Sexually Transmitted Infections[JOURNAL]
Sun
200 papers
Ongoing shortage of generic emtricitabine/tenofovir disoproxil fumarate undermines HIV prevention efforts among PrEP users in Italy.
Rossotti R, Moioli MC, Baiguera C … +4 more , Milani M, De Giorgio C, Cervi L, Puoti M
Sex Transm Infect · 2025 Nov · PMID 40813076 · Publisher ↗
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Characteristics of repeat syphilis infections and interinfection intervals in a retrospective clinical cohort: implications for syphilis retesting and prevention.
Huang TE, Chow EPF, Fairley CK … +4 more , Azzato F, Graves S, Towns JM, Chen MY
Sex Transm Infect · 2026 May · PMID 40803835 · Publisher ↗
BACKGROUND: Syphilis infections are rising in many countries. Syphilis reinfections can occur among patients with ongoing risk. We aimed to describe the characteristics of syphilis reinfections and the interval time betw...
BACKGROUND: Syphilis infections are rising in many countries. Syphilis reinfections can occur among patients with ongoing risk. We aimed to describe the characteristics of syphilis reinfections and the interval time between syphilis reinfections. METHODS: This was a retrospective study of patients with two or more syphilis infections between 2011 and 2022 diagnosed at Melbourne Sexual Health Centre, Australia. RESULTS: 474 patients, 98% men who have sex with men (MSM), had 1327 syphilis infections over 2062 person-years; 26.9% (n=357) primary syphilis, 20.9% (n=278) secondary and 48.3% (n=641) early latent syphilis. Individuals experienced up to nine syphilis infections. The proportion of people living with HIV (PLWH) increased with each subsequent syphilis infection from 40.1% (190/474) of first infections to 78.4% (29/37) of fifth infections. For first infections, the proportions were 36.5% for early latent, 31.6% for primary and 22.2% for secondary syphilis. In contrast, for fifth infections, proportions increased to 78.4% for early latent and decreased to 16.2% for primary and 5.4% for secondary syphilis. The median interinfection interval, between the first and second syphilis infection, for the entire cohort, was 656 days (IQR 325-1262 days). Pre-exposure prophylaxis (PrEP) users had a shorter median interinfection interval of 341 days (IQR 206-762 days), compared with the entire cohort (p<0.0001), HIV-negative patients not using PrEP (p<0.0001) and PLWH (p<0.0001). CONCLUSION: Among MSM, syphilis reinfections were common, especially among PLWH and HIV-negative PrEP users, with the latter having the shortest interval between infections. These groups should be retested for syphilis with frequent serological screening, PCR testing of syphilis lesions and should be targeted for syphilis prevention.
Pre-exposure prophylaxis (PrEP) uptake and retention in care in a group of transgender women at high risk of HIV: a French cohort of follow-up.
Isernia V, Cervantes M, Digumber M … +13 more , Peralta F, Louni F, Deprez A, Le Gac S, Vandendriessche C, Champenois K, Sautereau A, Bachelard A, Phung B, Benalycherif A, Landman R, Blanquart L, Ghosn J
Sex Transm Infect · 2026 Feb · PMID 40764038 · Publisher ↗
INTRODUCTION: Despite high HIV prevalence rates among trans women (TW), few preventive interventions have targeted this population. METHODS: We described sociodemographic and clinical data from a cohort of TW followed up...
INTRODUCTION: Despite high HIV prevalence rates among trans women (TW), few preventive interventions have targeted this population. METHODS: We described sociodemographic and clinical data from a cohort of TW followed up for pre-exposure prophylaxis (PrEP) at the Sexual Health Clinic of Bichat hospital in Paris between 2016 and 2023, via a multidisciplinary community-led PrEP programme.The total number of TW starting PrEP and having ongoing follow-up each year was assessed. We described retention in care at 3, 6 and 12 months and median time of follow-up. Incidence of PrEP discontinuation was calculated using Poisson regression. RESULTS: Between January 2016 and December 2023, 209 TW have been followed up for PrEP at Bichat Hospital, with a median age of 36 years and mostly originating from South America (79.4%, 166/209). Seventy-four per cent of TW (155/209) were sex workers and 53.6% (112/209) had regular health insurance. Most of TW were on daily PrEP (94.3 %, 197/209).The total number of TW followed-up for PrEP per year increased from 17 in 2016 to 129 in 2023. Median time of follow-up was 10.3 months and incidence of PrEP discontinuations was 58.2 (CI 95% 49.51 to 68.57) per 100 persons-year. Retention in care at 6 and 12 months was, respectively, 62% and 38% for users who started PrEP in 2016 and 81% and 31% for those who started in 2022. Seven per cent of TW (13/190) experienced adverse events, leading to PrEP discontinuation in 10/190 cases. Two cases of HIV seroconversion were reported, both in TW who had stopped PrEP for gastrointestinal intolerance. CONCLUSIONS: Our multidisciplinary reach-out community-led PrEP programme has increased PrEP access among our cohort of TW. Rates of retention in such a prevention programme of care remained poor. More interventions are needed to analyse PrEP barriers and improve retention in care for this specific population.
Association of self-reported HIV infection with oral pre-exposure prophylaxis use among women of reproductive age in Lesotho: evidence from mixed-effects estimates of nationally representative data.
Ekholuenetale M
Sex Transm Infect · 2025 Aug · PMID 40764037 · Full text
OBJECTIVES: This study examined the association of self-reported HIV status with history of oral pre-exposure prophylaxis (PrEP) use among reproductive-age women from Lesotho. METHODS: This study analysed a sample of 641...
OBJECTIVES: This study examined the association of self-reported HIV status with history of oral pre-exposure prophylaxis (PrEP) use among reproductive-age women from Lesotho. METHODS: This study analysed a sample of 6413 women from the 2023-24 Lesotho Demographic and Health Survey (LDHS) data. The data were collected between November 2023 and February 2024. Categorical data were analysed with percentages and χ tests. In addition, ever use of oral PrEP and covariates of self-reported HIV infection were investigated using binary multivariable multilevel logistic regression. HIV infection data were self-reported by the women based on their most recent HIV test. RESULTS: The weighted prevalence of self-reported HIV infection among women was 22.1% (95% CI 20.6% to 23.7%). Among women who ever used oral PrEP, the prevalence of self-reported HIV infection was 13.4% (95% CI 9.9% to 17.9%), but was 24.0% (22.0% to 26.1%) among women who have never used. History of oral PrEP use was associated with 62.0% reduction in the odds of self-reported HIV infection (adjusted OR (aOR) 0.38; 95% CI 0.28 to 0.51). Respondents who have heard of a sexually transmitted infection (STI) have 27.0% reduction in the odds of self-reported HIV infection when compared with those who have not heard of an STI (aOR 0.73; 95% CI 0.59 to 0.90). Women aged 25+ years at first sex had 60.0% reduction in the odds of self-reported HIV infection, when compared with those <18 years at first sex (aOR 0.40; 95% CI 0.19 to 0.84). Women with multiple total lifetime number of sexual partners had higher odds of self-reported HIV infection, when compared with those with single lifetime number of sexual partner. CONCLUSIONS: HIV infection among women in Lesotho remains high. Having a history of oral PrEP use was associated with lower odds of self-reported HIV infection. Stakeholders in healthcare should promote oral PrEP interventions and design programmes for HIV prevention among women.
Shingrix vaccination for recurrent genital herpes: a real-world clinic experience.
Palmer BS, Walker M, DeBurgh-Thomas A … +1 more , Rees K
Sex Transm Infect · 2025 Oct · PMID 40744528 · Publisher ↗
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Preferences for pre-exposure prophylaxis service package among men who have sex with men in Australia: a discrete choice experiment.
Tieosapjaroen W, Chan C, Fraser D … +9 more , Green KE, Cassell M, Murphy D, Bavinton BR, Schmidt HA, Phanuphak N, Zhang L, Tang W, Ong JJ
Sex Transm Infect · 2026 Feb · PMID 40744527 · Publisher ↗
OBJECTIVES: Pre-exposure prophylaxis (PrEP) usage remains below the Australian 75% coverage target. This study identified preferences for PrEP services shared among subgroups of men who have sex with men (MSM) living in...
OBJECTIVES: Pre-exposure prophylaxis (PrEP) usage remains below the Australian 75% coverage target. This study identified preferences for PrEP services shared among subgroups of men who have sex with men (MSM) living in Australia and explored heterogeneity preferences across different age groups and countries of birth. METHODS: MSM aged>18 years with no prior HIV diagnosis and residing in Australia completed an online discrete choice experiment between May and November 2022. The attributes included type of PrEP, service location, service cost, PrEP side effects, visit frequency and additional services. Participants were recruited through dating apps, Facebook and local MSM community organisations. We used a latent class model (LCM) to explore subgroups with similar preferences for PrEP programmes and a random parameters logit model with interactions to explore heterogeneity preferences. RESULTS: Overall, 1894 MSM participated, with a mean age of 40 (±12) years. The LCM identified four groups of MSM who shared similar preferences for PrEP services: 'Long-acting oral or injectable PrEP from community clinics' (22% of participants), 'Daily oral PrEP from pharmacies' (5%), 'Long-acting oral PrEP from pharmacies' (52%) and 'injectable PrEP from the hospital' (22%). The group preferring injectable PrEP (22%) preferred accessing PrEP services at hospitals offering sexually transmitted infection testing every 6 months, with a willingness to pay a small fee ($A25). They were willing to endure mild pain at the injection site as a side effect of injectable PrEP. Compared with Australian-born, overseas-born MSM preferred PrEP services offering injectable PrEP. Compared with younger MSM, MSM over 30 years old preferred services offering daily PrEP. CONCLUSIONS: There is a growing demand for alternatives to oral daily PrEP, with a significant group preferring services including long-acting oral or injectable PrEP and willing to pay a small fee to access it. The majority preferred decentralising access to PrEP through pharmacies. Diverse preferences for PrEP service delivery signify tailored PrEP implementation initiatives to increase PrEP coverage among underserviced populations.
Prevalence of chlamydial, gonococcal and syphilis positivity by anatomical site and sex via self-collected biospecimens using at-home testing kits among a large and diverse cohort of men and women enrolled in the MACS/WIHS Combined Cohort Study (MWCCS) in the USA.
Mimiaga MJ, Tian J, Chiu I … +22 more , Yonko EA, Noori G, Aziz N, Jamieson BD, Qian Y, Alcaide ML, Augenbraun M, Friedman MR, Kempf MC, Dionne-Odom J, D'Souza G, Edmonds A, Konkle-Parker D, French AL, Ofotokunc I, Palella FJ, Plankey MW, Sharma A, Tien PC, Ho K, Visconti AJ, Detels R
Sex Transm Infect · 2026 Feb · PMID 40713184 · Full text
INTRODUCTION: Cisgender men who have sex with men (MSM), transgender women, cisgender women and cisgender men who have sex with women only (MSW) have differential risk of acquiring (CT) and (GC), the two most commonly...
INTRODUCTION: Cisgender men who have sex with men (MSM), transgender women, cisgender women and cisgender men who have sex with women only (MSW) have differential risk of acquiring (CT) and (GC), the two most commonly reported bacterial sexually transmitted infections (STIs) in the USA. Similarly, MSM and transgender women have a higher number of syphilis infections in the USA than other groups. The presence of any of these three STIs is a significant risk factor for HIV acquisition and transmission, unless taking antiretroviral medication for HIV prevention (pre-exposure prophylaxis) or treatment (antiretroviral therapy). We sought to understand the prevalence rates of STIs in various vulnerable populations by anatomical site, sex and gender, which will inform the development of targeted prevention interventions and guide future updates to national testing guidelines. METHODS: Participants are enrolled in the MACS (Multicenter AIDS Cohort Study)/WIHS (Women's Interagency HIV Study) Combined Cohort Study (MWCCS)-the longest-running observational study of both people living with HIV (PLWH) and sociodemographically similar people living without HIV (PLWOH) in the world-with a total of 13 clinical research sites across the USA; participants (N=5700) complete quantitative assessments related to a variety of behavioural and health-related factors every 6 months. Regardless of whether or not they were sexually active or symptomatic/asymptomatic, all enrolled participants (ie, cisgender MSM, transgender women, cisgender women and cisgender MSW) were asked to complete surveillance testing for bacterial STIs (ie, syphilis, CT and GC). In addition to urethral samples, cisgender MSM, transgender women and cisgender MSW collected samples to test for extragenital pharyngeal and rectal CT and GC. Using at-home testing kits, participants self-collected biospecimens (ie, dried blood spots (DBS)/ microtainer of blood, urine and rectal and pharyngeal swabs) which were mailed to a central laboratory for nucleic acid amplification testing (for CT/GC) and syphilis testing using the reverse algorithm. STI results were linked to participants' HIV testing data and self-administered surveys on sociodemographics, sexual behaviours and psychosocial factors. RESULTS: Among those tested, 24.6% of cisgender MSM, 25.8% of transgender women, 7.4% of cisgender women and 14.6% cisgender MSW tested positive for at least one STI. Multiple STIs/anatomical sites were detected in 3.9% of participants, with the highest prevalence among transgender women (9.7%). Current/past syphilis prevalence was 11.2% across all participants, with cisgender MSM (19.7%) and transgender women (19.4%) having a higher prevalence than cisgender women (6.4%) and cisgender MSW (12.6%). Regarding CT, 2.1% of the participants tested were positive at one anatomical site. Among those who had extragenital testing, rectal CT was the most prevalent (3.2%), including 3.4% among cisgender MSM, 8.9% among transgender women and 0.9% among cisgender MSW. For GC, 1.4% of participants tested positive at one site. Among those who tested for extragenital STIs, rectal GC was the most common site, with a prevalence of 2.2%, including 2.3% for cisgender MSM, 4.3% for transgender women and 1.4% among MSW. Overall, 7.1% of participants tested positive for CT or GC at one or more anatomical sites. Finally, PLWH had a significantly higher prevalence of syphilis (13.74%) compared with PLWOH (6.11%) (p<0.001). CONCLUSION: There is a high prevalence of bacterial STIs among participants in the MWCCS. Self-collection of DBS/microtainer of blood, urine and rectal and pharyngeal swabs provided a useful, cost-effective option for screening participants outside of the traditional clinical setting. Given the possible asymptomatic nature of all three STIs, regular testing and education can be key to detection and treatment. Culturally appropriate and locally derived community outreach and engagement can be highly effective in reducing stigma around HIV and STIs and help reduce barriers to testing and treatment.
Emergence of multidrug-resistant isolates from urethral samples in men who have sex with men.
Rincon-Quintero A, Davina-Nunez C, De Malet A … +7 more , Montaño Barrientos BJ, Menéndez-Rodríguez C, Pérez-González A, Perez-Castro S, Cortizo-Vidal S, Ocampo A, Potel C
Sex Transm Infect · 2025 Jul · PMID 40695603 · Publisher ↗
OBJECTIVE: To investigate the urethral carriage rate of isolated in men who have sex with men and to describe the clinical characteristics of carriers. We performed an analysis of the resistance determinants, virulence...
OBJECTIVE: To investigate the urethral carriage rate of isolated in men who have sex with men and to describe the clinical characteristics of carriers. We performed an analysis of the resistance determinants, virulence factors and the genetic phylogeny of the isolates. METHODS: Clinical data were obtained from 234 patients attending the infectious diseases unit at the Álvaro Cunqueiro Hospital (Vigo, Spain) between 2021 and 2023. isolated in urethral samples was subjected to antimicrobial susceptibility testing and whole-genome sequencing. RESULTS: The urethral carriage rate was 25%. None of the risk factors studied (received antimicrobial therapy in the previous month, HIV status, Pre-Exposure Prophylaxis (PrEP) use and age) were related to a higher carriage rate. Neither multidrug-resistant (MDR), the presence of a capsule, nor virulence factors were useful to distinguish asymptomatic carriage from acute urethritis (urethral discharge, dysuria, irritation). Nearly half the isolates (48%) met the criteria for MDR. Furthermore, the gene was found in two isolates that were highly resistant to ceftriaxone (CRO). The other 22 CRO-resistant strains had low minimum inhibitory concentrations and showed alterations in the transpeptidase domain of penicillin-binding protein 3. Moreover, resistance to CRO was high (37%). Most of our urethral strains grouped into one cluster, and this difference was statistically significant when the phylogenetic analysis was performed with samples from different anatomical origins. CONCLUSIONS: The increase in strains isolated in the urethra belonging to only one cluster is worrying. Moreover, the isolation of strains increasingly resistant to different groups of antimicrobials highlights the need for close monitoring of the evolution of resistance and the transmission of these resistant strains in the future. Larger studies should be planned to establish the epidemiological relevance of these difficult-to-treat MDR bacteria.
The Centenary Series - STIs Through the Ages: .
Tsigkouli I
Sex Transm Infect · 2025 Jul · PMID 40675773 · Publisher ↗
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Introducing the first UK national guideline for the use of doxycycline postexposure prophylaxis (doxyPEP) for the prevention of syphilis.
Saunders J, Fifer H, Medland N … +1 more , guideline writing group
Sex Transm Infect · 2025 Jul · PMID 40675772 · Publisher ↗
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'It does fill me with a bit of unease': a qualitative study of the acceptability, facilitators and barriers to reducing the frequency of screening for asymptomatic sexually transmitted infections among gay, bisexual and other men who have sex with men.
Berners-Lee W, Cabecinha M, Bell J … +12 more , Phillips D, Witney T, Pulford CV, Lorencatto F, Fifer H, Foster K, Mohammed H, Sinka K, Williamson D, Rait G, Folkard K, Saunders J
Sex Transm Infect · 2026 Jan · PMID 40664501 · Full text
OBJECTIVES: The study aimed to explore the acceptability of reducing the frequency of asymptomatic (Ct) and (Ng) screening among gay, bisexual, and other men who have sex with men (GBMSM)(Although the term GBMSM is use...
OBJECTIVES: The study aimed to explore the acceptability of reducing the frequency of asymptomatic (Ct) and (Ng) screening among gay, bisexual, and other men who have sex with men (GBMSM)(Although the term GBMSM is used for convenience, the study also includes nonbinary people who were assigned male at birth who have sex with men.). Additionally, it sought to identify barriers and facilitators to implementing such changes and to develop potential interventions that could support a shift in current screening guidelines. METHODS: This qualitative study explored stakeholder perspectives on reducing screening frequency and identified potential interventions that could support future guideline changes of this kind. Semistructured interviews were conducted with 22 GBMSM and 8 professional stakeholders. Data were thematically analysed using the Capabilty, Opportunity, Motivation - Behaviour (COM-B) and Theoretical Domains Framework (TDF). TDF domains were mapped to behaviour change techniques to inform intervention development. Candidate interventions were refined based on acceptability, practicability, effectiveness, affordability, side effects, equity. RESULTS: Overall, GBMSM stakeholder responses to discontinuing asymptomatic Ng and Ct screening tended to be negative, while professional stakeholder opinions were mixed. Reducing the recommended screening frequency to 6 monthly was generally more acceptable to both groups. Barriers and facilitators to guideline changes included issues of knowledge and trust, social influence and identity, context and resources, concerns about consequences and emotional responses and habit. Ten candidate interventions were suggested. These involve providing information, social support, behavioural substitutions and feedback as well as facilitating discussions to resolve concerns. CONCLUSION: Any reduction in the recommended frequency of asymptomatic screening will encounter a range of interrelated barriers, including knowledge gaps, social influences and emotional factors. We identified evidence-based interventions that could improve acceptance and minimise unintended consequences. Future research should incorporate stakeholder workshops to refine these strategies.
Uncertain pathogenicity of in genital and extra-genital sites: insights from a French series of 25 cases.
Berset de Vaufleury J, Danset M, Truchot F … +4 more , Durupt F, Dauwalder O, Gouillon L, Godinot M
Sex Transm Infect · 2025 Nov · PMID 40645775 · Full text
is suggested as an emerging sexually transmitted pathogen in men who have sex with men. We analysed 25 cases, revealing a wider distribution and frequent concomitant infections. Our findings challenge its primary pathoge...
is suggested as an emerging sexually transmitted pathogen in men who have sex with men. We analysed 25 cases, revealing a wider distribution and frequent concomitant infections. Our findings challenge its primary pathogenic role, suggesting it may act as an opportunistic coloniser.
The Centenary Series - STIs Through the Ages: .
Galli M, Fois L
Sex Transm Infect · 2025 Aug · PMID 40645774 · Publisher ↗
OBJECTIVE: To describe the first wave of the syphilis pandemic in the Old World. METHODS: Summary and discussion of early and recent literary and documentary data describing the spread of syphilis in Europe at the end of...
OBJECTIVE: To describe the first wave of the syphilis pandemic in the Old World. METHODS: Summary and discussion of early and recent literary and documentary data describing the spread of syphilis in Europe at the end of the fifteenth and during the first decades of the sixteenth century. RESULTS: From the second half of 1493, the spread of a disease that was clearly perceived as being sexually transmitted was the cause of considerable scandal and so much concern as to force Emperor Maximilian I to proclaim that it was the punishment for the sins of the affected as early as August 1495. Considered as new and unprecedented by most contemporaries and appearing just after the return of Columbus' first expedition, a heated controversy concerning the origin of the disease began almost immediately and, despite the findings of phylogenetic studies of Treponema sequences taken from modern specimens and early remains, still continues today. Called by many often nationalistic names (particularly French morbus or Neapolitan disease), syphilis affected millions of people in the early sixteenth century, limiting their reproductive capacity and life expectancy, and greatly reducing their quality of life. CONCLUSIONS: Regardless of its geographical and temporal origins, the characteristics of this true pandemic were typical of those induced by a new pathogen in a virgin population.
Factors associated with the presence of stigma towards people living with HIV among healthcare workers in Poland.
Cholewik M, Fijołek F, Moskal Z … +3 more , Bieńkowski C, Kowalska JD, Skrzat-Klapaczyńska A
Sex Transm Infect · 2025 Jul · PMID 40628422 · Publisher ↗
BACKGROUND: People living with HIV constantly face stigma and discrimination. The role of healthcare workers in fighting stigmatisation, especially self-stigmatisation, remains a key component. MATERIALS AND METHODS: A c...
BACKGROUND: People living with HIV constantly face stigma and discrimination. The role of healthcare workers in fighting stigmatisation, especially self-stigmatisation, remains a key component. MATERIALS AND METHODS: A cross-sectional survey study was designed to measure HIV knowledge and attitudes in various healthcare settings in Europe and Central Asia. Responses from Poland were analysed separately and stratified by profession, length of work, experience with patients with HIV and gender. RESULTS: A total of 134 questionnaires were collected. The median age of participants was 41. Most of the participants were female (70.9%), doctors (57.9%), working for more than 10 years (73.9%) and working in a hospital (66.2%). Most of the respondents did not take care of people living with HIV in the year before implementing the survey (56.7%). At the same time, the majority presented up-to-date knowledge and assessment of risks arising from HIV transmission, along with acceptance and willingness to provide services. Healthcare professionals working for over 10 years were less concerned about contact with people living with HIV. Physicians, compared with other healthcare workers, presented less stigma and were less worried about contact with people living with HIV. Men and those who cared for more than five people with HIV also presented less discrimination against people living with HIV. CONCLUSIONS: The majority of Polish healthcare workers who responded to the survey presented a willingness to support and provide services for people living with HIV and/or at risk of HIV. However, there is still space for improvement in education, especially among non-doctors working in healthcare settings.
Stakeholder perspectives on integrating doxycycline postexposure prophylaxis into Kenyan HIV PrEP programmes.
Mogaka FO, Kwach B, Odira A … +4 more , O'Malley G, Hearst M, Bukusi EA, Stewart J
Sex Transm Infect · 2025 Jul · PMID 40628421 · Full text
OBJECTIVES: Doxycycline postexposure prophylaxis (doxyPEP) is an efficacious sexually transmitted infection (STI) prevention strategy. Implementation guidelines recommend a focus on people with prior STIs and/or those ta...
OBJECTIVES: Doxycycline postexposure prophylaxis (doxyPEP) is an efficacious sexually transmitted infection (STI) prevention strategy. Implementation guidelines recommend a focus on people with prior STIs and/or those taking HIV pre-exposure prophylaxis (PrEP), but trial results are insufficient for interventions to enter guidelines and clinical practice. The purpose of this paper is to describe potential barriers and facilitators for successful implementation strategies of doxyPEP in resource-limited settings. METHODS: This qualitative study explored the perceived acceptability, feasibility and sustainability of integrating doxyPEP for STI prevention into Kenyan HIV PrEP programmes. Semistructured interviews were conducted with policymakers, healthcare providers and HIV PrEP users. The interviews were recorded, transcribed and translated to English. Analysis was completed using Dedoose software using deductive reasoning based on the Consolidated Framework for Implementation Research. RESULTS: Forty interviews (7 policymakers, 16 HIV PrEP users, 17 healthcare providers) were conducted between August 2022 and April 2023. Collectively, study participants found doxyPEP to be an acceptable strategy and understood its potential use among HIV PrEP users. However, participants noted several considerations such as the relative advantage, quality and evidence strength, and tension for change alongside the needs, resources and knowledge of the recipient. Integrating doxyPEP into HIV PrEP programmes was deemed feasible, but there were concerns over long-term sustainability, antimicrobial resistance (AMR), surveillance, cost, pill burden and compatibility, and high workload for HIV PrEP providers. Establishing sustainable practice needs to consider costs, external policies, incentives to participate and engaging providers and recipients in the process. CONCLUSION: Kenyan HIV/STI policymakers, healthcare providers and HIV PrEP users perceived doxyPEP for STI prevention to be acceptable and feasible when addressing local contextual factors. Potential for sustainability was recognised if programmes can address concerns, including AMR, pill burden and additional workload for health professionals, prior to the implementation of doxyPEP into HIV PrEP programmes.
Estimating the number of people who could benefit from HIV pre-exposure prophylaxis (PrEP) in England and the unmet need.
Huntington SE, Bates L, Coukan F … +1 more , Adams EJ
Sex Transm Infect · 2025 Nov · PMID 40619164 · Full text
OBJECTIVE: To quantify how many people in England could benefit from using pre-exposure prophylaxis (PrEP) to prevent HIV acquisition (PrEP need), and of these, the number who did not access PrEP (unmet need) by populati...
OBJECTIVE: To quantify how many people in England could benefit from using pre-exposure prophylaxis (PrEP) to prevent HIV acquisition (PrEP need), and of these, the number who did not access PrEP (unmet need) by population group and ethnicity. METHODS: An established multiplier method was applied using published data from a behavioural survey of gay, bisexual and men who have sex with men (GBMSM) and national data on UK-acquired new HIV diagnoses categorised by ethnicity and probable HIV exposure route.After calculating the number of GBMSM who could benefit from PrEP, the number of people in other groups who could benefit from PrEP was calculated using the relative proportion of new HIV diagnoses within each group. The proportion of new HIV diagnoses by ethnicity was then used to calculate the number of people who could benefit from PrEP by ethnicity.Within each subgroup (population group and ethnicity), the number with unmet need for PrEP was calculated by subtracting those who accessed PrEP at a specialist sexual health service (SHS) from the estimated number who could benefit from PrEP. RESULTS: In 2023, there were an estimated 485 335 people who could benefit from PrEP in England, 80.1% (n=388 773) of whom did not access PrEP from an SHS-and of these, 94.5% (n=367 444) did not attend an SHS. There were 129 359 heterosexual women with unmet PrEP need, 93 049 GBMSM and 88 204 heterosexual men. There were three ethnicities for which >85% of people with PrEP need did not access PrEP: Black African (98.6%), Black other (96.3%) and Black Caribbean (85.4%). CONCLUSIONS: The findings indicate a considerable unmet need for PrEP in England. Most people with unmet need did not attend an SHS, highlighting an urgent need to raise awareness of the benefits of PrEP and expand PrEP access to additional settings.
'It's less traumatic because you're in your own home': exploring trauma-informed care for digital sexual health services - a secondary qualitative data analysis.
Conway A, Gibbs J, Spence T … +5 more , Howarth A, Reid D, Estcourt CS, Burns F, Lloyd KC
Sex Transm Infect · 2026 Jan · PMID 40555477 · Full text
OBJECTIVES: Trauma-an event or circumstance causing an individual physical and/or emotional harm-is associated with adverse sexual and reproductive health outcomes, including a higher prevalence of sexually transmitted i...
OBJECTIVES: Trauma-an event or circumstance causing an individual physical and/or emotional harm-is associated with adverse sexual and reproductive health outcomes, including a higher prevalence of sexually transmitted infections. Trauma-informed care (TIC) is a systematic framework that recognises and addresses the impact of trauma through an organisation's policies, practices and environment. Online delivery of sexual health services has rapidly become a standard of care in England; therefore, our research aims to provide valuable insights for implementing TIC in digital platforms. METHODS: We performed a secondary analysis of qualitative data from two mixed methods studies that conducted semi-structured interviews with n=100 and n=25 sexual health service users following purposive sampling. A sample of 11 transcripts was included, and an inductive-deductive approach was used to analyse the data. RESULTS: Our findings highlight six key themes of TIC: (1) Safety, (2) Trust and Transparency, (3) Peer Support and Self-Help, (4) Collaboration and Choice and (5) Cultural, Historical and Gender Issues. Participants reported that online postal self-sampling offered more privacy, comfort and control than in-person testing. They appreciated the use of gender-inclusive language and identified online postal self-sampling as a 'safer option' for individuals who fear being misgendered in clinical settings. However, some were concerned about providing sensitive information online, such as information about sexual partners or gender identity. There was limited evidence of peer support, and participants recommended improved signposting to sexual assault reporting and other trauma-related resources. CONCLUSIONS: This is the first known qualitative study exploring the intersection between TIC and digital sexual health interventions. Our study provides insight into how current online postal self-sampling practices facilitate the principles of TIC and which gaps remain. Future research should explore how these principles can be adapted to make digital sexual health services more trauma-informed.
Screening for gonorrhoea and chlamydia: identifying key target populations and intensity-a modelling study of MSM in Belgium.
Tsoumanis A, Vanbaelen T, Van Dijck C … +2 more , Kenyon C, Hens N
Sex Transm Infect · 2026 Feb · PMID 40518259 · Publisher ↗
BACKGROUND: (CT) and (NG) are two of the most common bacterial sexually transmitted infections (STIs) among men who have sex with men (MSM). Screening for CT and NG has been promoted as an intervention to reduce the pr...
BACKGROUND: (CT) and (NG) are two of the most common bacterial sexually transmitted infections (STIs) among men who have sex with men (MSM). Screening for CT and NG has been promoted as an intervention to reduce the prevalence of these STIs. We aimed to evaluate the effect of different screening intensities on the prevalence of CT, NG and the emergence of azithromycin-resistant NG (AR-NG) in an MSM population. METHODS: We developed a network-based model for CT and NG transmission among MSM in Belgium to estimate the prevalence of CT, NG and AR-NG in the population. The model simulates transmission of CT/NG among three anatomical sites in a population of 10 000 MSM, divided into high-activity and low-activity groups, over 10 years. The effect of different screening frequencies and coverage was evaluated in terms of CT, NG and AR-NG prevalence. RESULTS: Gonorrhoea prevalence ranged between 12% and 16% in scenarios screening 0-80% of the population. Screening among the low-activity MSM (LA-MSM) group had little effect on NG prevalence but increased the risk of AR-NG. Infrequent screening (less than every 180 days) with high coverage (over 40%) resulted in the highest risk for the spread of AR-NG in the population. Screening up to 40% of low-activity (HA-MSM) every 90 days and up to 20% of LA-MSM reduced NG prevalence to 14% without selecting for AMR. Screening coverage and frequency had little impact on CT prevalence in all scenarios. CONCLUSIONS: Our model suggests that NG/CT screening has a modest effect in controlling the prevalence of these infections in the MSM population in Belgium. Screening efforts should move away from LA-MSM. Screening alone would not be sufficient to control the CT/NG epidemic, and future models should incorporate the impact of additional interventions such as vaccination and doxycycline post-exposure prophylaxis.
Regression-based risk scores using sociodemographic and sexual behaviour data do not predict asymptomatic sexually transmitted infections among HIV PrEP users.
Jongen VW, Schim van der Loeff M, van Wees DA … +8 more , van den Elshout M, Hoebe CJPA, Götz HM, de Vries H, Prins M, Hoornenborg E, Dukers-Muijrers NHTM, Boyd A
Sex Transm Infect · 2026 Jan · PMID 40480809 · Publisher ↗
OBJECTIVES: Among users of oral HIV pre-exposure prophylaxis (PrEP), condom use is low and incidence of sexually transmitted infections (STIs) is high, hence guidelines recommend STI screening every 3-6 months. Identifyi...
OBJECTIVES: Among users of oral HIV pre-exposure prophylaxis (PrEP), condom use is low and incidence of sexually transmitted infections (STIs) is high, hence guidelines recommend STI screening every 3-6 months. Identifying individuals with higher asymptomatic STI risk for targeted screening may offer an opportunity to reduce the burden of STI screening. METHODS: In the Netherlands, PrEP has been offered through the National PrEP Pilot Program since 2019, which includes screening every 3 months. We included data of all individuals who received care through the PrEP programme between July 2019 and June 2022 and attended at least one PrEP care visit. STI-related symptoms and notification of possible STI exposure by sexual partners are recorded during each visit. We assessed the predictors of any chlamydia, gonorrhoea or syphilis infection diagnosed during routine asymptomatic STI screening (ie, no reported symptoms or partner notification) using logistic regression and calculated risk scores from coefficients of the multivariable logistic regression model. We estimated the sensitivity and specificity for the optimal prediction score cut-off. RESULTS: Among the 11 035 included individuals (97% men who have sex with men), 14 926 bacterial STIs (9114 diagnosed during routine asymptomatic screening) were diagnosed during a median of 24 months (IQR 15-30) of follow-up. We found that PrEP users who engaged in sex work, had condomless anal sex, participated in group sex or chemsex (ie, use of gamma-hydroxybutyrate/gamma-butyrolactone, mephedrone or crystallised methamphetamine during sex), injected drugs or used alcohol or non-chemsex-related drugs during sex had an increased risk of STIs diagnosed during routine asymptomatic screening. PrEP users born in the Netherlands and those who attended college or university had a lower STI risk. A risk score using these covariates resulted in a sensitivity of 0.55 (95% CI 0.54 to 0.56) and specificity of 0.55 (95% CI 0.54 to 0.55). Individuals eligible for STI screening accounted for 54% of STIs diagnosed during follow-up. CONCLUSIONS: Using routinely available demographic and behavioural data, it was not possible to construct a well-performing risk score to identify individuals at high risk of STIs diagnosed during routine asymptomatic screening. Other factors, methods or ways to analyse data may be needed to increase predictive capacity for STI risk scores.
Molecular investigation of a new HIV-1 outbreak among people who inject drugs in Greece: evidence for a dense network of HIV-1 transmission.
Kostaki EG, Papadimitriou E, Chatzopoulou F … +17 more , Roussos S, Tsirogianni E, Psichogiou M, Goulis I, Kalamitsis G, Kefala AM, Skoura L, Chrysanthidis T, Metallidis S, Tsiara C, Paraskeva D, Magiorkinis G, Beloukas A, Hatzakis A, Sypsa V, Chatzidimitriou D, Paraskevis D
Sex Transm Infect · 2025 Nov · PMID 40441776 · Publisher ↗
OBJECTIVES: Αn HIV-1 outbreak was identified among people who inject drugs (PWID) in Thessaloniki, Greece, during 2019-2021. We aimed to investigate the characteristics of this outbreak by means of molecular epidemiology...
OBJECTIVES: Αn HIV-1 outbreak was identified among people who inject drugs (PWID) in Thessaloniki, Greece, during 2019-2021. We aimed to investigate the characteristics of this outbreak by means of molecular epidemiology. METHODS: We analysed 57 sequences from PWID sampled in Thessaloniki during 2019-2023. Phylogenetic trees were inferred using all subtype A sequences from PWID sampled since 1999 in Greece and reference sequences (n=4824). Phylodynamic analysis was performed using the Bayesian birth-death skyline serial model. RESULTS: Most of the 57 study sequences belonged to sub-subtypes A6 (49, 86%) and A1 (4, 7%). Phylogenetic analysis revealed that two (50%) A1 sequences clustered together and 47 (95.9%) A6 sequences fell within three PWID-specific phylogenetic clusters. The 99.6% and 77.9% of pairwise genetic distances within the largest and second largest PWID clusters were lower than 0.015 substitutions/site. Using a more stringent threshold (0.0015 substitutions/site), we identified five networks of sequences from PWID infected within 1 year. The effective reproduction number (R) started to increase at the beginning of 2019 and remained high almost until the end of 2021. The estimated time from HIV-1 infection to diagnosis showed an increasing trend during 2020-2023 (p<0.001). CONCLUSIONS: The regional clustering of the PWID sequences and their low genetic divergence confirm its local spreading and the recent nature of the outbreak. Using a stringent genetic distance threshold, we showed that HIV-1 transmission occurred among large groups of PWID. The time of epidemic growth coincided with the time of the initial identification, and HIV-1 transmission continued at high rates until 2021.
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