Schiavoni R, Labate L, Cerchiaro M
… +6 more, Rosa R, Niccolo M, Mezzogori L, Taramasso L, Bassetti M, Di Biagio A
Sex Transm Infect
· 2025 Jul · PMID 40210491
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The incidence of syphilis is rising, particularly among men who have sex with men. Ocular involvement, often manifesting as bilateral uveitis, typically occurs in later stages and is more severe and difficult to recognis...The incidence of syphilis is rising, particularly among men who have sex with men. Ocular involvement, often manifesting as bilateral uveitis, typically occurs in later stages and is more severe and difficult to recognise in individuals living with HIV. We describe the case of a man with HIV infection who presented to our outpatient clinic with vision loss and a cutaneous maculopapular rash.
Truong HM, Otieno B, Kadede K
… +12 more, Odeny D, Opiyo M, Hewa M, Opondo F, Heylen E, Amboka S, Odhiambo H, Ogolla D, Miller L, Cohen CR, Bukusi EA, Maneno Yetu Study Team
Sex Transm Infect
· 2025 Oct · PMID 40199577
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OBJECTIVES: Sexually transmitted infections (STIs) diagnoses in Kenya are based on the identification of characteristic symptoms or syndromes without laboratory testing. Syndromic management likely underestimates STI pre...OBJECTIVES: Sexually transmitted infections (STIs) diagnoses in Kenya are based on the identification of characteristic symptoms or syndromes without laboratory testing. Syndromic management likely underestimates STI prevalence due to undiagnosed asymptomatic infection. We assessed the prevalence and factors associated with chlamydia and gonorrhoea infections among adolescent boys and girls participating in , a sexual and reproductive health study in Kenya. METHODS: Adolescents aged 15-19 years residing in informal settlements in Kisumu were eligible to participate in a cross-sectional survey. Participants were recruited using respondent-driven sampling. Urine specimens were tested using the Molecular Xpert CT/NG test. Associations were assessed by multivariate logistic regression. RESULTS: STI testing was offered to 1238 adolescents who reported having sex and 1167 accepted. Of the 1159 adolescents who had interpretable STI test results, 53% were girls and 74% were 18-19 years old. STI prevalence was 9.6% overall and higher among girls than boys (12.5% vs 6.3%; p<0.001). Of 111 adolescents who tested positive, 96 had chlamydia, 9 had gonorrhoea, 6 had both chlamydia and gonorrhoea, and 73 reported never experiencing any STI symptoms. Girls were twice more likely than boys to test positive for an STI after controlling for other demographic characteristics, sexual behaviour and STI-related characteristics (aOR=2.01, 95% CI 1.25, 3.24). CONCLUSIONS: Nearly 10% of adolescents were diagnosed with chlamydia or gonorrhoea. STI prevalence was two times higher among girls than boys. Two-thirds of adolescents with a positive STI test result did not report experiencing symptoms and thus would have been missed by syndromic management. Undiagnosed and untreated STIs can result in onward transmission and significantly impact their reproductive health. Our findings lend support for expanding STI testing services in resource-constrained settings and developing point-of-care diagnostic assays that are rapid, inexpensive and accurate to address the STI epidemic and reduce the risk of sequelae.
Aung ET, Yodkitudomying C, Fairley CK
… +5 more, Phillips T, Vodstrcil L, Bradshaw CS, Chen MY, Chow EPF
Sex Transm Infect
· 2025 Oct · PMID 40199576
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BACKGROUND: Few studies have examined the sexual practices of female sex workers (FSWs) outside of their sex work and their association with the detection of bacterial sexually transmitted infections (STIs). This study a...BACKGROUND: Few studies have examined the sexual practices of female sex workers (FSWs) outside of their sex work and their association with the detection of bacterial sexually transmitted infections (STIs). This study aimed to investigate the annual trends in the number of non-work sexual partners and condom use among FSWs and their association with STIs. METHODS: We conducted a repeated cross-sectional study of FSWs attending a sexual health clinic in Melbourne for the first time between January 2011 and December 2020. Data on sexual practices with non-work male and female sexual partners, condom use and STI diagnoses among FSWs were extracted. RESULTS: Of the 3075 FSWs included in the analysis, 70% (n=2167) reported having non-work sexual partners in the past 12 months, 66% (n=2041) reported having non-work male sexual partners, 20% (n=608) reported having non-work female sexual partners and 18% (n=556) reported having both non-work male and female sexual partners. From 2011 to 2020, the proportion of FSWs who had non-work casual male sexual partners increased from 37% (115/315) to 61% (69/113) (p<0.001). Condomless sex with non-work casual male sexual partners increased from 43% (50/115) to 67% (46/69) (p<0.001). The positivity of any STIs increased from 5% (16/312) to 13% (14/110) (p<0.001). Multivariable analyses showed that FSWs who had condomless sex with non-work casual male sexual partners had higher odds of having any STIs (adjusted OR 1.41; 95% CI: 1.01, 1.95) compared with those who consistently used condoms with these sexual partners. CONCLUSION: Our study highlights a shift in the sexual practices of FSWs outside of sex work, in line with the trends observed in the general population. These changes may contribute to changes in STI transmission dynamics in this population. Overall, we found that the STI positivity in FSWs is low.
BACKGROUND: Evidence of self-collection human papillomavirus (HPV)-RNA testing in cervical cancer screening is limited among women with HIV (WHIV). Most studies are in low-risk patient populations in high-income countrie...BACKGROUND: Evidence of self-collection human papillomavirus (HPV)-RNA testing in cervical cancer screening is limited among women with HIV (WHIV). Most studies are in low-risk patient populations in high-income countries. We examine the prevalence of high-risk HPV (hrHPV) using the APTIMA HPV-RNA assay on self-collected versus provider-collected specimens, and the associated risk factors for high-grade cervical intraepithelial neoplasia (CIN2/3) among women engaged in sex work in Kenya. Among WHIV, we examine the performance of both collection methods for the detection of CIN2/3. METHODS: Participants were aged ≥18 years, non-pregnant and had no previous treatment for cervical precancer. The screening process included self-collection of cervicovaginal samples using a Viba cytobrush (Rovers), provider-collected cervical samples, visual inspection with acetic acid (VIA) and Pap smear. The APTIMA HPV Assay (Hologic) was used to detect E6/E7 oncogene RNA of 14 hrHPV types in both self-collected and on provider-collected samples. Risk factors for CIN2/3 were determined via multivariable logistic regression. We estimated test characteristics for each screening method for CIN2/3 detection. RESULTS: A total of 400 women (194 WHIV, 206 women without HIV) underwent screening between 2013 and 2018, with 399 valid HPV results. WHIV had a higher prevalence of hrHPV by self-collection compared with women without HIV (44.0% vs 29.6%, p<0.05) and CIN2/3 (19.0% vs 9.7%, p<0.05). After adjusting for age and HIV status, hrHPV-positivity increased the risk of CIN2/3 by 13 to 20 times. Among WHIV, the sensitivity for CIN2/3 detection was similar between self-collection (85% (66-96)) and provider-collection (93% (76-99)), both of which were higher than the sensitivity of high-grade cytology (high-grade squamous intraepithelial lesion cut-off) (47% (95% CI 23 to 72)). The specificity for both collection methods (self: 66% (95% CI 57 to 75) and provider: 67% (95% CI 58 to 75)) was lower than cytology (85% (95% CI 78 to 91)). CONCLUSION: Self-collection for HPV-RNA testing performed similarly to provider-collection among WHIV. For WHIV, while the higher sensitivity of HPV-RNA testing compared with cytology for the detection of clinically relevant cervical disease is important, the lower specificity supports the inclusion of a triage test in the screening algorithm.
Siatravani E, Panopoulou AD, Polemis M
… +6 more, Chryssou SE, Moschos I, Magaziotou I, Beloukas A, Tzelepi E, Miriagou V
Sex Transm Infect
· 2025 Aug · PMID 40147884
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OBJECTIVES: To monitor epidemiological characteristics and antibiotic susceptibility trends of in Greece during 2009-2023. METHODS: Microbiological and epidemiological data for 1756 gonococci received by the Greek Natio...OBJECTIVES: To monitor epidemiological characteristics and antibiotic susceptibility trends of in Greece during 2009-2023. METHODS: Microbiological and epidemiological data for 1756 gonococci received by the Greek National Reference Centre for were evaluated. Strains were isolated consecutively from gonorrhoea cases in hospitals throughout Greece. Minimum inhibitory concetrations of antibiotics were determined by E-test. Plasmid content analysis was performed for penicillinase-producing isolates (PPNG) and for isolates exhibiting tetracycline resistance (TRNG). , and genes were identified by PCR and RFLP/sequencing. Isolates were subjected to serotyping. Genomic analysis by pulsed-field gel electrophoresis (PFGE) was performed for extended-spectrum cephalosporin (ESC)-resistant isolates. RESULTS: Only 2.8% of the isolates were fully susceptible to all antibiotics. High rates of resistance were observed for penicillin G (27.5%), tetracycline (59.2%) and ciprofloxacin (68.8%). PPNG and/or TRNG isolates accounted for 26% of the total sample, the majority (81.6%) being simultaneously quinolone-resistant (QRNG). The isolation frequency of QRNG isolates was stably high as in previous years. Interestingly, a proportion of QRNG isolates exhibited cross-resistance to all antibiotics except spectinomycin. Azithromycin resistance is showing an increasing trend since 2021 at alarming levels (32.7% in 2023). The percentage of isolates exhibiting decreased susceptibility to ESCs (CDS) remained stable until 2019, whereas no CDS strains were isolated from 2020 to 2023. Spectinomycin was active against all isolates. Serotyping results revealed a strong association of quinolone resistance with Bpyut, Bpyust and Bropyst serovars and I/S phenotypes with Bpyvut and Byut serovars. PFGE showed that CDS isolates were classified into eight groups, with the majority clustered in three main clones including the predominant CDS clone isolated during 2001-2008. CONCLUSIONS: The gonococcal population showed a continuous change in the resistance phenotypes and predominating clones during 2009-2023 underlining the need for continuous monitoring of the traits of this pathogen.
Enkhjargal S, Lhagva-Ochir O, Purvee A
… +9 more, Artbazar G, Anolli MP, Enkhbat A, Ariungerel N, Enkhtur M, Ravjir O, Vangan N, Dashdorj N, Oidovsambuu O
Sex Transm Infect
· 2025 Oct · PMID 40147883
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OBJECTIVES: Hepatitis delta virus (HDV) is the smallest human virus that causes the most severe form of viral hepatitis. However, the virus's biological features, transmission routes and causes of endemicity in particula...OBJECTIVES: Hepatitis delta virus (HDV) is the smallest human virus that causes the most severe form of viral hepatitis. However, the virus's biological features, transmission routes and causes of endemicity in particular populations are not yet fully understood. HDV shares the hepatitis B virus (HBV) parenteral mode of transmission with HBV; therefore, sexual transmissions are also possible. However, data on sexual transmission of HDV are limited. METHODS: This study included 60 patients with chronic HBV/HDV coinfection. The median age (IQR) of patients was 35 (23-47) years, and all were Mongolian. HDV-RNA, HBV-DNA and hepatitis B surface antigens were tested in serum, seminal plasma and cervical swab samples collected at the Liver Centre, Mongolia. Binary logistic regression analysis was used to create a model that predicts the possibility of HDV detection in seminal plasma and cervical swab samples based on HDV-RNA levels in serum samples. RESULTS: HDV-RNA was detected in cervical swab samples from 24 of 30 patients (80%) and in seminal plasma from 15 of 30 patients (50%) (Fisher's exact test, p=0.03). Patients with detectable HDV-RNA in either seminal or cervical fluid samples showed higher levels of HDV-RNA in serum ((females: 6.44 vs 4.21 log IU/mL (p<0.0001); males: 6.69 vs 5.65 log IU/mL (p<0.0001)). A correlation between HDV-RNA levels in the serum was identified in females (r=0.56, p=0.004; 95% CI 0.206 to 0.788) but not in males (r=0.38, p=0.15, 95% CI -0.15 to 0.75). The regression model identified threshold points of serum HDV-RNA levels that can be used to predict HDV-RNA detection in seminal plasma and cervical swabs. CONCLUSIONS: HDV-RNA can be detected in cervical swabs and seminal plasma of patients with HBV/HDV coinfection, and the detection was more common in females than in males. The probability of HDV-RNA detection in male seminal plasma and female cervical swab samples can be predicted based on the HDV viral load in serum.
Chessell C, Erin B, Dempsey M
… +2 more, Williams D, Richardson D
Sex Transm Infect
· 2025 Nov · PMID 40139774
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BACKGROUND: Clinical guidelines for sexually transmissible enteric infections can provide a framework for testing, management, antimicrobial stewardship and public health control. This review aimed to evaluate the curren...BACKGROUND: Clinical guidelines for sexually transmissible enteric infections can provide a framework for testing, management, antimicrobial stewardship and public health control. This review aimed to evaluate the currently available clinical guidelines and to highlight any areas for improvement. METHOD: A comprehensive online search for clinical guidelines was performed and reported using Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines, followed by evaluation using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool by three independent reviewers. An AGREE II domain score of >60% is the threshold for sufficient quality, and each guideline was rated high, average or low based on the domain percentages (five domains scoring >60%=high, 3-4 domains scoring >60%=average and ≤2 domains scoring>60%=low). Two authors developed a bespoke quality framework for sexually transmissible enteric infection guidelines and this was used to evaluate each guideline. RESULTS: Six clinical guidelines were identified from the UK (British Association for Sexual Health and HIV (UK-BASHH)), USA (Centers for Disease Control and Prevention (USA-CDC)), Europe (International Union against Sexually Transmitted Infections (Europe-IUSTI)), Canada-government, Brazil-government and Australia (Australasia Society for HIV, Viral Hepatitis, and Sexual Health Medicine (Australia-ASHM)). The overall AGREE II score was 56% (IQR 43-67) (domain 1 (scope and purpose) 67% (IQR=42-67), domain 2 (stakeholder involvement) 46% (IQR 34-62), domain 3 (rigour of development) 42% (IQR 22-49), domain 4 (clarity of presentation) 80% (IQR 57-89), domain 5 (applicability) 23% (IQR 11-30) and domain 6 (editorial independence) 67% (IQR 56-84)). The median global scores (out of 7) and rating (low, medium and high) were UK-BASHH (5/7, high), USA-CDC (5/7, average), Europe-IUSTI (4/7, average), Canada government (4/7, low), Brazil government (3/7, low) and Australia-ASHM (1/7, low). All six guidelines recommended testing using molecular platforms: UK-BASHH, USA-CDC and Europe-IUSTI recommended offering sexual health interventions and STI testing; the UK-BASHH and Australia-ASHM did not recommend empirical antimicrobials, and the Europe-IUSTI and Brazil government guidelines made specific antimicrobial recommendations, including macrolides, quinolones and cephalosporins. CONCLUSION: Future clinical guidelines for sexually transmissible enteric infections require consistency and to improve their applicability, rigour of development, stakeholder involvement and recommendations for sexual health interventions, sexually transmitted infection testing, partner notification, handwashing and food handlers' advice and antimicrobial treatment.
Lara I, Hernandez-Ruiz V, Fernández-Huerta M
… +9 more, Rodriguez-Grande J, Arnaiz De Las Revillas F, Rodriguez-Lozano J, Calvo-Montes J, Ocampo-Sosa A, Fariñas MC, Roiz Mesones MP, Garcia-Fernandez S, Moure Z
Sex Transm Infect
· 2025 Nov · PMID 40081911
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OBJECTIVES: (MG) STIs represent a global concern, especially considering its rapid ability to acquire antimicrobial resistance. The objective of this study was to investigate the epidemiology of MG and antibiotic resist...OBJECTIVES: (MG) STIs represent a global concern, especially considering its rapid ability to acquire antimicrobial resistance. The objective of this study was to investigate the epidemiology of MG and antibiotic resistance among the general female and male populations in northern Spain. METHODS: Between April 2019 and May 2023, individuals attending healthcare facilities for STI screening were tested for MG and macrolide and fluoroquinolone resistance mutations. Phylogenetic analysis was conducted using single-locus sequence-based typing of the gene and complemented by dual-locus sequence-based typing combining the and MG309 genes. RESULTS: Of the 6350 people tested for MG during the study period, 5269 (83%) were women. Macrolide resistance mutations were identified in 25.4% of cases, with a higher prevalence in men (40% vs 17.14%) and coinfection with was found predominantly in women (18.6% vs 7.5%). Phylogenetic analysis revealed two distinct epidemiological clades strongly correlated with gender. Clade A predominantly involved men with higher rates of HIV and syphilis history and detection of resistance mutations, while clade B exclusively comprised women, with only one case of macrolide resistance. CONCLUSIONS: The predominance of women in STI screening requests reflects local trends in screening patterns and underscores the importance of understanding MG infection in women in our region. The clear separation of clades suggests two independent sexual networks, with clade A representing a high-risk population and dense connectivity. This research provides a foundation for future studies on the prevalence, transmission dynamics and impact of MG infection, particularly among the female population, where understanding remains limited.
Cyrus E, Turpin R, Dyer T
… +8 more, Hashemi E, Ali S, Bazo AC, Morgan-Lopez A, Scheidell JD, Leon SR, Sciaudone M, Altice FL
Sex Transm Infect
· 2025 Oct · PMID 40081910
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OBJECTIVES: Despite parallel global trends of increasing incarceration rates and sexually transmitted infections (STIs) among women, STI epidemiological data for this vulnerable at-risk population are limited. The study...OBJECTIVES: Despite parallel global trends of increasing incarceration rates and sexually transmitted infections (STIs) among women, STI epidemiological data for this vulnerable at-risk population are limited. The study objective was to characterise patterns of STI symptoms and explore covariates and drivers of indicating STI symptoms using syndemic theory among a population of incarcerated women in Peru. METHODS: In a cross-sectional study, a sample of 249 incarcerated women responded to a questionnaire on substance use, depression, sexual behaviour, STI symptoms and violence, among other variables, between May and July 2015 in Santa Manica Prison (Lima, Peru). Univariate and bivariate analyses informed a latent profile analysis (LPA) and logistic regression. RESULTS: Most women (93.5%) were Peruvian; 86.6% had prison sentences <5 years; the median age was 37 years (range 18-70 years); 2.6% were pregnant, 7.2% had children residing with them in prison; most women (78.7%) had a high school degree; >1/3 of the sample had ≥2 STI symptoms. The LPA analysis revealed that 39% of the sample had a 'syndemic' profile (co-occurrence of multiple STI symptoms, experiences of violence and substance use). Approximately 87% of women who were characterised by the syndemic profile were <50 years of age. The 'syndemic' profile was associated with double the prevalence of having multiple STI symptoms (≥2 symptoms: Prevalence Ratio (PR)=1.88 (95% CI 1.18, 2.99); ≥3 symptoms: PR=2.55 (95% CI 1.32, 4.93)). CONCLUSIONS: To address this syndemic, younger incarcerated women presenting with co-occurring STI symptoms (>2) can be clinically screened for diagnosis and treatment and assessed for substance use and risk of violence. Further research in this area may help stem and prevent deleterious health outcomes, including STIs, abuse and substance misuse, that can impact the individual and families.
Sex Transm Infect
· 2025 Aug · PMID 40050019
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OBJECTIVES: To examine the temporal trend and risk factors associated with lack of prenatal care and the association between lack of prenatal care and adverse outcomes in pregnancies complicated by syphilis. METHODS: We...OBJECTIVES: To examine the temporal trend and risk factors associated with lack of prenatal care and the association between lack of prenatal care and adverse outcomes in pregnancies complicated by syphilis. METHODS: We conducted a retrospective cohort study using US vital statistic data (2016-2022). We included non-anomalous, singleton live births delivered by pregnancies complicated by syphilis at 24-42 weeks of gestation in a hospital. The exposure variable was prenatal care (had care vs no care). We used Adequacy of Prenatal Care Utilization Index. Adverse outcomes were examined. The annual per cent change (APC) was calculated to assess the trend of lacking prenatal care. Multivariable Poisson regression models with robust error variance were used to examine the association. Adjusted relative risks (aRR) with 95% CIs were calculated. RESULTS: Among the study population of 38 583 live births, 2417 (6.3%) lacked prenatal care. The rate of lacking prenatal care increased over time (APC=11.4; 95% CI 4.7 to 18.5). Maternal education, insurance, nulliparity, prepregnancy body mass index, prior preterm birth, smoking, diabetes, hepatitis C and year of delivery were associated with lacking prenatal care. Compared with individuals with prenatal care, those without care were associated with a higher risk of preterm birth <37 weeks (aRR 2.57; 95% CI 2.40 to 2.74) and <34 weeks (aRR 3.56; 95% CI 3.13 to 4.05). Compared with patients with adequate care, those without care were associated with a higher risk of preterm birth <37 weeks (aRR 5.07; 95% CI 4.59 to 5.60) and <34 weeks (aRR 6.42; 95% CI 5.32 to 7.75). Similar associations were shown in other adverse outcomes. CONCLUSIONS: Among pregnancies complicated by syphilis in the USA, there was an upward trend in lack of prenatal care from 2016 to 2022. Modifiable factors of lacking prenatal care were identified. The risks of adverse outcomes were higher among individuals without prenatal care.
McHugh MP, Aburajab K, Maxwell A
… +9 more, Anderson J, Cairns F, Cotton S, Gough A, Malloy B, Mathers K, Renwick L, Shepherd J, Templeton KE
Sex Transm Infect
· 2025 Nov · PMID 40050018
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OBJECTIVES: Describe the clinical, phenotypic and genomic characteristics of ceftriaxone-resistant from Scotland. METHODS: Cases were identified in routine care from 2018 to 2024. Minimum inhibitory concentrations were...OBJECTIVES: Describe the clinical, phenotypic and genomic characteristics of ceftriaxone-resistant from Scotland. METHODS: Cases were identified in routine care from 2018 to 2024. Minimum inhibitory concentrations were determined for seven antimicrobial agents. Whole genome sequencing was performed with Illumina and Oxford Nanopore Technology instruments. A phylogeny containing global ceftriaxone-resistant genomes was generated with Parsnp. A collection of ST8780 genomes was also analysed to give further context using reference-based mapping with Snippy. RESULTS: There were five cases of ceftriaxone-resistant detected. One case (multilocus sequencing typing (MLST) ST1903) clustered within the FC428 lineage in a returning traveller from an Asia-Pacific country. Two cases belonged to the recently described extensively drug-resistant MLST ST16406, a returning traveller from an Asia-Pacific country and a sexual contact within Scotland. The final two cases were a resident of an Asia-Pacific country and a sexual contact within Scotland, both belonged to MLST ST8780. These were distinct from other publicly available ST8780 genomes, suggesting a novel introduction of the mosaic -60.001 allele. All cases were initially treated with ceftriaxone-based regimes, four returned for test of cure and showed clearance of infection. CONCLUSIONS: As ceftriaxone resistance is increasingly identified, multiple public health interventions are required to reduce the impact of resistance on gonorrhoea treatment globally.