Sexually Transmitted Infections

ObjectivesWe determined the frequency of sexually transmitted infection (STI) testing among people accessing sexual health services (SHS) in England. MethodsWe assessed STI testing frequency in face-to-face and online SHSs in England using data from the GUMCAD STI surveillance system. We quantified different combinations of tests (e.g. single chlamydia test or full STI screen), number of tests completed in 2024 and test positivity by sociodemographic and behavioural characteristics, as well as clinical setting and outcomes. ResultsOverall, there were 2,222,028 attendances at SHS in England in 2024 that involved tests for chlamydia, gonorrhoea, syphilis and/or HIV. Most of these attendances involved tests for all four of these STIs. Most people accessing SHS in England tested once (80.1%), and a small minority (1.9%) tested at least quarterly (4+ times). Some groups had a comparably larger proportion of quarterly testers; these included gay, bisexual, and other men who have sex with men (GBMSM) (6.7%), London residents (3.6%), online testers (2.5%), people using HIV-PrEP (13%), and people with 5+ partners in the previous 3 months (10.6%). Only 10.5% of GBMSM reporting higher-risk sexual behaviours tested quarterly despite recommendations for quarterly testing in this group. ConclusionsThe majority of those who tested for STIs in England in 2024 only tested once. The minority who tested at least quarterly had a higher proportion of GBMSM, people using HIV-PrEP, London residents and people reporting higher risk behaviours. Quarterly testing often appears to be aligned with current testing recommendations in England; however, we also observed that only a low proportion of behaviourally high-risk GBMSM and HIV-PrEP users are meeting these recommendations. It is important to acknowledge groups with lower or higher testing frequency when developing interventions and updating guidelines related to STI testing. WHAT IS ALREADY KNOWN ON THIS TOPICThe effectiveness of asymptomatic testing for chlamydia and gonorrhoea in gay, bisexual and other men who have sex with men (GBMSM), and the potential impact of the consequent increased antibiotic use on rising antimicrobial resistance and individual harm has recently been questioned. Testing and treatment remains a key pillar of STI prevention and management; despite this, there is limited evidence of STI testing frequency within sexual services (SHS) on a national level. WHAT THIS STUDY ADDSThis analysis shows that the majority of people attending SHSs in England in 2024 tested once, and only a small proportion of behaviourally high-risk people tested frequently. HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICYAwareness of groups that are behaviourally high risk but testing infrequently is important to guide interventions and messaging regarding STI testing. The low levels of frequent testing, even among those who would be recommended quarterly testing under UK guidelines, provides important context for wider discussion around asymptomatic STI screening.

Abstarct Chlamydia trachomatis (CT) is a sexually transmitted infection (STI). In 2020, an estimated 128.5 million new CT infections were reported among adults worldwide. The global prevalence was 4.0% in women and 2.5% in men. Young adults are the most frequently infected. This bacterial STI is often asymptomatic but can lead to serious complications, particularly in pregnant women. The objective of this study was to determine the prevalence and sociodemographic profile of CT infection in pregnant women living in resource-limited settings. Methods We conducted a cross-sectional study between June 2023 and december 2023 in a maternity ward located west of Kinshasa in an impoverished area with a low-income population. During the study period, we collected 239 cervical swab samples from pregnant women. CT DNA was extracted using the QIAamp DNA Mini Kit. Molecular diagnosis was performed by amplification of a 201 bp fragment of bacterial 16S rDNA from the cryptic plasmid. Results The age group most affected by CT in our cohort was 25 to 35 years (65.83%); married women were more represented than single women (83.22% versus 16.77%). The incidence of CT infection was 18%. The most common vaginal symptoms associated with the infection were vaginal itching and abnormal vaginal discharge, while the most common hypogastric symptom was chronic pelvic pain. Prematurity and spontaneous abortions were the most frequently observed pregnancy complications. Conclusion Chlamydia trachomatis (CT) infection is common among pregnant women living in poverty in Kinshasa. The infection particularly affects the most sexually active age group. It is associated with vaginal and hypogastric symptoms, as well as complications related to the progression of the pregnancy.

Background Vagina-stimulating products (VSPs) are widely used in sub-Saharan Africa for perceived sexual enhancement, hygiene, or cultural practices, yet their biological implications for cervical health remain poorly understood, particularly among adolescent girls and young women (AGYW). These practices occur within largely unregulated informal markets and intersect with gender norms, sexual negotiation, and reproductive health vulnerability among AGYW. We present baseline findings from a prospective cohort examining associations between VSP use, cervicovaginal abnormalities, and sexually transmitted infections (STIs). Methods Cross-sectional baseline data were analysed from 252 sexually active, HIV-negative participants enrolled in rural KwaZulu-Natal, including adolescents (n=188, 14-19 years) and adults (n=64, 25-35 years). Participants completed structured questionnaires and underwent clinical examination, STI testing, human papillomavirus (HPV) genotyping, vaginal pH assessment, and colposcopy. VSP use was categorised as intravaginal, ingested, or none. Age-stratified multivariable logistic regression models estimated statistical associations, adjusting a priori for age, hormonal contraceptive use, condom use, vaginal pH and lifetime number of sexual partners. Results VSP use was common among adolescents (68.1%) and adults (69.8%), with adolescents more likely to report intravaginal use and adults more likely to report ingested products. Among adolescents, VSP use was not statistically associated with cervicovaginal abnormalities after adjustment. However, exploratory analyses showed higher prevalence of Trichomonas vaginalis infection (p=0.021) and HPV-16 (p=0.007) among VSP users. Alum use was statistically associated with lower odds of visible cervicovaginal injury (OR 0.14; 95% CI 0.04-0.48), though this finding should be interpreted cautiously. Among adults, both intravaginal (aOR 3.7; 95% CI 1.2-11.8) and ingested (aOR 2.9; 95% CI 1.1-8.5) VSP use were statistically associated with cervical ectopy, while product-specific associations with individual products did not persist after adjustment. Conclusion VSP use is highly prevalent among AGYW, with distinct age-specific patterns. In this cross-sectional baseline analysis, VSP use was statistically associated with cervical ectopy among adults, while exploratory findings suggested associations with STI and HPV patterns among adolescents. These hypothesis-generating findings underscore the need for longitudinal and mechanistic studies to clarify biological pathways linking VSP use with infection risk, and highlight the potential importance of culturally responsive sexual health interventions and regulatory attention to informal vaginal product markets.

BackgroundDigital services for sexually transmitted and blood borne infection (STBBI) testing may influence demand in publicly funded health systems by enabling low barrier, self-directed access to testing, raising concerns about repeated use and sustainability. We examined longitudinal utilization of GetCheckedOnline, British Columbias digital STBBI testing service, to characterize testing trajectories and assess factors associated with higher intensity use. MethodsWe conducted a retrospective cohort study using GetCheckedOnline program data for users who created an account between April 2020 and November 2022, with 24 months of follow-up. We used group-based trajectory modelling to identify patterns of testing over time among (1) all users and (2) users with at least one test. Multilevel regression models with local health area random intercepts were used to examine associations between higher intensity trajectory membership, individual risk indicators, and geographic clustering. ResultsAmong 34,228 users, 22,542 (65.9%) completed at least one test and 42,451 tests were conducted (median 1; range 0-44). Two trajectories were identified in both analytic samples, with a minority demonstrating sustained higher intensity testing. The top 10% of users accounted for 39.6% of tests. Higher intensity trajectory membership was associated with sexual risk indicators including having multiple partners, condomless sex with multiple partners, and prior STBBI diagnosis. Geographic clustering across local health areas was modest in the null model (ICC 0.042) and attenuated with adjustment. ConclusionGetCheckedOnline utilization reflects a prevention-oriented pattern that appears more consistent with service needs than indiscriminate overuse. A small subset of users with elevated sexual risk account for higher-intensity testing. Findings support risk aligned stewardship including education and differentiated guidance, rather than universal restrictions to reducing testing volumes. Author SummaryDigital services are being used to make testing for sexually transmitted and blood borne infections (STBBIs) easier to access. Some health systems decision makers worry that online testing could lead to too much testing and higher costs. We examined how people used GetCheckedOnline, British Columbias public online STBBI testing service, over two years. Most people used the service only once or tested occasionally (less than once in six months). A smaller group tested more often. People who tested more often were also more likely to report higher sexual health risk, such as having multiple partners or a recent STBBI diagnosis. This suggests that repeat testing is often done by people who may benefit from testing more often, rather than people testing without need. For health systems, this means it may be more helpful to give clear guidance and education about when to test instead of placing broad limits on access to online testing.

Introduction : The World Health Organization (WHO) recommends testing for sexually transmitted infections (STIs), but laboratory-based and rapid or point-of-care (POC) testing are often unavailable and unaffordable, especially in low-resource settings, leading to empiric (usually antibiotic) treatment. Community pharmacies (CPs) are often the first point of contact for persons with symptoms of STIs, where pharmacists dispense treatment without diagnostic testing or prescriptions. This study evaluated clients, providers, and policymakers perspectives on POC testing for STIs in CPs for targeted treatment. Methods : We nested a qualitative study into a study of participants seeking both STI and non-STI treatments in CPs. They were tested for HIV, syphilis, trichomonas, chlamydia, and gonorrhea using both rapid POC tests and a central reference lab. A purposive sample of 50 participants from September 2020 to June 2022 consented to participate in in-depth and key informant interviews. Data were analyzed thematically using an inductive approach. Results: Clients (n=35), health care providers (n=9), and policy makers (n=6) highlighted the benefits of POC tests for HIV and STIs at CPs, including affordability, accessibility, and ensuring convenience. The impact of POC testing for STI diagnosis and treatment was promoting behavioral change, rapid results turnaround time, leading to faster treatment access compared to conventional laboratory methods, and supporting sustainable antimicrobial resistance (AMR) control. Barriers to POC testing included a lack of awareness among clients and health workers, inadequate privacy and space, long wait times, unclear self-sample collection instructions, stigma around HIV testing, and reluctance to test for STIs beyond HIV. To address these, participant recommendations included raising STI awareness, providing more explanation of test results, increasing test access, addressing stigma, provider training, and ensuring a sustainable supply chain for testing kits. Conclusions : POC testing for STIs and HIV in CP settings was found to be highly acceptable to both pharmacy clients and providers. Integrating POC testing in CPs could be beneficial for national STI management programs. If the existing barriers are addressed, POC tests could improve accessibility to STI diagnostics and facilitate better linkage to care.

ObjectivesTo evaluate whether on-site molecular point-of-care testing (POCT) for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) is associated with reduced antibiotic overtreatment for presumed sexually transmitted infections (STIs) among adults living with HIV in rural Uganda. MethodsWe conducted a single-site quasi-experimental pre-post intervention study at Kumi Hospital, comparing syndromic management (April-August 2024) with CT/NG POCT-guided management (September 2024-January 2025). Adults living with HIV presenting with symptoms suggestive of an STI were included. Overtreatment in the pre-intervention phase was estimated by comparing antibiotic prescribing with the expected number of CT/NG infections based on positivity observed during the intervention phase. ResultsA total of 404 participants were included (203 pre-intervention, 201 intervention). During the intervention phase, CT and/or NG were detected in 14 individuals (7.0%). Median test turnaround time was 95 minutes, enabling same-day treatment in 93% of positive cases. Antibiotic prescribing decreased from 99.0% to 11.4% following POCT implementation (P < 0.001), corresponding to an absolute reduction of 87.6 percentage points. Estimated overtreatment declined from 30.0% to 5.0% for NG and from 74.9% to 6.0% for CT (both P < 0.001). ConclusionsImplementation of CT/NG POCT in routine HIV care was associated with a marked reduction in antibiotic prescribing and estimated overtreatment for presumed STIs. These findings support the potential of POCT-guided, aetiology-based STI management to reduce unnecessary antimicrobial exposure in settings where syndromic management remains standard practice.

Syphilis is a sexually transmitted and bloodborne infection caused by Treponema pallidum spp. pallidum. Given the paucity of data on syphilis in Kenyan sex workers and gay, bisexual, and other men who have sex with men (GBMSM), we conducted a retrospective study of syphilis seropositivity in female sex workers (FSW) and GBMSM in Nairobi, Kenya. Seropositivity testing of cryopreserved plasma samples showed that 11.1% (72/647) were positive. Syphilis seropositivity was associated with HIV status, and FSWs were disproportionately represented in the seropositive group (66/72, 92%). Here, we report a higher seropositive rate than in previous studies in Kenya, and ongoing community and surveillance supports are important for addressing the ongoing public health impacts of syphilis.

In the United States, gay, bisexual, and other men who have sex with men (MSM) experience a disproportionate burden of sexually transmitted infections (STIs), with notable racial/ethnic disparities. Doxycycline post-exposure prophylaxis (doxy-PEP) has emerged as a promising strategy to prevent bacterial STIs. This study analyzed 2023 National HIV Behavioral Surveillance data to examine doxy-PEP awareness, use, and intent to use among MSM in New York City (NYC), in a predominantly Hispanic/Latino sample. Among 134 participants, awareness and prior use were low (38.8% and 9.0%, respectively), but intent to use was high (75.4%). In Poisson regression models, intent was higher among participants reporting non-injection drug use and 2-10 partners in the past 12 months, while marginally lower among those above the Federal Poverty Level and recent migrants. Findings suggest doxy-PEP is acceptable for MSM in NYC, but addressing barriers among low-income groups and recent migrants is critical to reducing disparities.

BackgroundLiterature on sexual assault prevalence among homeless women is limited, with few studies disaggregating risk by geography, resource access, mental health, LGBTQ status, or disability. ObjectiveThis study provides two distinct meta-analyses to ascertain the aggregated overall prevalence (k=20 studies) and the aggregated 12-month prevalence (k=14 studies) of sexual assault among homeless women. By examining each recall period independently, we elucidate cumulative burden throughout the life cycle and annual risk, offering unique insights for public health interventions. By synthesizing global data, we aimed to clarify risks for women with disabilities, mental illness, or Lesbian, Gay, Bisexual, Transgender, Queer or Questioning, Plus (LGBTQ+) identities to inform crisis care interventions. MethodsFollowing PRISMA 2020 guidelines, six databases were searched for studies published after 2010 reporting sexual assault prevalence in homeless women. Twenty studies met the inclusion criteria. Random-effects meta-analyses were performed using a logit transformation. Heterogeneity was assessed with I{superscript 2} and Cochrans Q; publication bias with funnel plots and Eggers test. ResultsThe pooled lifetime prevalence of sexual assault was 39.2 % (95 % CI 25-56 %), and 12-month prevalence was 22 % (95 % CI 16-30 %). Heterogeneity was extreme (I{superscript 2} = 97 %). Subgroup analyses showed the highest prevalence among women with disabilities (92 %, single study), followed by LGBTQ+ (33 %) and women with mental illness (34 %). HIV-positive women had the lowest prevalence (2.6 %). Eggers test indicated no publication bias (p = 0.64). ConclusionHomeless women face disproportionately high rates of sexual assault, far exceeding the general female population, with particularly elevated estimates among women with disabilities, LGBTQ+ women, and those with mental illness. These preliminary findings highlight the need for improved screening practices and tailored public health interventions to address sexual assault in doubly vulnerable populations. Standardizing definitions of sexual assault and investigating risk factors could lead to more tailored public health interventions. HighlightsO_LIMarked Epidemiologic Burden: Nearly 40% of homeless women report lifetime sexual assault. C_LIO_LIPersistent risk: One in five homeless women assaulted within the past 12 months. C_LIO_LIMarginalized Impact: Rates highest among disabled, LGBTQ+, and HIV+ women. C_LIO_LIHigh Variability: Extreme heterogeneity (I{superscript 2} {approx} 97%) shows research inconsistency. C_LIO_LIResearch Priority: Standardize methods and definitions to improve accuracy. C_LI

BackgroundIn 2022, the yearly rate of congenital syphilis (CS) cases in California reached its highest point since 1950. We explored how different prevention strategies in California could impact future CS case incidence. MethodsScenario modeling was used to project CS incidence from 2025 through 2030 based on 2015-2024 surveillance data. We compared a baseline scenario with scenarios that modeled 1) changes in the rate of annual female syphilis cases; and 2) changes in the proportion of pregnant persons adequately treated for syphilis. We then used 2016-2023 hospitalization discharge data from California to estimate charges associated with treatment of a CS case. ResultsA 5-50% reduction in the absolute rate of female syphilis cases led to a 3-30% decrease in cumulative CS cases during the projection period. Increasing the proportion of pregnant persons adequately treated for syphilis by 5-50% led to a 2-23% decrease; combining both scenarios resulted in a 4-45% reduction. In the baseline scenario, projected CS treatment-associated hospitalization charges were estimated to total $399 million. A 45% reduction in CS cases resulting from the combined interventions would reduce charges by $158 million. DiscussionFemale syphilis incidence and adequate treatment during pregnancy have substantial impact on CS case incidence and associated charges. California has implemented universal syphilis screening guidelines for all people aged 15-49 years alongside interventions supporting testing and treatment of pregnant persons. Continued implementation of these interventions will result in considerable savings around CS treatment and reduced need for management of long-term sequelae.

BackgroundRisky sexual practices contribute significantly to the transmission of sexually transmitted infections (STIs) and HIV/AIDS. Taxi and three-wheeled vehicle drivers may be particularly vulnerable due to occupational mobility and related lifestyle factors. However, evidence on this population in Ethiopia remains limited. MethodsA community-based cross-sectional study was conducted among taxi and three-wheeled vehicle drivers in Arba Minch town, Ethiopia, from July 26 to August 26, 2025. Participants were selected using a simple random sampling technique. Data were collected using an interviewer-administered questionnaire through the Kobo Toolbox mobile application. Data were exported to SPSS version 27 for cleaning and analysis. Binary logistic regression analysis was performed to identify factors associated with current risky sexual practices. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were used, and statistical significance was declared at p < 0.05. ResultsA total of 640 drivers participated in the study (response rate: 97.6%). The prevalence of lifetime risky sexual practices was 46.9% (95% CI: 43.0%-50.8%), while the prevalence of current risky sexual practices was 37.2% (95% CI: 33.4%-41.1%). Factors independently associated with current risky sexual practices included living alone (AOR = 3.01; 95% CI: 2.03-4.45), not discussing sexual and reproductive health issues (AOR = 2.09; 95% CI: 1.17-3.75), substance use (AOR = 1.69; 95% CI: 1.10-2.61), attending nightclubs (AOR = 2.04; 95% CI: 1.41-2.96), and exposure to pornographic materials (AOR = 2.19; 95% CI: 1.49-3.23). ConclusionA substantial proportion of taxi and three-wheeled vehicle drivers reported engaging in risky sexual practices, indicating a significant and overlooked public health concern within this occupational group. These practices were independently associated with modifiable behavioral and lifestyle factors, including substance use, nightlife attendance, and inadequate communication on sexual and reproductive health issues. The findings underscore the urgent need for innovative, multi-sectoral interventions that extend beyond conventional health service delivery. Integrating basic sexual and reproductive health education and risk-reduction messaging into driver licensing and refresher training programs may provide a feasible and scalable opportunity to reach this mobile and high-risk population. Such integration, in collaboration with transport authorities and public health sectors, has the potential to improve awareness, promote safer behaviors, and reduce vulnerability to risky sexual practices among drivers.

Background: Sexual and gender minorities (SGM), including men who have sex with men (MSM) and transgender women, often face stigma, legal constraints, and limited access to sexual and reproductive health services. These conditions restrict prevention and care, increasing vulnerability to HIV and human papillomavirus (HPV) infections. While strong HIV-HPV interaction is documented in high-income settings, evidence from low- and middle-income countries remains limited. This study examines the burden, co-infection dynamics, and progression of HPV infection and anal dysplasia among MSM and transgender women in Pakistan. Methods: A cross-sectional study was conducted between September 2015 and October 2016 among men who have sex with men (MSM) and transgender women recruited from sexual health and antiretroviral therapy centers in Karachi. Eligible participants were aged [&ge;]18 years and self-reported anal sex within the past 6 months (N=298). Two anal specimens were collected for HPV DNA detection and genotyping using PCR, and anal squamous intraepithelial lesions (ASIL) were assessed cytologically using the Bethesda classification. Associations were estimated using Cox proportional hazards regression algorithms to derive prevalence ratios (PRs). Results: Among participants, 44% (n=133) were living with HIV. Overall HPV prevalence was 65.1%, rising to 87% among HIV-positive individuals compared to 48% among those without HIV ({chi}{superscript 2}p[&le;]0.001). Likewise 28.9% of participants living with HIV were infected with two or more than two types of HPV as compared with 18.8% participants without HIV ({chi}{superscript 2}p[&le;]0.001). HIV infection was strongly associated with HPV acquisition (adjusted PR 2.81, 95% CI 2.16-3.82). Among HPV-positive participants (n=194), 58.8% were co-infected with HIV. High-risk HPV was highly prevalent among those living with HIV (83.2% vs. 35.3% ({chi}{superscript 2}p[&le;]0.001)), with HPV16 as the dominant oncogenic type. Multiple HPV infections were more common among HIV-positive individuals ({chi}{superscript 2}p[&le;]0.001), and HIV seropositivity was 3.43 (95% CI: 2.55-3.51) times higher among those with high-risk HPV. Co-infected participants demonstrated prolonged smoking, longer duration of sex work, high-intensity sex work with limited condom negotiation, and higher prevalence of anal warts (all p<0.05). Anal dysplasia (ASIL) was present in 35% of participants and was higher among HIV-positive individuals (42.4% vs. 28.1%, p<0.001). HIV-HPV co-infection was independently associated with ASIL (adjusted PR 1.75, 95% CI 1.07-2.88), while high-risk HPV further amplified this risk (PR 3.04, 95% CI 1.75-5.26). Conclusion: These findings demonstrate a biological continuum in HIV-positive MSM and transgender women, where HIV increases HPV acquisition, persistence, and multiplicity, accelerating progression to anal dysplasia. This reflects a syndemic shaped by biological interaction and structural vulnerability. Integrating HPV screening and vaccination within HIV services is essential to interrupt progression to cancer in this high-risk population.

Indigenous and nomadic communities worldwide face disproportionate and persistent barriers to reproductive health services, including family planning and safe abortion. The Raute of Nepal -- one of the country's last nomadic hunter-gatherer groups represent a uniquely marginalized population for whom no prior population-level quantitative reproductive health data exist. This gap prevents health authorities and program implementers from designing evidence-based, culturally appropriate interventions for this community. This census-based cross-sectional study enrolled all 192 eligible married women of reproductive age in the Raute community of Parshuram Municipality, Dadeldhura district, Sudurpaschim Province, Nepal. Data were collected through structured, pre-tested, face-to-face interviews, and analyzed using descriptive statistics, chi-square tests, and binary logistic regression in IBM SPSS version 16. More than half of participants (53.6%) currently used family planning, with injectable contraceptives being the most common method (42.7%), followed by female sterilization (33.0%) and implants (24.3%). Condom use was negligible at 1.0%. Among non-users (46.4%), 97.7% cited lack of interest as the primary reason for non-use. Knowledge of safe abortion services was reported by 61.5% of women, yet only 8.3% had ever accessed such services, and awareness of Nepal's national safe abortion policy, which has been in effect since 2002 was critically low at 10.4%. In bivariate analysis, no socio-demographic or socioeconomic variable was significantly associated with family planning use. The sole significant independent predictor of current family planning utilization in the adjusted logistic regression model was non-utilization of safe abortion services (adjusted odds ratio = 4.275; 95% confidence interval: 1.145-15.954; p = 0.030), suggesting that contraceptive use and abortion service use represent alternative reproductive management strategies in this community. Younger age ([&le;]30 years) and urban residence were significantly associated with safe abortion use in bivariate analysis but were attenuated after adjustment, reflecting limited statistical power arising from the small number of outcome events (n = 16). These findings reveal critical gaps in reproductive method diversity, safe abortion policy literacy, and male partner engagement. Community-based mobile outreach tailored to nomadic movement patterns, targeted legal literacy programs in the local language, and structured male involvement strategies are urgently required to improve reproductive health equity in this vulnerable indigenous population.

BackgroundSince September 2024, France has implemented a national reform allowing prescription-free access (PFA) to sexually transmitted infection (STI) screening in medical biological laboratories (MBLs). This study aims to characterize the populations undergoing STI testing according to their access modality and evaluate the probability of test positivity in relation to testing pathway, sex, and age groups. MethodsWe conducted a cross-sectional analysis of all individuals screened for Chlamydia trachomatis, Gonorrhoea, human immunodeficiency virus (HIV), hepatitis B virus (HBV), and syphilis by treponemal-specific immunoassay (TSI) in Cerballiance MBLs between Mars 2025 and February 2026. Multivariable logistic regression models stratified by sex and adjusted for age and region assessed associations between screening modality and STI positivity. ResultsAmong 1,008,737 individuals included, 27.8% were under PFA and 72.2 under prescription-based access (PBA). PFA users were more frequently male (47.4% vs. 36.3%, p<0.001) and aged 20-39 years (34.0%, p<0.001). Overall positivity rates differed by modality: PFA was associated with higher detection of Chlamydia (4.6% vs. 3.6%). PBA group showed more positive cases of syphilis (3.4% vs. 1.2%), HBV (1.3% vs. 0.4%), and HIV infections (0.3% vs. 0.2%, all p<0.001). Co-infection and gonorrhoea proportions did not significantly differ between modalities. ConclusionsPFA substantially increased STI screening uptake, particularly among young adults and men, and enhanced detection of bacterial STIs. PBA remains essential for diagnosing viral and chronic infections. These findings highlight the complementary roles of both access strategies and support PFA screening as an effective public health intervention to broaden STI detection and reduce transmission.

There are several barriers to uptake of intrauterine devices (IUDs), with the fear of pain during insertion an emerging concern. Using data from an online survey, we sought to understand the experience of women who had undergone IUD insertion, with a particular focus on their expectation compared with their reported experience of pain. We found that, while most participants expected a moderate level of pain at insertion, many reported a high level of pain. Pain relief offered was variable, and, aside from that administered by an anaesthetist, no single method appeared to significantly reduce reported pain.

BackgroundSexually transmitted infections (STIs) pose major risks in pregnancy, including stillbirth, preterm delivery, and congenital infections. Globally, pooled antenatal prevalence estimates are HIV 2.9%, HBV 4.8%, HCV 1.0%, and syphilis 0.8%, but burdens are higher in low-income countries, reaching HIV 5.2%, HBV 6.6%, HCV 2.7%, and syphilis 3.3% (). In Ghana, reported rates are variable: HBV 4-10%, HCV 0.8-12%, HIV 1-3%, and syphilis 0.4- 3.6%. Despite a national policy mandating integrated antenatal screening, evidence on the prevalence and co-infection patterns among pregnant women remains fragmented. This study aimed to determine the prevalence of HIV, HBV, HCV, and syphilis, co-infections, and associated determinants among Ghanaian pregnant women. MethodsA cross-sectional study was conducted using secondary data from 1,316 pregnant women attending antenatal care across four municipalities in Ghana (2023-2024). Prevalence, co-infection patterns, and risk factors were assessed using descriptive statistics, logistic regression, and kappa agreement tests. ResultsThe median age of participants was 28 years (IQR: 23-33). Syphilis was most prevalent (10.5%), followed by HBV (4.0%), HIV (2.5%), and HCV (1.9%). Marked geographic disparities were observed, with syphilis prevalence ranging from 0.8% in Afigya Kwabre to 38.9% in Cape Coast. Co-infections were common: 26.6% of HBV-positive women also had syphilis ({kappa} = 0.348, p < 0.001), and 16.6% of HIV-positive women had syphilis ({kappa} = 0.237, p < 0.001). Predictors of syphilis included urban residence (aOR: 4.79; 95% CI: 2.99- 7.69), multiparity (aOR: 3.08; 95% CI: 1.92-4.96), and early gestational age. ConclusionThe high burden of syphilis and frequent co-infections among Ghanaian pregnant women reveal critical gaps in implementing integrated antenatal screening. Despite national policy mandates, inconsistent practice leaves mothers and infants vulnerable to preventable complications. Strengthening compliance with comprehensive STI screening while tailoring interventions to high-risk groups is essential to reducing adverse maternal and neonatal outcomes.

Methicillin-resistant Staphylococcus (MRS) infections are a significant public health concern. Anterior nares serve as a major reservoir and source of spread of MRS ssp. People living with HIV (PLWHIV) tend to be at higher risk of colonisation with MRS organisms due to frequent healthcare exposure. We assessed the prevalence of MRS nasal carriage and associated factors among PLWHIV at the HIV clinic of Kiruddu National Referral Hospital, Kampala, Uganda, from May to July 2024. Nasal swabs from 256 PLWHIV were cultured, and microbiological isolation was performed at MBN Clinical Laboratories. Prevalence was calculated as proportions, and logistic regression identified associations with clinical and socio-demographic factors (p < 0.05). Of 256 participants, 163 (63.7%) carried Staphylococcus, with 82 (32%) identified as MRS carriers (8.9% MRSA, 23% MRCoNS). Frequent hospital visits ([&ge;]3) (adjusted incidence risk ratio [A-IRR] = 1.18 x 107, p < 0.001), second-line antiretroviral therapy (ART) (A-IRR = 3.82, p = 0.041), and unsuppressed viral load (>1000 copies/mL) (adjusted odds ratio [AOR] = 11.3, 95% CI: 2.11-60.58, p = 0.005) were significantly associated with MRS carriage. Mask-wearing was protective against MRCoNS (A-IRR = 1.66, 95% CI: 1.06-2.58, p = 0.026). MRS isolates exhibited high resistance to erythromycin (81.7%) and trimethoprim-sulfamethoxazole (79.3%), but susceptibility to linezolid (93.9%). MRS nasal carriage is prevalent among PLWHIV. Individuals with frequent health care contact and those on second-line ART regimens are more susceptible to MRS colonization, while individuals who wear face masks and those with an undetectable HIV viral load are less susceptible. Antimicrobial Resistance (AMR) surveillance within HIV programs, enhanced infection control, ART adherence, and targeted screening for high-risk groups are critical to mitigate colonization.

Background: Vasectomy remains one of the most underutilized contraceptive methods in Uganda, with a prevalence of only 0.2% despite its safety, effectiveness, and potential contribution to fertility reduction. Understanding the factors influencing awareness, knowledge, and attitudes toward vasectomy acceptance is crucial for developing effective promotion strategies in the Ugandan context. Methods: A cross-sectional study was conducted among 617 men aged 20-60 years, selected through simple random sampling of participants attending Kapchorwa General Hospital. Data were collected using a structured questionnaire. Results: Knowledge scores showed a negative association with age ({beta} = -0.044, p < 0.001) and varied significantly by marital status, with married participants demonstrating higher knowledge than single ({beta} = -0.624, p < 0.001) and widowed ({beta} = -0.950, p < 0.001) individuals. Counterintuitively, higher knowledge was associated with more negative attitudes ({beta} = -1.729, p < 0.001). Age demonstrated the strongest negative effect on attitudes ({beta} = -0.249, p < 0.001), and 99.9% of participants believed contraception is primarily women's responsibility. Behavioral data revealed that 75.0% desired more children, with 51.2% preferring a family size of 3-4 as the ideal. Conclusion: The study shows a disconnect between knowledge, attitudes, and behaviors regarding vasectomy. While general awareness is high, deep-seated misconceptions, cultural norms around masculinity and contraceptive responsibility, and fertility preferences present significant barriers to acceptance.

Background Fertility rates in Australia have been declining over recent decades, reaching a record low total fertility rate of 1.48 births per woman in 2024. Concurrently, vasectomy remains widely accessible and increasingly normalised as a permanent contraceptive option. Despite extensive commentary on falling birth rates, no contemporary Australian study has examined vasectomy rates relative to birth rates over time. We aimed to compare population level vasectomy and birth rates across Australian jurisdictions and age groups. Study design Nationwide retrospective time-series study. Retrospective population-based study using Medicare Benefits Schedule item 37623 to identify vasectomy procedures performed between July 2015 and December 2024. Rates were calculated per 100,000 male population using quarterly Australian Bureau of Statistics (ABS) population estimates and summarised as rolling 12-month averages. Birth rates were derived using matched ABS data for women across equivalent age strata (18-24, 25-34, 35-44 years). Results: Vasectomy rates increased nationally from 32 per 100,000 in 2016 to 55 per 100,000 in 2023 before declining modestly in 2024. Birth rates declined from 5,200 to 3,800 per 100,000 over the same period. Trends were consistent across states and age groups, with the greatest vasectomy uptake in men aged 35-44 years. Conclusion: Australia is undergoing a demographic shift characterised by rising vasectomy uptake and declining fertility. While vasectomy rates remain lower than birth rates, their convergence signals changing reproductive intentions and contraceptive behaviours. Ongoing monitoring of permanent and long-acting contraception is essential to understand evolving population dynamics and inform reproductive health policy.

Understanding the immune response against HIV-1 and the natural resistance exhibited by HIV-exposed Seronegative Individuals (HESN) offers the possibility of proposing new control strategies. Several studies suggest an important role of HLA and KIR genes in protecting against HIV-1 infection. Moreover, there is an important gap in the knowledge of these genetic factors in seronegative Latin American men who have sex with men (MSM), a population largely underrepresented in HIV immunogenetic studies. This study aimed to identify HLA and KIR genetic profile associated with potential resistance to HIV-1 acquisition, in a cross-sectional study including a cohort of 60 HIV-1-seronegative Colombian MSM at low and high risk of HIV-1 infection. The high-risk group showed a higher frequency of the HLA-B*18 allele, and a lower frequency of the HLA*B35, which have been previously associated with protection and susceptibility to HIV-1 infection respectively. Likewise, the high-risk group exhibited a low frequency of Bx haplotypes, a higher frequency of one AA haplotype and differences in KIR gene profile, with a low frequency of the inhibitory KIR2DL5 and both activating KIR2DS1, KIR2DS2 and KIR2DS5 genes. These findings suggest that host immunogenetic factors may contribute to resistance to HIV-1 acquisition in highly exposed individuals.