUSIONS: Patients diagnosed with syphilis stages that require multi-dose treatments are at higher risk for inadequate treatment. Efforts to promote early diagnosis and staging in this community are needed. Widespread neglect of partner treatment may be contributing to this epidemic.
Spurway C, Williams I, Ayinde OC
… +9 more, Bohm C, Burns F, Gibbs J, Josh J, Munro H, Woode Owusu M, Solomon D, Ross JD, Jackson LJ
Sex Transm Infect
· 2026 Feb · PMID 40998585
·
Full text
OBJECTIVES: Timely access to sexual health screening and contraception is an important public health issue. Substantial funding reductions for sexual and reproductive health services (SRHS) and COVID-19 have led to signi...OBJECTIVES: Timely access to sexual health screening and contraception is an important public health issue. Substantial funding reductions for sexual and reproductive health services (SRHS) and COVID-19 have led to significant changes in service delivery, including the rapid introduction of remote consultations, as a substitute for in-person contact. There is limited evidence relating to the barriers to remote consultations and how these may impact sexual health outcomes and wider health inequalities. This study synthesises existing evidence on remote consultations to examine effectiveness, cost-effectiveness, experiences, access and equity. METHODS: Eighteen electronic databases were systematically searched to locate relevant studies published from OECD (Organisation for Economic Co-operation and Development) countries after 2010. The Mixed Methods Appraisal Tool was used to evaluate the quality of the studies. RESULTS: Out of 8690 studies identified, 48 met the inclusion criteria. The included studies were heterogeneous and covered a range of topics; however, few focused on health inequalities and remote consultations, with satisfaction and quality of care being the most common outcome measures. Many of the studies were completed post-2020 in response to COVID-19 and were of medium to low quality. Access to technology and communication challenges were found to impact inequality when accessing SRHS via remote consultations, although they enhance convenience for service users and service providers. CONCLUSIONS: Overall, the review shows that a range of studies have investigated remote consultations in SRHS, but there remains limited evidence on the impact on health inequalities and sexual health outcomes. The surge in post-2020 research, spurred by COVID-19, indicates the necessity for further high-quality research into equitable SRHS delivery in the post-COVID era, particularly in addressing technological and communication barriers. There is a need to further optimise access and the delivery of remote consultations in SRHS, considering the needs of service users, and minimising inequality (observed differences) and inequity (unfair differences).CRD42023397288.
OBJECTIVES: Vulvovaginal candidiasis is the second most common cause of vaginitis among women of childbearing age worldwide and is often self-diagnosed and self-treated by women. However, self-management of vaginal sympt...OBJECTIVES: Vulvovaginal candidiasis is the second most common cause of vaginitis among women of childbearing age worldwide and is often self-diagnosed and self-treated by women. However, self-management of vaginal symptoms has been shown to have very poor outcomes. Hence, reliable self-tests are essential for improving the management of VVC. Here, we evaluated and compared the diagnostic performance of four marketed self-tests. METHODS: Remnant diagnostic material was collected from 140 vaginal samples analysed by culture in the Netherlands. This was used in four commercially available self-tests: Rapid Test Beright, StrongStep Antigen Rapid Test, Tigsun VVC-TV-GV Combo Antigen Test and VagiQUICK. Furthermore, DNA was extracted and used to quantify using qPCR. The performance of each test was compared with culture and qPCR results using appropriate statistical methods. RESULTS: The Beright, StrongStep, Tigsun and VagiQUICK tests exhibited sensitivities of 47.3%, 30.8%, 73.0% and 66.3% and specificities of 100%, 100%, 100% and 97.4%, respectively, compared with culture. Compared with qPCR, the tests exhibited a sensitivity of 43.4%, 60.2%, 60.8% and 54.7% and a specificity of 89.7%, 73.3%, 80.0% and 75.9%, respectively. Sensitivity improved with increasing concentration thresholds. CONCLUSIONS: The investigated self-tests demonstrated varying performances, with both sensitivity and specificity being consistently lower than manufacturer claims. These findings underscore the urgent need for developing and validating more reliable self-tests to support adequate management of women's health. The sensitivity of currently marketed tests is only slightly better than empirical or self-diagnosis, which limits their clinical utility.
OBJECTIVES: Describe the clinical evolution of a person with recurrent gonococcal cervicitis despite appropriate treatment and lack of reinfection. METHODS: We used the tolerance detection test to confirm that all three...OBJECTIVES: Describe the clinical evolution of a person with recurrent gonococcal cervicitis despite appropriate treatment and lack of reinfection. METHODS: We used the tolerance detection test to confirm that all three culture-positive gonococcal isolates were tolerant to ceftriaxone. RESULTS: Over a period of 6 months, a transgender man with gonococcal cervicitis experienced eight episodes of treatment failure despite receiving ceftriaxone 1 g intramuscularly on each occasion. The isolate remained susceptible to ceftriaxone throughout this period. His infection was then successfully eradicated with a prolonged course of ceftriaxone. CONCLUSIONS: We propose that bacterial tolerance be considered a possible cause of treatment failure in . A tolerance detection test can be used to diagnose tolerance.
Remera E, Nsanzimana S, Chammartin F
… +1 more, Bucher HC
Sex Transm Infect
· 2025 Oct · PMID 40903275
·
Full text
BACKGROUND: In 2018, Rwanda incorporated oral pre-exposure prophylaxis (PrEP) with tenofovir and emtricitabine (Truvada) into national HIV guidelines as part of a comprehensive HIV prevention programme for female sex wor...BACKGROUND: In 2018, Rwanda incorporated oral pre-exposure prophylaxis (PrEP) with tenofovir and emtricitabine (Truvada) into national HIV guidelines as part of a comprehensive HIV prevention programme for female sex workers (FSWs). This study assessed the impact of PrEP on HIV incidence among FSWs in urban Rwanda. METHODS: We conducted a retrospective cohort study among HIV-negative FSWs aged≥18 years at 20 health facilities in Kigali from January 2019 to October 2021. All participants received standard HIV prevention services including routine condom distribution, peer education activities and the option to receive daily oral PrEP. Those who consented to receive PrEP formed the exposed group and those who declined or were not eligible to receive PrEP formed the control group. We used Cox regression to assess HIV seroconversion and logistic regression to assess retention in care. RESULTS: Among 1897 FSWs (median age 30.1 years, IQR: 25.2-35.6), 1129 (59.5%) initiated PrEP. The HIV incidence rate was 0.40 per 100 person-years (PYs) among FSWs in the PrEP group versus 1.83 per 100 PYs for those in the non-PrEP group. In multivariate analysis, PrEP was associated with a reduced risk of HIV seroconversion (adjusted HR: 0.25; 95% CI: 0.09 to 0.71). Retention in the HIV prevention programme at 12 months was 77.6% among FSW who used PrEP versus 73.6% among non-users (adjusted OR: 1.29 (95% CI: 1.03 to 1.60). CONCLUSIONS: Oral PrEP was associated with reduced HIV risk of HIV seroconversion among FSWs in Kigali. However, the small number of HIV seroconversions and limitations of the observational design warrant cautious interpretation of study findings.
OBJECTIVE: To quantify preferences for sexually transmitted and blood-borne infections (STBBI) testing in the general adult population in Canada. METHOD: We developed an online discrete choice experiment survey and admin...OBJECTIVE: To quantify preferences for sexually transmitted and blood-borne infections (STBBI) testing in the general adult population in Canada. METHOD: We developed an online discrete choice experiment survey and administered it to a sample of the general Canadian population aged 19 and up recruited using an online market research panel. We included six attributes based on the literature and a qualitative study: location of test administration; requisition and personal information requirement; specimen collection method; test accuracy (false-negative rate); time to result and out-of-pocket costs. The final design consisted of six blocks of 10 choice tasks, plus three choice tasks that were used for consistency checks. Data were analysed using conditional logit, mixed logit and latent class models. RESULTS: Analyses were based on 5113 respondents. There were positive preferences for STBBI testing using less invasive methods of testing, missing fewer infections, having a shorter time to result and lower costs. Latent class analysis identified four classes: non-testers, accuracy-driven testers, doctor's office testers and multiattribute testers. Regardless of class, accuracy and costs remained the two most important attributes. These classes had different preferences for the location of testing and requisition and personal information requirements. Compared with non-testers, multiattribute testers were more likely to be African, Caribbean and/or black; under 25 years; indicate sexual activities that would place people at high risk for acquiring HIV; and use injection drugs. CONCLUSION: Adults in the general population in Canada indicated strong preferences for low-cost and accurate tests. A variety of testing locations may be needed to reach diverse populations.
Wilson J, Graves R, Stott C
… +2 more, Richardson D, Wallace H
Sex Transm Infect
· 2026 May · PMID 40903273
·
Publisher ↗
OBJECTIVE: To assess the views of men who have sex with men (MSM) and transgender women (TGW) on acceptability of using meatal swabs compared with first-catch urine (FCU), and acceptability and accuracy of pooling three-...OBJECTIVE: To assess the views of men who have sex with men (MSM) and transgender women (TGW) on acceptability of using meatal swabs compared with first-catch urine (FCU), and acceptability and accuracy of pooling three-site samples compared with individually analysed samples, for gonorrhoea and chlamydia detection, using a questionnaire. METHODS: Prospective, convenience, sample of MSM/TGW attending UK sexual health clinic. Randomised order of self-taken samples from the pharynx and rectum, plus self-taken penile-meatal swab and FCU, for gonorrhoea and chlamydia detection. Participants were then asked to complete a questionnaire on acceptability and ease of taking the meatal swabs compared with FCU samples, and the pooling processes compared with individual samples. RESULTS: Questionnaire completion was 426/432 (98.6%) of participants offered it. Over 90% reported: finding written instructions and diagrams about taking the meatal swab clear and easy to follow; feeling confident about taking the meatal swab; finding written instructions and diagrams of how to pool the samples clear and easy to follow; and being confident about pooling the samples.When asked 'If the pooled sample with the meatal swab was the same at finding chlamydia as the pooled sample with the urine' 50% would prefer the meatal swab, 42% preferred urine and 8% had no preference. When asked 'If the pooled sample with the meatal swab was better at finding chlamydia than the pooled sample with the urine' 86% would prefer the meatal swab, 12% preferred urine and 2% had no preference. CONCLUSIONS: In this first study to assess people's views of taking their own penile-meatal swab versus FCU, the MSM/TGW participants found taking meatal swabs was easy and acceptable and a small majority preferred them to FCU even if no improved diagnostic sensitivity over urine. These results challenge the conventional thinking that urine is the preferred urogenital sample in MSM/TGW.
Rossotti R, Raccagni AR, D'Amico F
… +9 more, Nicastri E, Mazzola G, Cascio A, Falcone M, Gentile I, Giacomelli A, Mussini C, Parrella R, Nozza S
Sex Transm Infect
· 2026 Feb · PMID 40897406
·
Publisher ↗
OBJECTIVES: Doxycycline postexposure prophylaxis (DoxyPEP) has emerged as a promising tool for reducing bacterial sexually transmitted infections (bSTIs), particularly among men who have sex with men. This study aims to...OBJECTIVES: Doxycycline postexposure prophylaxis (DoxyPEP) has emerged as a promising tool for reducing bacterial sexually transmitted infections (bSTIs), particularly among men who have sex with men. This study aims to investigate the attitudes and prescribing practices of Italian infectious disease (ID) physicians regarding DoxyPEP for the prevention of bSTIs. METHODS: This is a cross-sectional survey conducted between October 2024 and March 2025 among ID specialists registered with the Italian Society of Infectious and Tropical Diseases. An anonymous online questionnaire assessed demographics, prescribing behaviour, attitudes and concerns regarding DoxyPEP. Favourability was rated on a visual analogue scale from 0 to 100. Descriptive and non-parametric statistics were used, and a Poisson regression model for predictors of favourable attitude was weighted according to the inverse of the probability of being sampled for responding to the survey. RESULTS: Of 132 respondents, 44.0% reported prescribing DoxyPEP, primarily in STI or pre-exposure prophylaxis clinics and urban settings. Median favourability was 70/100 and was higher among DoxyPEP prescribers (80 vs 50, p<0.001). The main reasons for prescribing were repeated STIs and specific sexual behaviour. The most frequently cited concern was antimicrobial resistance (96.2%), followed by the perceived superiority of condoms in preventing bSTIs and DoxyPEP toxicity. Informal use of DoxyPEP without medical supervision was reported by 46.2%, but counselling was significantly lower among non-prescribers. Older age was independently associated with higher favourability (p=0.005). CONCLUSIONS: This national survey shows a favourable attitude towards DoxyPEP among Italian ID physicians. DoxyPEP prescription was reported by less than half of the respondents, suggesting limited real-world use in Italy, with a variability in physicians' concerns and attitudes towards this preventive strategy for bSTIs.
Sex Transm Infect
· 2026 Jan · PMID 40889890
·
Publisher ↗
HIV cases in the Philippines have surged dramatically, with 5101 new diagnoses reported in the first quarter of 2025-a 57% increase from the same period in 2024. Young individuals aged 15 to 34 years are the most affecte...HIV cases in the Philippines have surged dramatically, with 5101 new diagnoses reported in the first quarter of 2025-a 57% increase from the same period in 2024. Young individuals aged 15 to 34 years are the most affected, with 96% of new infections linked to sexual transmission. Alarmingly, there has also been a 12% rise in advanced HIV cases, reflecting delays in diagnosis and limited access to care. The country remains far from achieving UNAIDS 95-95-95 targets, with only 55% of people diagnosed, 66% on treatment and 40% achieving viral suppression. This letter calls for urgent public health action, including expanded testing, awareness campaigns, improved access to treatment and pre-exposure prophylaxis, and stronger surveillance systems. International collaboration is essential, and support from global health organisations is critical to reversing this trend and preventing wider regional consequences.
Sex Transm Infect
· 2026 May · PMID 40889889
·
Publisher ↗
BACKGROUND: Previous analyses from South Africa have found that the ecological association between the prevalence of HIV and syphilis switched from positive to negative in the wake of the HIV pandemic. This was attribute...BACKGROUND: Previous analyses from South Africa have found that the ecological association between the prevalence of HIV and syphilis switched from positive to negative in the wake of the HIV pandemic. This was attributed to the impact of HIV mortality on sexual network connectivity. We conducted an ecological analysis of HIV prevalence and syphilis seropositivity among all districts in South Africa in 2010 and 2022. METHODS: We used Spearman's correlation to compare the weighted prevalence of HIV and syphilis per district using South Africa's 2022 Antenatal HIV Sentinel Survey. We calculated the change in the weighted syphilis and HIV prevalence per district between 2010 and 2022. RESULTS: The district-level antenatal prevalence of HIV in 2022 was positively correlated with the prevalence of syphilis (Rho=0.42; p=0.0018). A comparison of the same scatter plot from 2010 revealed that the six districts with the highest HIV prevalence in 2010 had large increases in syphilis prevalence from 2010 (median 0.1%, IQR 0.0%-0.4%) to 2022 (median 5.2%, IQR 4.2-5.8%). CONCLUSIONS: The positive association between HIV and syphilis prevalence is compatible with an increase in sexual network connectivity in the districts with the largest increases in syphilis prevalence.
Spurway C, Williams I, Bohm C
… +9 more, Ayinde OC, Burns F, Gibbs J, Josh J, Munro H, Solomon D, Woode Owusu M, Ross JDC, Jackson LJ
Sex Transm Infect
· 2025 Nov · PMID 40854800
·
Full text
INTRODUCTION: The use of remote consultations, such as appointments via telephone, video, online or text in sexual and reproductive health services (SRHS) across the UK, has expanded in recent years. This review synthesi...INTRODUCTION: The use of remote consultations, such as appointments via telephone, video, online or text in sexual and reproductive health services (SRHS) across the UK, has expanded in recent years. This review synthesises grey literature from different organisations to identify current practice and guidance for remote consultations. METHODS: We searched for a range of grey literature document types, including unpublished reports, evaluations, published standards, guidance, blogs and opinion pieces. The searches were conducted between March 2023 and July 2024 using Google, as well as the Healthcare Management Information Consortium database and preidentified organisational websites (eg, the British Association for Sexual Health and HIV, the Faculty of Sexual and Reproductive Healthcare). Data extracted included terminology, challenges to implementation and linked guidance and equity considerations in the use of remote consultations in SRHS. Narrative synthesis was used to analyse findings. RESULTS: The available guidance on implementing and delivering remote SRHS is modest in scope and volume and draws on a sparse evidence base. Existing guidance recommends the use of safeguarding assessments and checklists to support pathways from remote into in-person care. While remote consultations were seen as potentially enhancing equity, challenges included differences in technology access and digital literacy. Equity-related guidance included prioritising disadvantaged groups for in-person appointments and flexible care pathways. DISCUSSION AND CONCLUSIONS: The grey literature highlights the potential of remote SRHS to improve access and equity while also identifying risks in implementation and outcomes. There is an ongoing requirement for detailed, evidence-informed guidance that incorporates service user perspectives.
Rayo E, Malingamba G, Marti H
… +5 more, Onorini D, Leonard CA, Low N, Hampel B, Borel N
Sex Transm Infect
· 2026 Jan · PMID 40819902
·
Full text
OBJECTIVE: (CT) and (NG) are the most commonly reported sexually transmitted infections globally. Anorectal CT/NG detection among men who have sex with men (MSM) and coinfections is common. Epidemiological studies sugg...OBJECTIVE: (CT) and (NG) are the most commonly reported sexually transmitted infections globally. Anorectal CT/NG detection among men who have sex with men (MSM) and coinfections is common. Epidemiological studies suggest that CT/NG coinfections might result in greater bacterial load and transmissibility than single infection. The purpose of this study was to compare bacterial load and symptoms between CT/NG single and coinfections in MSM. METHODS: MSM positive for CT or NG on a triple swab (throat, urethra and rectal locations combined) were enrolled. Before treatment, they self-collected anorectal swabs. Bacterial loads for CT/NG were calculated using real-time PCR and compared between single or coinfected individuals, with or without rectal symptoms. RESULTS: We enrolled 382 MSM from December 2021 to December 2024. Among all samples: total CT (n=114), total NG (n=125), CT/NG coinfection 29/382 (7.6%). The bacterial loads in single and coinfected samples were comparable. The mean difference between CT alone and CT/NG was 0.40 target copies/mL (95% CI (-0.09 to 0.89), p value=0.107). The mean difference for NG alone and CT/NG was 0.24 copies/mL (95% CI (-0.49 to 0.99), p value=0.498). Among 382 MSM, 15.4% (n=59/382) experienced anorectal symptoms. There was no statistical difference in bacterial burdens between symptomatic and asymptomatic (CT difference of the means 0.52 copies/mL, 95% CI (-0.51 to 1.55); p value=0.313) (NG difference of the means 0.63, CI (0.01 to 1.28); p value=0.05). CONCLUSIONS: In contrast to prior research, we found similar bacterial burdens in anorectal MSM samples with single CT/NG versus coinfection. Further research is needed to understand the clinical implications of CT/NG coinfections. Future studies should investigate factors influencing anorectal CT/NG bacterial burden, transmissibility and susceptibility, including the function of pre-exposure prophylaxis and the rectal microbiota.