Venereology

Human Papillomavirus (HPV) is a highly prevalent sexually transmitted infection associated with malignancies of the cervix, vulva, and vagina. While prophylactic vaccination with Gardasil^®9 is FDA-approved through age 45, no clinical trials have evaluated its use in older adults who remain sexually active and at risk for HPV-related cancers. We describe the case of a woman who presented with recurrent high-risk HPV and received the three-dose Gardasil^®9 series off-label at the age of 67. Following vaccination, her cervical cytology was negative for HPV and subsequent colposcopy did not demonstrate any evidence of intraepithelial lesion or malignancy. As this is a single case report, this temporal association cannot establish that vaccination caused viral clearance. Nonetheless, this case raises important questions regarding age-based HPV vaccination limits. Immunosenescence in older populations may impair viral clearance and could increase cumulative risk of progression from dysplasia to malignancy. Vaccination may therefore serve both prophylactic and potentially therapeutic roles; however, this must be evaluated in further controlled studies. This case highlights the need for further research into HPV vaccination in patients over the age of 45 years with or without history of HPV infection.

Sexually transmitted infections (STIs) remain a public health challenge, with rising incidence rates and significant loss to follow-up in traditional testing models. Point-of-care (POC) testing promises same-day diagnosis and treatment, potentially transforming STI management. We conducted a narrative review with perspective elements of commercially available POC and near-POC tests for STIs, identifying tests through regulatory and product-specific sources including the Food and Drug Administration (FDA), World Health Organization (WHO) prequalification list, Australia’s Therapeutic Goods Administration (TGA), China’s National Medical Products Administration (NMPA), publicly available European regulatory and manufacturer sources for CE-marked in vitro diagnostic devices under the EU In Vitro Diagnostic Regulation framework, and the published literature. Several nucleic acid amplification test (NAAT)-based platforms now deliver results rapidly with excellent sensitivity and specificity for common bacterial and protozoal STIs, including Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis. For viral STIs, POC testing is most mature for human immunodeficiency virus (HIV), with numerous approved rapid antibody tests, although viral load and resistance testing remain laboratory-based. Most NAAT platforms require dedicated instruments, specialized training, and significant infrastructure. At-home testing options are emerging but face challenges with sensitivity, public health surveillance, and regulatory oversight. In conclusion, POC testing for STIs is advancing but not yet fully realized, and true POC tests (those usable at the bedside without laboratory support) remain limited. While rapid NAAT platforms represent significant progress over traditional laboratory-based testing, barriers to true POC implementation persist. Future developments in antimicrobial resistance detection, multiplex testing, instrument-free platforms, and integration of at-home testing with public health surveillance will be critical to achieving broader STI testing and control.

Infectious diseases remain a major global public health concern, disproportionately causing morbidity and mortality in low- and middle-income countries. Sexually Transmitted Infections (STIs) heavily affect sexually active populations. Sex workers, encompassing female sex workers (FSWs), male sex workers (MSWs), and transgender/gender-diverse individuals, face heightened vulnerabilities due to occupational exposures, structural barriers, stigma, and criminalization. While substantial focus has historically centered on HIV, non-HIV STIs such as Neisseria gonorrhoeae, Chlamydia trachomatis, Treponema pallidum, and viral hepatitis present significant co-morbidity. Crucially, drug resistance across these pathogens presents distinct biological and epidemiological challenges: bacterial antimicrobial resistance (AMR) in N. gonorrhoeae and C. trachomatis, antiretroviral (ARV) resistance in HIV, and direct-acting antiviral (DAA) resistance in hepatitis B and C. This perspective article synthesizes the current epidemiological landscape, critiques the reliance on syndromic management over molecular diagnostics (e.g., NAATs, point-of-care, and genomic surveillance), highlights diagnostic stewardship, and outlines priority public health strategies aligned with the WHO 2022–2030 Global Health Sector Strategies.