Goldstein E, Ure R, Winter A
… +6 more, Currie A, McHugh M, Doumith M, Cole MJ, Smith A, Gunson RN
Sex Transm Infect
· 2026 Feb · PMID 40441775
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OBJECTIVES: To investigate specimens that exhibit diagnostic escape when the gonococcal pseudogene is employed as the target of nucleic-acid amplification tests (NAATs). METHODS: Eight NAAT specimens, from five patient...OBJECTIVES: To investigate specimens that exhibit diagnostic escape when the gonococcal pseudogene is employed as the target of nucleic-acid amplification tests (NAATs). METHODS: Eight NAAT specimens, from five patients, were identified as potential diagnostic escape mutants over a 7-month period (2023-2024) in Scotland. All specimens tested positive for on the first-line NAAT, which uses the gene target. However, all tested negative with confirmatory testing using a NAAT which included both and targets. To investigate these false-negative results, whole genome sequencing was performed on available gonococcal isolates (n=4) from the three patients in which cultures had been collected, and a nested PCR approach was applied directly to NAAT specimens for the remaining two patients. RESULTS: The isolates were all multilocus sequence type ST-9363, a common genotype. However, these genomes harboured a neisserial gene (NEIS1364, allele 3890) typically found in . This meningococcal gene is not detected in the pseudogene confirmation assay, resulting in false negative results. CONCLUSION: We report a novel strain of containing a gene derived from resulting in diagnostic escape when using a commonly employed NAAT target. While our findings suggest this may be a local cluster, ongoing vigilance is required both within the diagnostic and sexual health communities to prevent misdiagnoses and maintain diagnostic assurance.
Chen KH, Lin KY, Huang YS
… +8 more, Huang SH, Liu WD, Wu TY, Chuang YC, Cheng A, Su LH, Sun HY, Hung CC
Sex Transm Infect
· 2025 Nov · PMID 40368583
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OBJECTIVES: Syphilis remains a public health challenge, particularly among people with HIV (PWH). This study aimed to examine the trends of syphilis and associated factors among PWH in Taiwan, 2016-2023, before the imple...OBJECTIVES: Syphilis remains a public health challenge, particularly among people with HIV (PWH). This study aimed to examine the trends of syphilis and associated factors among PWH in Taiwan, 2016-2023, before the implementation of doxycycline postexposure prophylaxis (DoxyPEP). METHODS: PWH aged 18 years or older who sought HIV care at a university hospital and had at least two serological tests for syphilis during the study period were included. Annual incidence rates of syphilis were calculated as the number of new syphilis cases per 100 person-years of follow-up (PYFU), while the prevalence was defined as the proportion of PWH who had a positive rapid plasma reagin (RPR) titre. Reinfection was defined as a ≥4 fold increase in RPR titre following a prior syphilis diagnosis. Multivariable logistic regression was used to identify factors associated with syphilis acquisition. RESULTS: Among 3828 PWH, a total of 3201 incident syphilis cases were recorded during a total of 23 385.1 PYFU. The incidence rate decreased significantly from 16.78 per 100 PYFU in 2016 to 11.14 per 100 PYFU in 2023, a 33.6% reduction. The prevalence peaked at 45.0% in 2019 before declining to 41.6% in 2023. Reinfections constituted 66.3-85.0% of incident cases annually. Factors associated with acquiring syphilis included younger age (adjusted OR (AOR), per 10-year increase, 0.71; 95% CI, 0.67 to 0.75), men who have sex with men (AOR, 1.75; 95% CI, 1.32 to 2.32), a previous syphilis history (AOR, 7.26; 95% CI, 6.48 to 8.14) and no follow-up RPR data in the preceding year(s) (AOR, 3.02; 95% CI, 2.08 to 4.38). CONCLUSIONS: While the declines in incidence and prevalence of syphilis among PWH before the implementation of DoxyPEP were likely driven by an ageing population in Taiwan, regular serological testing for syphilis remains imperative for early diagnosis and treatment of syphilis to prevent further transmission.
Harrison A, Harbottle J, Campbell M
… +9 more, O'Donnell K, Perry M, Sykes A, Nugent C, Bradley DT, Baraitser P, Igoe D, Lyons F, Coyle R
Sex Transm Infect
· 2025 Oct · PMID 40360270
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OBJECTIVES: There is limited evidence about the prevalence of oropharyngeal gonorrhoea (OPNG) in heterosexuals. To test the hypothesis that the oropharynx acts as a reservoir for gonorrhoea, potentially contributing to h...OBJECTIVES: There is limited evidence about the prevalence of oropharyngeal gonorrhoea (OPNG) in heterosexuals. To test the hypothesis that the oropharynx acts as a reservoir for gonorrhoea, potentially contributing to high rates of infection, we assessed OPNG positivity in self-sampling individuals. METHODS: From November 2023 to March 2024, SH:24, an online postal self-sampling service, expanded gonorrhoea (NG) nucleic acid amplification testing to include oropharyngeal swabs for heterosexual individuals aged 17-24 years in Northern Ireland and Ireland. Participants were included if they identified as heterosexual with no same or both-gender sexual partners. Positivity was compared by sex and infection site, with χ tests. Island-of-Ireland weighted positivity with 95% CI was estimated. RESULTS: OPNG was detected in 92% (208/226) of NG cases, representing 2.9% (95% CI 2.6 to 3.4) of the tested population. Single-site OPNG infections accounted for 63% (143/226) of cases, corresponding to an overall single-site oropharyngeal positivity of 1.9% (95% CI 1.7 to 2.4). Genital-only infections occurred in 8% (18/226) of cases, while concurrent oral and genital (multisite) infections were identified in 29% (65/226). Overall NG positivity (across all anatomical sites) was 3.2% (226/7009; 95% CI 2.8 to 3.7). Of 12 011 individuals who requested a self-sampling kit, 7036 (58.6%) returned both oropharyngeal and genital swabs suitable for analysis, with valid test results available for 7009 individuals. CONCLUSIONS: Our findings suggest the oropharynx is a common NG infection site among young heterosexuals, often occurring independently of genital infection. Most OPNG cases (63%) did not coincide with genital infection and would have been missed by testing protocols limited to urogenital sites. These results suggest a potential risk for onward transmission, the need to consider a review of testing guidelines in this population and further research to better understand behavioural risk factors associated with OPNG positivity.
Adeniyi T, Horwood J, Doran M
… +15 more, Piggott K, Namurach AM, Harryman L, Oldenbourg E, Kiflu M, Speare N, Griffin M, Wilson M, Febrache M, Allbless R, Dravie-John D, Copping J, De Vocht F, Walter S, Fox F
Sex Transm Infect
· 2026 Jan · PMID 40360269
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OBJECTIVES: African and Caribbean heritage (ACH) communities in the UK face disproportionately high rates of HIV and often experience delayed diagnoses, worsening health inequities. Increasing HIV testing in these commun...OBJECTIVES: African and Caribbean heritage (ACH) communities in the UK face disproportionately high rates of HIV and often experience delayed diagnoses, worsening health inequities. Increasing HIV testing in these communities is essential to address these disparities and support the UK's HIV reduction targets. This study examines barriers and facilitators to HIV testing among Bristol's ACH community, a high-prevalence area with significant rates of late diagnoses, filling a critical gap in context-specific data. METHODS: Using a mixed-methods approach, this study combined 29 in-depth interviews and 41 online surveys, capturing ACH community members' views on HIV stigma, healthcare trust and testing experiences. Data were thematically analysed and mapped to the Social Ecological Model (SEM) framework, with community researchers conducting data collection and analysis to enhance participants' engagement and trust and contribute to a deeper contextual analytical understanding. RESULTS: Findings highlight significant barriers across SEM levels: individual-level knowledge gaps and stigma, interpersonal confidentiality concerns within tight knit communities, community-level taboos and distrust and organisational barriers, such as discriminatory healthcare experiences. Effective facilitators included culturally specific services, flexible testing options, community-driven outreach and increased healthcare representation, all of which fostered greater trust and engagement in testing. CONCLUSION: The study underscores the importance of culturally aligned interventions, including representation within and training in cultural competence for healthcare providers and community co-production in service design. Implementing such strategies could reduce late diagnoses and support the normalisation of routine HIV testing in ACH communities, ultimately contributing to health equity. Future research should explore gender and age-specific barriers, while assessing the long-term impact of community-led interventions to inform national HIV policy and public health strategies for marginalised communities in the UK.
Qi Y, Xie Q, Lin J
… +4 more, Zhang R, Tang Y, Wang Z, Lin X
Sex Transm Infect
· 2025 Oct · PMID 40360268
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OBJECTIVES: (NG), a bacterium characterised by multidrug resistance, is traditionally treated with ceftriaxone, either as a monotherapy or in conjunction with azithromycin. However, the emergence of strains resistant to...OBJECTIVES: (NG), a bacterium characterised by multidrug resistance, is traditionally treated with ceftriaxone, either as a monotherapy or in conjunction with azithromycin. However, the emergence of strains resistant to these antibiotics presents a considerable challenge to current therapeutic approaches, which necessitates the exploration of alternative treatment strategies. METHODS: Agar dilution and broth microdilution to determine the minimum inhibitory concentrations (MICs) of antibiotics and 7,8-dihydroxyflavone. The development of 7,8-dihydroxyflavone drug resistance was detected under the treatment of sublethal concentration for 30 passages. Genotypic analysis was conducted to examine , alleles and multilocus sequence typing. RESULTS: 55 clinical NG isolates emphasised the high-level rates of the current antimicrobial resistance, with a notable prevalence of the -60.001 FC428 clone and high-level azithromycin-resistant clones characterised by the -1 (A2059G) and -2 (C2611T) alleles. Among the strains that are representative of clinical circulation, 7,8-dihydroxyflavone demonstrated inhibitory activity, with MIC and MIC values of 10 mg/L and 20 mg/L, respectively, which are unlikely to induce drug resistance in NG. CONCLUSIONS: 7,8-dihydroxyflavone may represent a promising antimicrobial agent in the context of escalating antibiotic resistance.
Vanbaelen T, Huis In 't Veld D, Visser BJ
… +5 more, De Baetselier I, Van Praet JT, Manoharan-Basil SS, Van den Bossche D, Kenyon C
Sex Transm Infect
· 2026 Jan · PMID 40335273
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OBJECTIVES: In Belgium, approximately a quarter of infections are resistant to both macrolides and fluoroquinolones-termed multidrug-resistant (MDR) infections. The optimal treatment approach for these MDR infections re...OBJECTIVES: In Belgium, approximately a quarter of infections are resistant to both macrolides and fluoroquinolones-termed multidrug-resistant (MDR) infections. The optimal treatment approach for these MDR infections remains uncertain. Combination therapy has shown promise in treating other MDR pathogens by enhancing efficacy and reducing resistance development. We report the first five cases of MDR urethritis successfully treated with a novel combination therapy regimen consisting of minocycline, metronidazole, methenamine and pristinamycin ('M3P'). METHODS: We describe a case series of five individuals treated with M3P as salvage therapy for urethritis. Clinical data, laboratory findings, resistance profiles and treatment outcomes were reviewed. RESULTS: All five men with macrolide-resistant and fluoroquinolone-resistant urethritis received M3P for a minimum of 14 days. Two men received an extended 28-day M3P regimen, in which minocycline and methenamine were given for 28 days. All five patients experienced clinical and microbiological cure. Adverse effects were minimal and transient, with one patient reporting increased urinary frequency during treatment and another reporting mild dyspepsia. CONCLUSIONS: This case series demonstrates the potential efficacy of M3P as a novel salvage therapy for MDR urethritis, particularly where standard therapies have failed. The combination of pristinamycin, methenamine, and other agents may synergistically reduce bacterial load and increase efficacy. Further, in vitro and clinical studies are required to assess the optimal treatment strategies for MDR .
Reyes Nieva H, Zucker J, Tucker E
… +4 more, McLean J, DeLaurentis C, Gunaratne S, Elhadad N
Sex Transm Infect
· 2025 Oct · PMID 40318862
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OBJECTIVES: This study aimed to develop robust machine learning (ML)-based and deep learning (DL)-based models capable of detecting mpox cases for surveillance efforts using clinical notes. METHODS: As part of a learning...OBJECTIVES: This study aimed to develop robust machine learning (ML)-based and deep learning (DL)-based models capable of detecting mpox cases for surveillance efforts using clinical notes. METHODS: As part of a learning health system initiative, we conducted a retrospective study of clinical encounters at the Columbia University Irving Medical Center in New York City. We included patients with mpox diagnoses confirmed by PCR testing between 15 May 2022 and 15 October 2022 and three matched controls for each case based on patient age, sex, race, ethnicity and visit month. We trained three mpox surveillance models using: (1) logistic regression with L1 regularisation (least absolute shrinkage and selection operator (LASSO)), (2) ClinicalBERT and (3) ClinicalLongformer. We evaluated model performance using precision, recall, F1 score, area under the receiver operating characteristic curve (AUROC), area under the precision-recall curve (AUPRC) and recall at 80% precision (RP80). RESULTS: The study included 228 PCR-confirmed mpox cases and 698 controls. LASSO regression outperformed the DL models with a precision, recall and F1 score of 0.93, AUROC of 0.97, AUPRC of 0.93 and RP80 of 0.89. ClinicalBERT achieved a precision of 0.88, recall of 0.89, F1 score of 0.88 and AUROC of 0.93. ClinicalLongformer achieved a precision of 0.87, recall of 0.88, F1 score of 0.87 and AUROC of 0.92. Phrases related to symptoms (eg, lesions and pain) were among the most predictive features in LASSO regression. CONCLUSIONS: ML and DL models based on clinical notes show promise for identifying mpox cases. In this study, LASSO regression outperformed DL models and excelled in minimising false positives. These findings highlight the potential for ML and DL methods to support case surveillance for mpox and other infectious diseases. These methods may also prove helpful for flagging missed or delayed diagnoses as part of continuous quality improvement.
Tsai CS, Tsai BY, Huang SH
… +5 more, Huang MH, Chen GJ, Lin CY, Hung CC, Ko WC
Sex Transm Infect
· 2026 Feb · PMID 40274403
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OBJECTIVES: Lymphogranuloma venereum (LGV) caused by genotypes L1-L3 has been resurging among men who have sex with men (MSM) and people with HIV (PWH) in Western countries. While historically attributed to tropical reg...OBJECTIVES: Lymphogranuloma venereum (LGV) caused by genotypes L1-L3 has been resurging among men who have sex with men (MSM) and people with HIV (PWH) in Western countries. While historically attributed to tropical regions, rectal LGV has been rarely recognised in Asia, with Taiwan recently becoming the second Asian country to report cases. METHODS: A multicentre, laboratory-based surveillance was conducted from January 2020 to December 2023 in Taiwan. Specimens were collected from MSM through syndromic testing and screening of high-risk populations. was identified using commercial multiplex PCR assays, with genotyping performed through gene sequencing. LGV-positive samples underwent multilocus sequence typing (MLST) following established protocols. RESULTS: Among 446 . -positive samples, 391 (87.7%) underwent successful sequencing. Genovariant L2b accounted for 9.7% of cases, predominantly among PWH with rectal chlamydia (18.2%). PWH accounted for 85.7% of all genovariant L2b cases. Of 38 genovariant L2b samples from 35 cases, 34 (84.2%) samples completed MLST, revealing sequence type (ST) 53 as the predominant strain (74%). ST39 and ST63 were identified as unreported STs in Western countries, along with previously reported ST58. The four identified STs formed a cluster. CONCLUSIONS: Our findings indicate the clonal spread of L2b-ST53 among MSM in Taiwan, primarily affecting PWH. The predominance of ST53 suggests potential international and domestic spread, indicative of the need for enhanced surveillance.
Vialard F, Zhang Q, Webster D
… +5 more, Materniak S, Dumont Blais A, Nair S, Bartlett S, Pant Pai N
Sex Transm Infect
· 2025 Oct · PMID 40274402
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OBJECTIVES: Across Canada, in the last decade, incidence rates of sexually transmitted and blood-borne infections (STBBI) have peaked (syphilis) or plateaued (hepatitis C virus (HCV) and HIV). Key populations (gay, bisex...OBJECTIVES: Across Canada, in the last decade, incidence rates of sexually transmitted and blood-borne infections (STBBI) have peaked (syphilis) or plateaued (hepatitis C virus (HCV) and HIV). Key populations (gay, bisexual and other men who have sex with men, trans and gender-diverse people, and people who use injection drugs) are at greater risk for these STBBIs, so correctly predicting risk before screening potentially infected individuals is crucial. We developed and validated a diagnostic clinical risk prediction model (CRPM) estimating HIV, HCV and syphilis risk for two key populations in two Canadian provinces. METHODS: We used 20 variables and STBBI test results from a cross-sectional study evaluating multiplexed testing (detection of coinfections) in New Brunswick and Quebec (n=400) to develop our CRPM. We randomly split the data into development (n=300) and validation (n=100) datasets using clinic-stratified sampling. We used Bayesian predictive projection with development data to select ranked STBBI predictors. We obtained the ORs of the highest performing submodel measured as area under the receiver operating curve (AUC), sensitivity and specificity with 89% credible intervals (89% CrI) using validation data. Analyses were performed in R (≥V.4.2.3). RESULTS: Out of 400 participants, 73 were infected with HIV (n=16), HCV (n=60), and/or syphilis (n=5). An internally validated submodel with two predictors (, ) displayed the highest AUC (0.79; 89% CrI 0.66 to 0.79), sensitivity (0.85; 89% CrI 0.79 to 0.91) and specificity (0.30; 89% CrI 0.15 to 0.50). The predictor contributing most to STBBI risk was (OR=7.62; 89% CrI 4.41 to 13.07). CONCLUSIONS: This Bayesian-based CRPM is the first to identify high-risk individuals for HIV, HCV and syphilis with an overall good performance that minimises case missing. After additional validation, it could serve as a promising novel tool for prescreening key populations and improve Canadian STBBI multiplexed screening strategies.
Sagaon-Teyssier L, Hoyer M, Dos Santos M
… +20 more, Mora M, Bourrelly M, Protière C, Maradan G, Verger P, Michels D, Salcedo M, Velter A, Certoux M, Peretti-Watel P, Tong PB, Lugaz V, Leclercq V, Assoumou L, Siguier M, Pialoux G, Molina JM, Roux P, Spire B, Girard G
Sex Transm Infect
· 2026 Jan · PMID 40250995
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OBJECTIVES: This study investigated the acceptability by gay men, bisexual men and other men who have sex with men (GBMSM) of French public health information and prevention measures implemented during the 2022 Mpox outb...OBJECTIVES: This study investigated the acceptability by gay men, bisexual men and other men who have sex with men (GBMSM) of French public health information and prevention measures implemented during the 2022 Mpox outbreak. METHODS: ANRS-MPX-SHS "Mpox: perception of risks, health measures and vaccination" is a cross-sectional survey conducted in GBMSM between July and September 2022. Online questionnaires collected information about Mpox-related awareness, perceptions and prevention behaviours. Multiple correspondence analysis identified participant profiles according to their level of acceptability of the information and prevention measures implemented during the 2022 outbreak. The study outcome was a variable grouping participants into three profiles: 'strong endorsers', 'uninformed hesitant endorsers' and 'indifferent objectors'. Multinomial logistic regression was used to estimate factors associated with each profile. RESULTS: Of the 5688 participants, 5320 (93.5%) had available data for the outcome. The latter were mostly cisgender men (98%), aged between 35 and 54 years (54.5%), with tertiary education (82%); 44% were living in the Greater Paris region. Strong endorsers, uninformed hesitant endorsers and indifferent objectors accounted for 77.8%, 14.4% and 7.8% of the sample, respectively. Participants with tertiary education, those who had sex exclusively with men, those taking pre-exposure prophylaxis (ie, HIV-negative participants), HIV-positive participants and individuals living in the Greater Paris region, were all less likely to be uninformed hesitant endorsers or indifferent objectors. Participants with no lifetime HIV/sexually transmitted infection (STI) screening and those with infrequent screening were, respectively, more likely to belong to these two profiles. CONCLUSIONS: Participants' acceptability of the information and prevention measures implemented during the 2022 Mpox outbreak in France depended on the perceived capability of public health authorities to effectively diversify information targets, representations and communication channels. In order to prevent the transmission of Mpox (and other STIs) in the general population in future outbreaks, information and measures adopted must take into account the needs, perceptions and experiences of persons never or not regularly screened for HIV/STIs.