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.

BackgroundAustralia is experiencing its worst syphilis epidemic in decades, driven by two distinct outbreaks -- a heterosexual epidemic disproportionately affecting Aboriginal and Torres Strait Islander communities in northern Australia, and a predominantly MSM-associated epidemic in urban centres. We examined the spatial dynamics of this dual epidemic, including geographic clustering, service accessibility associations, and COVID-19 impacts. MethodsWe analysed publicly available aggregate surveillance data (2013-2024). Spatial autocorrelation (Global/Local Morans I, Getis-Ord Gi*), spatial regression (OLS, spatial lag, spatial error), and geographically weighted regression (GWR) were applied to 74-75 Victorian local government areas (LGAs). Congenital syphilis vulnerability was mapped at SA3 level using composite proxy scoring. COVID-19 impact was assessed using interrupted time series (ITS) analysis. ResultsNational notifications rose 3.5-fold from 1,719 (2013) to 6,036 (2022). Strong spatial clustering was identified (Morans I=0.560, p<0.001), with 11 high-high clusters in inner Melbourne. The spatial lag model identified distance to sexual health clinic (coefficient: -0.225, p=0.050) and Indigenous population proportion (coefficient: 0.210, p=0.045) as significant predictors. Eleven SA3 areas were classified as high vulnerability for congenital syphilis, predominantly in remote northern Australia. Monthly NSW ITS found a non-significant 6% reduction in notifications during COVID restrictions (IRR=0.94, p=0.123). Comparing the COVID period (2020-2021) with pre-COVID means, remote area notifications increased 91% and female notifications increased 108% compared with 45% for males, reflecting the steep underlying epidemic trajectory. ConclusionsAustralias syphilis epidemic exhibits distinct spatial patterns shaped by service accessibility and sociodemographic factors. The concentration of high-vulnerability areas in remote northern Australia highlights the need for targeted service expansion, point-of-care testing, and culturally appropriate outreach. The acceleration of heterosexual transmission signals increasing congenital syphilis risk requiring urgent antenatal screening strengthening.

Background Digital 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. Methods We 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. Results Among 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. Conclusion GetCheckedOnline 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.

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.

ObjectivesThis study aimed to estimate the prevalence of antibiotic post-exposure prophylaxis (STI PEP) use among gay, bisexual and other men who have sex with men (GBMSM) in England, and to identify demographic and behavioural factors associated with STI PEP use among early adopters. MethodsWe synthesised individual-level data from nine surveys conducted between 2019 and 2024. To harmonise variables that differed subtly across surveys, we generated composite indicators for STI diagnosis, chemsex, and condomless sex. Multiple imputation was used to address partial missingness; participants missing core sociodemographic data were excluded. The primary outcome was self-reported STI PEP use. We calculated the prevalence of use in each survey and assessed associations using mixed-effects logistic regression. Composite variables were included as random effects if they were found to have an interaction with survey. ResultsAcross nine surveys with 14,142 participants, STI PEP use prevalence ranged from 3.61% (95% confidence interval (CI): 2.78-4.68%) in RiiSH 2020 to 13.05% (11.85-14.36%) in RiiSH 2024. Use was higher among those aged 40-44 (adjusted odds ratio (aOR) = 1.26; 95% CI: 1.00-1.58) and lower in those under 25 (aOR = 0.56; 0.39-0.82) or over 65 (aOR = 0.64; 0.41-0.99), compared to ages 30-34. Transgender women (aOR = 3.87; 1.75-8.50), Black (aOR = 1.85; 1.34-2.56) and Asian (aOR = 1.43; 1.09-1.88) individuals, and people living with HIV (aOR = 3.40; 2.69-4.31) had higher odds of use, compared with cisgender male, White, and HIV negative individuals, respectively. Chemsex (aOR = 2.15; 1.80-2.56), condomless sex (aOR = 1.59; 1.32-1.92), and recent STI diagnosis (aOR = 1.83; 1.34-2.51) were also associated with use. ConclusionSTI PEP use was more common among those practising behaviours associated with higher STI risk. However, participation and sampling biases limit finding generalisability, particularly to underrepresented groups such as women, ethinic minorities and heterosexuals. This analysis will provide a baseline from which to estimate the impact of the recommendation of doxycycline for STI post-exposure prophylaxis in the UK.

ObjectiveCongenital syphilis remains a preventable cause of fetal and neonatal morbidity and mortality, despite the availability of inexpensive diagnostics and effective treatment. We aimed to evaluate the maternal and congenital syphilis burden at the Instituto Nacional Materno Perinatal, Perus national referral center for maternal and perinatal care. MethodsWe conducted a retrospective analysis of aggregated, de-identified surveillance data from January 2023 to December 2025. Maternal prevalence and congenital syphilis incidence were calculated and compared with World Health Organization (WHO) elimination benchmarks. FindingsAmong 59,568 pregnant women screened, maternal syphilis prevalence ranged between 1{middle dot}0% and 1{middle dot}2% of all women screened. Across 36,094 live births, congenital syphilis incidence ranged between 191 and 259 per 100,000 live births, consistently exceeding the WHO target of 50 per 100,000 live births. More than half of maternal infections were diagnosed at outside facilities before referral. Reported treatment coverage exceeded 90% among mothers and 100% among infants in all years. ConclusionThe prevalence of congenital syphilis exceeded WHO elimination benchmarks despite stable maternal prevalence, highlighting gaps in timely diagnosis and linkage between diagnosis and treatment.

Objectives: To 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. Methods: We 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. Results: A 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). Conclusions: Implementation 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.

High-risk sexual behaviour has been shown to be influenced by interpersonal, social, and economic factors in different situations and been linked to food insecurity. This study therefore investigated the individual, household and community factors associated with high-risk sexual behaviour among women age 18-49 in Zambia, paying particular attention to food insecurity status. It was anchored on the Socio-Ecological Model and used a cross-sectional non-intervention study design. We fitted survey weighted logistic regression models based on 1784 weighted cases to examine the association between food insecurity and high-risk sexual behaviour and determine the predictors of high-risk sexual behaviour. The results show that 44 percent of the women engaged in of high-risk sexual. We found that 53.9 ({+/-}6.3) percent of the women age 18-49 experienced moderate to severe food insecurity while 21.2 ({+/-}2.9) percent experienced severe food insecurity. Food insecurity is associated with high-risk sexual behaviour before controlling for other covariates. Our results show that women with higher education [aOR= 0.471 95%CI 0.254,0.872], women who were married [aOR= 0.123 95%CI 0.065, 0.231], women whose most recent pregnancy was intended [aOR= 0.482 95%CI 0.328, 0.709], women in the rich wealth tertile [aOR= 0.372 95%CI 0.188, 0.736] and women in rural areas[aOR= 0.425 95%CI 0.239, 0.758] had lower odds of engaging in high-risk sexual behaviour. Our findings confirm that high-risk sexual behaviour is influenced by factors beyond the individual level. Thus, HIV prevention response should be holistic in nature. Greater attention should be paid to adolescent girls to reduce high-risk sexual behaviour and avert possible consequences. Improving the social-economic status of women through education and economic empowerment among other interventions, will advertently reduce vulnerability to HIV infection, unintended pregnancy, improve the health and well-being of women and ensure that women are not left behind.

BackgroundBetween May and December 2022, the UK Health Security Agency reported 3,585 cases of mpox. The 2022 global outbreak was characterised by transmission predominantly within sexual networks of gay and bisexual men (GBMSM). UK public health responses included information and vaccination campaigns, supported by behaviour change among GBMSM. We describe community reflections on the UK mpox outbreak and the responses to it. MethodsBetween August 2023 and April 2024, we conducted five focus groups with participants (n=27) recruited through community organisations in London and Manchester. Participants were predominantly gay men from ethnically diverse backgrounds. Data were analysed thematically. ResultsComing soon after COVID-19, the mpox outbreak intensified fears of returning to lockdown. Reports of GBMSM being most affected, and its framing in the media as a gay disease, coupled with warnings within GBMSM networks echoed earlier experiences of HIV. Those who had acquired mpox reported that media coverage had intensified their experiences of stigma and discrimination. Participants perceived vaccine roll out as inequitable; Furthermore, the perceived sudden cessation of public health messaging and advice left participants uncertain about ongoing risk and the need for prevention. ConclusionsParticipant reflections two years after the 2022 mpox outbreak demonstrate how previous pandemics shape emotional responses to new outbreaks. Key challenges included stigmatising media coverage, inequitable vaccine rollout, and sudden discontinuation of public health messaging. These findings highlight the importance of targeted, non-stigmatising and unambiguous communication from trusted sources during and after an outbreak. What is already known on this topicThe media response to the 2022 UK mpox outbreak led to stigma among GBMSM and public health measures were not equitably accessible What this study addsPeople from communities affected by the outbreak sought timely information from trusted sources. Communication needs do not end with outbreaks How this study might affect research, practice or policyThere is a need for ongoing public health work to build trusted networks who can maintain inter-outbreak communications and respond rapidly to outbreaks

Remote consultations, including telephone, video, text or web-based consultations, are now common in sexual and reproductive health services (SRHS) in England and Wales, offering convenience and efficiency but raising concerns about safeguarding service users compared to in-person care. Ensuring protection and support for individuals remain central to SRHS. While guidance exists, evidence on how safeguarding is enacted remotely is limited. This study explores how safeguarding is managed in remote SRHS, examining associated challenges, benefits, and perceptions of acceptability. This qualitative study, part of the CONNECT study (NIHR153151), explored safeguarding in remote delivery of SRHS across three diverse case study areas in England and Wales. Semi-structured interviews were conducted with service users and providers (March 2024-January 2025). Data were thematically analysed using inductive and deductive approaches. Eighty-nine interviews were conducted with 54 service users/potential service users and 35 professional stakeholders across three study sites. Four key themes were identified: (1) challenges of delivering remote safeguarding in practice, (2) importance of a safe space for the patient, (3) one size approach does not fit all, and (4) strategies to support remote safeguarding. Participants described difficulties identifying risks without visual cues, variable comfort with disclosure, and privacy concerns. Providers used adaptive, collaborative approaches to build trust, ensure safety, and tailor safeguarding to individual circumstances. Both service users and providers recognised the effectiveness of remote safeguarding largely depended on clinician judgement, structured questioning, and sensitive communication. While remote consultations offered flexibility, remote safeguarding relied on service users having access to safe, private space. People with language barriers or those less able to create a safe space at home, such as those experiencing housing instability or coercive control may also have greater safeguarding needs. Ensuring access to in-person options, clear safeguarding protocols, and appropriate clinician training is essential to mitigate these challenges. Author summaryDuring the COVID-19 pandemic, sexual and reproductive health services used more remote appointments, such as phone, video, or online consultations. These appointments can make it easier for some people to get care. But there are concerns about whether staff can spot safeguarding issues, such as people who may be at risk of harm, without seeing them in person. In this study, we spoke with people who use sexual and reproductive health services, people who had never used these services before, and staff who work in these settings. People described challenges with remote appointments, including not being able to see body language, feeling unsure about talking about sensitive issues, and worries about privacy at home. Staff described changing how they worked by asking careful questions, building trust, and making safeguarding fit each persons situation. Both service users and staff felt that keeping people safe during remote appointments depends on clear communication and professional judgement. It is harder when people do not have a private space, face language difficulties, or live in unsafe housing or controlling relationships. Our findings show the importance of keeping in-person appointments available and making sure staff have the right training and guidance.

People who inject drugs (PWID) experience a high burden of HIV and hepatitis C virus (HCV) infection due to unsafe injection practices and limited access to harm-reduction services. In Mozambique, data on PWID remain limited. This study analyzed two rounds of biobehavioral surveys conducted in 2014 and 2023 in Maputo and Nampula to assess trends in HIV and HCV prevalence and to identify associated behavioral and structural factors. We compared unweighted prevalence estimates using descriptive analysis and applied multivariable logistic regression to examine independent associations with each infection and interaction effects with survey year. HIV prevalence declined across most demographic and behavioral groups. Among PWID aged [&ge;]25 years, prevalence decreased from 55.7% to 26.3%, and among men from 45.7% to 16.7% (both p < 0.001). Reductions were also observed among daily injectors (58.0% to 21.3%) and individuals reporting syringe sharing (75.0% to 21.8%). In Maputo, HIV prevalence declined from 56.6% to 28.0%, while the decrease in Nampula was not statistically significant. Age and female sex were strong predictors of HIV infection in the earlier survey, although the association with age weakened in 2023. HCV prevalence showed divergent trends. In Maputo, prevalence decreased from 49.3% to 18.7% (p < 0.001), whereas in Nampula it increased from 11.7% to 48.1% (p < 0.001). PWID aged 16-24 years experienced a fivefold increase in HCV prevalence. Interaction analysis demonstrated a significant rise in Nampula in 2023 (AOR 14.6; p < 0.001). Lower injection frequency and not sharing needles were protective factors for both HIV and HCV. These findings indicate a substantial reduction in HIV prevalence among PWID in Mozambique over the past decade, alongside an increase in HCV prevalence in specific geographic and age groups. The contrasting trends highlight the need for differentiated harm-reduction strategies, expansion of HCV prevention and treatment services, and tailored interventions for subgroups at elevated risk.

Despite the availability of vaccinations and screenings, cervical cancer (CC) remains a major global health challenge. Understanding the factors influencing adherence to CC prevention strategies is essential, particularly among overlooked groups such as middle-aged and/or underprivileged women. For this purpose, a cross-sectional study was conducted in a population comprising 379 women (aged 37-64 years, recruitment: 2019-2023) from Valencia (Spain), representing diverse socioeconomic profiles, including female sex workers (FSWs; n = 46). Data were analysed using multivariate logistic regression models. Overall, 88.65% of participants adhered to CCS recommendations and 22.16% reported past-year condom use, compared with 86.96% and 76.09%, respectively, among FSWs. In the overall population, CCS adherence was significantly associated with higher education and marginally associated with a history of candidiasis, non-condom contraceptive use in the past year, and having more children and sexual partners. Higher condom use was associated with lower alcohol consumption, being single, non-Spanish origin, not being postmenopausal, use of vaginal health products, and not previous recurrent urinary tract infections. Marginally significant positive associations were also observed for the absence of chronic disease and a history of sexually transmitted infections. Among FSWs, earlier menarche age and lower gravidity were marginally associated with higher CCS adherence, while older age at entry into prostitution and earlier sexual debut were associated with condom use, the latter marginally significant. Overall, our findings highlight the importance of further research into underprivileged groups such as midlife women across socioeconomic strata. Novelty and ImpactFirst study to assess 28 determinants of CC prevention in middle-aged women from diverse socioeconomic backgrounds, an often overlooked group. Key factors were education, alcohol consumption, relationship status, birth country, menopausal status, vaginal product use, and recurrent UTIs. Weaker associations were found for candidiasis history, non-condom contraception, number of children and sexual partners, STI history, and chronic disease. Our findings underscore the need for targeted public-health interventions to support the WHO strategy to eliminate CC.

BackgroundFemale sex workers (FSW) are a key population for HIV prevention and care. Increasing evidence suggests that social and structural barriers are key drivers of HIV transmission. This global systematic review assesses whether experiencing violence is associated with worse HIV outcomes among FSW. Methods and FindingsWe searched MEDLINE, Embase, and PsycINFO databases for studies published from January 1st, 2010 to February 10th, 2025 assessing the impact of violence on HIV outcomes among FSW, without restriction to language and study design. Some studies had multiple estimates due to reporting on multiple outcomes or exposures of interest. We pooled data from eligible studies using multi-level random-effects meta-analyses to quantify associations between recent (past year) or lifetime exposure to violence (physical, sexual, emotional/psychological and/or financial) and HIV outcomes (prevalent and incident HIV infection, HIV testing, ART use, ART adherence, and viral suppression) among FSW. We preferentially used adjusted estimates over unadjusted estimates if both were available. We included 91 studies with 221 estimates, comprising 179,727 FSWs in 37 countries. We found higher odds of prevalent HIV infection among FSWs with recent (pooled odds ratio (pOR):1.33; 95%CI:1.17-1.51; I2:64%; n=73 estimates) and lifetime (pOR:1.36; 95%CI:1.24-1.49; I2:38%; n=67) experiences of violence. Recently experiencing violence was associated with reduced odds of ART use (pOR:0.78; 95%CI:0.64-0.94; I2:8%; n=17). Lifetime exposure to violence was associated with reduced odds of viral suppression (pOR:0.88; 95%CI:0.79-0.98; I2:20%; n=6). There was no evidence of associations between violence and HIV incidence, HIV testing and ART adherence. ConclusionsExperiencing violence may increase HIV transmission risk and worsen HIV treatment outcomes among FSW. HIV interventions for FSWs must address violence as a structural determinant of HIV.

IntroductionGenital chlamydia is one of the most common sexually transmitted infections (STIs) among young people aged 15-24 years old and may lead to serious complications in women, men, and newborns. This study aimed to evaluate the effectiveness of a five-day interactive hybrid educational workshop on knowledge, attitudes, and practices (KAP) related to genital chlamydia in Bamako, Mali. Materiel and MethodsA descriptive pre-test/post-test study was conducted in 2025 among 174 young participants aged 15-24 years old. Data were collected using a standardized questionnaire assessing KAP related to genital chlamydia and STIs. Proportions before and after the intervention were compared using the chi-square ({chi}{superscript 2}) test or Fishers exact test, with a significance level set at = 0.05. ResultsOverall knowledge of STIs showed a slight improvement after the intervention, with the "poor knowledge" category disappearing at post-test. The proportion of participants able to identify at least three modes of transmission of genital chlamydia increased from 41.7% to 50.0%. Improvements were also observed in the identification of symptoms and complications, with a statistically significant increase in knowledge of male complications (p = 0.045 for at least one complication; p = 0.003 for at least two complications). Information sharing about genital chlamydia with partners remained limited (8.3% vs. 7.4%), whereas discussion of STI status between partners increased (62.5% to 72.2%). Preventive practices improved modestly, including consistent condom use (62.5% to 66.7%), prompt health-care seeking (95.0% to 96.3%), and acceptability of on-demand STI screening (70.8% to 83.3%). ConclusionThe hybrid educational workshop contributed to improved knowledge and several positive attitudes toward genital chlamydia, particularly regarding communication about STI status and acceptability of screening. However, persistent stigma and limited information sharing with sexual partners underscore the need for sustained and repeated educational interventions targeting young people for chlamydia prevention and control.

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

Background: Since 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. Methods: We 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. Results: Among 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. Conclusions: PFA 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.

IntroductionPersistent infection with high-risk Human Papillomavirus (hr-HPV) in women is a leading cause of cervical cancer, and its co-infection among people living with HIV (PLHIV) increases the risk of HPV-associated cancer, including oropharyngeal and anogenital cancers. In sub-Saharan Africa, awareness of HPV is limited, screening and vaccine adoption are critically low, undermining efforts toward sexually transmitted infection (STI) elimination. MethodsFrom Awareness to ACTion (FACT) study assessed HPV knowledge, screening, and vaccine uptake in adolescent-mother pairs participating in the HOMINY (HPV, Human Immunodeficiency Virus, and Oral Microbiota Interplay in Nigerian Youths) prospective cohort study. Participants were enrolled, including adolescents aged 9-18 years (N=636) and mothers aged 29-59 years (N=385). FACT was conducted at the University of Benin Teaching Hospital, Nigeria, with adolescent participants grouped as perinatally acquired HIV, HIV-exposed without acquisition and HIV-unexposed, and mothers by HIV serostatus. In line with the national immunisation programme protecting girls in Nigeria, sensitisation programmes were integrated into the research study to promote awareness and adoption of screening and vaccination practices. Knowledge and attitudes regarding HPV and its vaccination benefits were assessed through thematic discussions, field notes, interactive sessions, and questionnaires administered over the study period. ResultsAt baseline, HPV awareness was low, with 34.5% of mothers and 1.4% of adolescents being aware of HPV. Post-sensitisation, awareness increased significantly to 64.4% and 19% in mothers and adolescents, respectively. Vaccination uptake rose from 0% to 3.4% in adolescents, and the proportion of mothers who underwent HPV-related screening (Visual Inspection with Acetic Acid and/or Papanicolaou test) increased from 38.7 % at baseline to 52.4 % after a year (p < 0.0001). Barriers to the adoption of preventive services included misconceptions, healthcare provider gaps, myths, misinformation, mistrust, skepticism, and limited access. ConclusionsHPV awareness programmes significantly improved knowledge, vaccination uptake, and screening practices in this vulnerable population. As part of comprehensive STI elimination strategies, integrating HPV education and vaccination initiatives into HIV care and research will enhance prevention and address significant barriers. Lessons from a unique programmatic science framework provide critical insights for scaling vaccine delivery, and the design of future vaccine programmes.