Search Results (45)

Background/Objectives: High-risk human papillomavirus (HR-HPV) causes cervical cancer, but other sexually transmitted infections (STIs) act as possible cofactors. We herein evaluated the feasibility, logistics, and epidemiology of a community-based screening program in Romania using an innovative veil-based self-sampling device and a digital platform. Methods: Adult women self-collected genital secretions using the Vaginal Veil Collector V-Veil UP2™ device (V-Veil-Up Production SRL, Pitesti, Romania). A digital platform managed registration and results. Dry impregnated veils were transported at ambient temperature via standard courier to an accredited French laboratory for molecular testing using in parallel the Allplex™ HPV HR Detection assay (Seegene, Seoul, Republic of Korea), detecting 14 HR-HPVs, and the Allplex™ STI Essential Assay (Seegene), detecting 7 major pathogens causing STIs [Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, Trichomonas vaginalis, Mycoplasma hominis, Ureaplasma urealyticum, Ureaplasma parvum]. Results: Among 960 included women (mean age 41.3 years), technical success was high: 97.7% of samples yielded valid results for HR-HPV and 97.4% for STIs. Sample stability at ambient temperature eliminated cold-chain requirements. Overall, 17.2% of women were positive for HR-HPV and 26.7% for an STI. The most frequent genotypes were HPV-68 (3.0%), HPV-16 (2.9%), and HPV-31 (2.3%); Ureaplasma parvum (24.0%) was the most prevalent bacterial pathogen. The 18–29 age group exhibited the highest risk for HR-HPV (22.2%) and STIs (36.8%). Multivariate analysis revealed strong biological associations: Chlamydia trachomatis was independently associated with overall HR-HPV (aOR: 4.52; 95% CI: 1.26–16.11) and multiple HR-HPV infections (aOR: 13.96; 95% CI: 3.70–52.64). Mycoplasma hominis and Ureaplasma species were also independently associated with HR-HPV (aOR: 1.83 and 1.67, respectively) or nonvaccine types (aOR: 2.75 and 5.03, respectively). Conclusions: Veil-based self-sampling combined with digital logistics is highly feasible, scalable, and overcomes geographical barriers. The marked association between Chlamydia trachomatis, Mycoplasma hominis, Ureaplasma species, and HR-HPV strongly advocates for integrated molecular co-testing models in public health screening programs. Full article

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. Full article

Background/Objectives: This study aimed to investigate the genital pathogen profile and co-infection dynamics using multiplex RT-qPCR, specifically evaluating the independent associations with age, sex, and HIV status. Methods: Data from 1217 patients who underwent a sexually transmitted infection (STI) panel study at the Microbiology Laboratory of Marmara University Pendik Training and Research Hospital between January 2024 and December 2025 were retrospectively reviewed. Pathogen detection was performed using a commercial kit (Bioeksen, Istanbul, Türkiye) with the multiplex RT-qPCR method. The independent effects of HIV positivity, age, and sex on pathogen frequency and co-infection were analyzed using logistic regression models; results were evaluated using adjusted odds ratio (aOR) and 95% confidence interval (CI). Results: Any-pathogen positivity was detected in 57.8% of patients, with Ureaplasma spp. (36.9%) and Gardnerella vaginalis (32.5%) being the most prevalent. While overall pathogen positivity did not differ significantly by HIV status (p = 0.158), HIV-positive patients exhibited distinct microbiological architectures. Higher positivity rates were observed in women in both groups, and a strong correlation was found between sex and the presence of infection (p < 0.001). Multivariate analysis revealed that HIV positivity was independently associated with an over fivefold increase in HSV-2 detection (aOR = 5.09, 95% CI: 1.47–17.65; p = 0.010). Furthermore, HIV-positive individuals were significantly enriched for complex polymicrobial patterns involving three or more pathogens (p = 0.008). Conversely, male sex was independently associated with a substantially lower risk of co-infection (aOR = 0.17, 95% CI: 0.12–0.22; p < 0.001), and increasing age showed an inverse relationship with co-infection frequency (aOR = 0.98 per year, 95% CI: 0.97–0.99; p = 0.001). Conclusions: This study adds to current epidemiological evidence by showing that genital pathogen distribution is shaped by age- and sex-related heterogeneity, with flora-associated co-infections predominating in women and more classical STI-related agents occurring more often in men. Our findings suggest that multiplex RT-qPCR provides value not only for broad pathogen detection but also for identifying demographic- and HIV-associated co-infection patterns that may support stratified screening and targeted clinical management. Full article

Syphilis and HIV are sexually transmitted disease (STDs) that interact synergistically. However, data on HIV–syphilis co-infection in Romania remain limited. We conducted a retrospective cohort study at a single Romanian HIV/AIDS Day Clinic, including 439 adult people living with HIV (PLWH) monitored between 2020 and 2025. Demographic, epidemiological, clinical, and laboratory data were collected, including HIV staging and syphilis history. Syphilis co-infection was identified in 81 patients (18.5%), and 61.5% met criteria for AIDS. Viral suppression was achieved in 82.2%, and 78.4% achieved CD4 counts >350 cells/mm³. Male sex, urban residence, unmarried status, sexual HIV transmission, genital condyloma, and other STIs were independently associated with syphilis. First episodes of syphilis were predominantly secondary (61%), neurosyphilis was present in 5%, and serofast evolution occurred in 12%, more frequently after reinfection. Among deceased patients, 20.9% had a history of syphilis, but co-infection was not significantly associated with mortality. Nine of 28 patients lost to follow-up had prior syphilis, suggesting a potential impact on retention in care. These findings indicate that HIV–syphilis co-infection is increasingly prevalent in Romania, driven primarily by behavioral factors, and highlight the need for targeted STD screening and prevention strategies among high-risk PLWH. Full article

Mycoplasma genitalium (MG) is a cell wall–deficient bacterial pathogen associated with several sexually transmitted infections (STIs), including nongonococcal urethritis, cervicitis, and pelvic inflammatory disease. In the context of increasing antibiotic resistance and the challenges in clinical management, molecular epidemiological data are crucial for supporting surveillance strategies. This study aimed to assess the prevalence and genetic diversity of M. genitalium infections in a tertiary care hospital located in Northeastern Italy. In 2023, 2524 subjects (1622 men and 902 women) were screened using real-time multiplex PCR for the detection of major urogenital pathogens. M. genitalium-positive samples were molecularly characterized using a locus-typing approach based on sequence polymorphisms in the mgpB gene and the MG309 locus, enabling enhanced strain discrimination. Results revealed an overall positivity rate of 7.4% (118 cases), with a significantly higher prevalence in men (10.2%) than in women (2.6%), and the highest detection rate found in rectal swab specimens. Coinfections were detected in 48% of M. genitalium-positive subjects, most commonly involving Ureaplasma urealyticum (24%) and Metamycoplasma hominis (14%). Molecular typing on 22 M. genitalium-positive samples revealed significant locus-specific genetic heterogeneity, alongside the presence of a dominant cluster of 14 isolates with closely related allele profiles, suggesting the circulation of predominant local M. genitalium alleles within the analysed population. Full article

Ureaplasma species are associated with various reproductive health issues, while human papillomavirus (HPV) is associated with cervical, vaginal and vulvar cancers. Data on the association between Ureaplasma species and HPV are limited in South Africa. This study investigated the prevalence of Ureaplasma urealyticum (U. urealyticum), Ureaplasma parvum (U. parvum), and HPV coinfection and their associated factors, among adolescent girls and young women (AGYW) in the Eastern Cape Province, South Africa. A total of 214 participants were retrospectively recruited, and secondary data on HPV, U. urealyticum, U. parvum, demographics, and sexual behavior were used. HPV was detected using the Roche Linear Array HPV Genotyping Test, while U. urealyticum and U. parvum were detected using Allplex™ sexually transmitted infection (STI) essential Assay. Statistical analyses were performed using GraphPad Prism Version 8.0.1.244. The prevalence of U. urealyticum was 43.9% (94/214) and increased significantly with age (p = 0.036, R² = 0.8497); while U. parvum prevalence was 68.7% (147/214) and was not influenced by age. Having four to six lifetime sexual partners (PR: 1.77, 95% CI: 1.04–3.00, p = 0.043) was associated with increased risk of U. urealyticum. A proportion of 36.3% (77/212) had HPV-U. urealyticum coinfection and its risk was increased among those with 3–6 lifetime sexual partners (PR: 1.59, 95% CI: 1.10–2.53, p = 0.017), 2–4 new partners past three months (PR: 2.14, 95% CI: 1.19–2.42, p = 0.021); vaginal sexual intercourse frequency past 1-month (2–3 vaginal intercourse: PR: 1.54, 95% CI: 1.06–2.53, p = 0.037; 4–10 vaginal intercourse: PR: 1.91, 95% CI: 1.83–1.91, p = 0.005) and alcohol consumption (PR: 1.85, 95% CI: 1.20–3.28, p = 0.004). U. urealyticum positives had a significantly higher risk of HPV types targeted by Cervarix^® HPV vaccine than negatives (PR: 2.56, 95% CI: 1.23–5.37, p = 0.013), Gardasil^®4 (PR: 2.16, 95% CI: 1.25–3.75, p = 0.006) and Gardasil^®9 (PR: 1.70, 95% CI: 1.25–2.32, p = 0.001). AGYW of Eastern Cape Province, South Africa had high prevalence of U. urealyticum-HPV and U. parvum-HPV coinfections. Ureaplasma species coinfection was associated with HPV prevalence and distribution of genotypes. The U. urealyticum prevalence and its coinfection with HPV were associated with sexual behavior. Data from this study could contribute to the design of sexual health and STI interventions and could serve as a baseline for future epidemiological studies, which include ongoing surveillance of HPV genotype prevalence to evaluate the impact and effectiveness of HPV vaccination programs in the population. Full article

Pelvic inflammatory disease (PID), although traditionally viewed as a sexually transmitted infection (STI), can also result from non-sexually transmitted microorganisms that display distinct epidemiologic and clinical characteristics. Unlike STI-related PID, these infections are less influenced by sexual behavior, often show a bimodal age distribution, and are linked to bacterial vaginosis (BV)-associated dysbiosis, iatrogenic uterine procedures, postpartum states, or inadequate access to timely screening and care. Non-STI-related PID is usually polymicrobial, predominantly involving BV-associated vaginal, enteric, or urinary commensals that ascend into the upper genital tract, while respiratory tract organisms, mycobacteria, and biofilm-associated pathogens may also play a role. Pathophysiological mechanisms include disruption of the endocervical barrier, mucus degradation, biofilm formation, hematogenous or iatrogenic seeding, and chronic cytokine-mediated inflammation and fibrosis. Clinical manifestations range from asymptomatic/subclinical disease to acute pelvic pain and tubo-ovarian abscess (TOA) and can progress to systemic infection and sepsis. Diagnosing non-STI PID is challenging due to nonspecific symptoms, negative STI tests, and inconclusive imaging findings, while management relies on broad-spectrum antimicrobials with surgery as needed. Given these complexities, this review aims to synthesize current knowledge on non-STI-related PID, clarify key considerations for its diagnosis, management, and prevention, and outline future perspectives to improve clinical outcomes. Full article

HSV-1 is associated with oral lesions and non-sexual transmission; HSV-2 is primarily transmitted through sexual contact and causes genital infections. Understanding the epidemiological dynamics of both viruses is essential for guiding targeted public-health responses. We conducted a retrospective analysis of 177,599 clinical specimens collected between September 2018 and December 2022 from patients with symptoms suggestive of sexually transmitted infections (STIs) at healthcare institutions across South Korea. HSV-1 and HSV-2 were identified using a real-time PCR assay; positivity rates were stratified by age, sex, specimen type, and year of testing. The overall positivity rate was 0.26% for HSV-1 and 1.60% for HSV-2. HSV-1 was most prevalent among individuals aged <19 years; HSV-2 showed the highest positivity in females aged 20–29 years, declining with age thereafter. HSV-2 positivity was significantly higher in females than in males. A significant decline in HSV-2 positivity was observed over the 5-year study period, while HSV-1 positivity remained stable. This nationwide PCR-based study reveals distinct age- and sex-related epidemiological patterns of HSV-1 and HSV-2. The findings support the need for age-specific and gender-specific STI screening strategies and health education programs. The declining trend in HSV-2 infection may reflect the impact of recent public-health initiatives. Full article

Sexually transmitted infections (STIs) remain a global health concern, but large-scale multiplex PCR surveillance data are limited. This study aimed to characterize sex- and age-specific distributions, temporal patterns, and co-infection dynamics of 12 urogenital and sexually transmitted infection (STI) pathogens in Korea. We retrospectively analyzed 1,399,431 multiplex PCR test records (902,713 females, 496,718 males) collected nationwide between 2021 and 2024. Positivity rates were stratified by sex, age, month, season, and year. Co-infection coverage and inter-pathogen correlations were assessed; φ coefficients ≥0.20 were considered relevant. Overall, 67.23% of tests were positive for at least one pathogen. Annually, positivity rates for most pathogens, including the six traditional STIs (N. gonorrhoeae, C. trachomatis, M. genitalium, T. vaginalis, T. pallidum, and HSV II), showed a significant decline over the four-year period (p < 0.0001). Females had higher positivity than males (77.73% vs. 48.14%, p < 0.0001), largely driven by G. vaginalis (64.70%), U. parvum (41.37%), and C. albicans (18.07%), whereas traditional STIs, except T. vaginalis and HSV II, were more frequent in males (p < 0.0001). Adolescents and young adults carried the highest burden of traditional STIs such as C. trachomatis and N. gonorrhoeae (p < 0.0001). In females, C. albicans decreased with age (32.17% in 10s to 6.45% in 80s) but increased annually (p = 0.0058), while HSV II positivity significantly declined in males over time (p = 0.0038). No seasonal variation was observed (p > 0.90). Co-infections were predominantly commensal-driven, with U. parvum/G. vaginalis being the most frequent pair in females, and U. urealyticum/G. vaginalis being frequent in males (8.24% in 10s, 10.48% in 20s). Traditional STI co-infections were rare but concentrated in adolescents, with C. trachomatis/N. gonorrhoeae reaching 4.25% in males. Correlation analysis confirmed strong associations among commensals (φ = 0.24–0.35) and moderate correlations involving C. trachomatis in youth (φ = 0.25–0.28), with G. vaginalis consistently identified as the central hub organism across all age groups. This nationwide four-year analysis highlights declining prevalence of traditional STIs, sex-specific STI patterns, distinct age-specific distributions, and commensal-driven co-infection patterns. The findings underscore the need for age- and sex-tailored screening strategies, particularly in adolescents, young adults, and women of reproductive age, and highlight the value of multiplex PCR for STI surveillance. Full article

Background: Chlamydia trachomatis is the most prevalent bacterial sexually transmitted infection (STI) globally, linked to severe complications such as pelvic inflammatory disease and infertility. In the Brazilian Amazon, socioeconomic vulnerability and the absence of screening policies exacerbate risks, particularly among female sex workers (FSWs). Objective: This study aimed to determine the seroprevalence of anti-C. trachomatis IgG antibodies among FSWs in five municipalities of Pará State, Brazilian Amazon, and identify epidemiological factors associated with infection. Methods: A retrospective cross-sectional study (2005–2007) included 348 FSWs recruited via convenience sampling. Sociodemographic and behavioral data were collected through questionnaires, and blood samples were analyzed by ELISA for anti-C. trachomatis IgG. Statistical analyses included Fisher’s exact tests, odds ratios (ORs), and 95% confidence intervals (CIs), using SPSS 21.0. Results: Overall seroprevalence was 93.9% (327/348; 95% CI: 83.1–90%). Significant associations included a household income of 1–3 minimum wages (98.4%; p = 0.0002), sexual partners from the same region (98.8%; p = 0.0421), and age >42 years (96.3%). Most reported inconsistent condom use (43.7%), multiple monthly partners (54.6%), and illicit drug use (53.4%). Discussion: The extremely high seroprevalence reflects chronic C. trachomatis exposure, driven by socioeconomic deprivation and limited healthcare access. Comparisons with global data underscore the urgent need for screening policies, absent in Brazil for FSWs, and highlight the vulnerability of this population. Conclusions: The findings reveal an alarming burden of C. trachomatis exposure among Amazonian FSWs. Integrated strategies, including routine screening, sexual health education, and inclusion of FSWs in priority health programs, are critical to reduce transmission and associated complications. Full article

Background: The objective of this study is to investigate the prevalence and epidemiological changes of major sexually transmitted infections (STIs) in Korea over the past decade. Methods: From 2010 to 2021, patients diagnosed with STIs based on ICD-10 codes were analyzed using Korean Health insurance data. The analysis included the number of patients, prevalence, and age-specific prevalence (in 5-year intervals) over this period. We examined changes in disease patterns over time by analyzing the annual trends and age-specific prevalence of bacterial STIs such as chlamydia, mycoplasma, gonorrhea, and syphilis; viral STIs such as genital herpes, human papillomavirus (HPV), and human immunodeficiency virus (HIV); and other infections including scabies, pubic lice, and trichomoniasis. Results: In 2010, the STI with the highest prevalence due to an infectious pathogen was trichomoniasis (256.65/100,000), while latent syphilis had the lowest prevalence (5.29/100,000). In 2021, the STI with the highest prevalence was genital herpes (254.54 per 100,000 persons), and latent syphilis continued to have the lowest prevalence. Bacterial STIs showed a decreasing trend. Viral STIs showed a continuous increase throughout the study period, with anogenital warts (AGW) having the highest rate of increase. Other infections showed a decreasing trend. HIV and AGW in men showed a rapid increase. Gender differences varied depending on the disease. Conclusions: While bacterial STIs have gradually declined, viral STIs have continued to increase during last decade. The characteristics of each pathogen vary according to age and gender, necessitating the establishment of risk groups for each pathogen and the development of prevention policies accordingly. Full article

Background/Objectives: Mycoplasma and Ureaplasma species are pathogens commonly associated with urogenital infections in sexually active individuals. Despite their clinical relevance, these organisms are less frequently studied than other sexually transmitted infections (STIs), leading to limited data on their antimicrobial susceptibility and resistance profiles. This study aimed to characterize the antimicrobial susceptibility and resistance patterns of Mycoplasma hominis and Ureaplasma spp. among individuals in Salvador, Bahia, Brazil, and to identify the potential associated risk factors. Methods: We conducted a retrospective descriptive study during 2022–2024 using secondary data obtained from the SMARTLab^® diagnostic system. Sociodemographic and epidemiological data, along with results from IST2 and IST3 diagnostic tests, were analyzed. Absolute and relative frequencies were calculated by sex, age group, and antimicrobial susceptibility profile. Results: Our results revealed a predominance of M. hominis and Ureaplasma spp. infection among women (98.5%), and in individuals aged 38 to 47 years. Ureaplasma spp. accounted for the majority of positive cases. High rates of resistance were observed in the IST2 test, with 75.0% of M. hominis and 84.1% of Ureaplasma urealyticum resistant to ciprofloxacin. In the IST3 test, Ureaplasma spp. demonstrated a 7.3% resistance rate to levofloxacin, which increased to 22.2% in cases of co-infection. Conclusions: These findings underscore the growing threat of antimicrobial resistance in Mycoplasma and Ureaplasma species and highlight the need for targeted public health strategies and diagnostic tools to manage infections caused by these organisms, particularly in high-risk populations. Full article

Sexually transmitted infections (STIs) are a significant public health issue, especially among adolescents and young adults. Despite improvements in diagnostic tools and treatments, over 1 million new STIs occur daily worldwide, many of which are asymptomatic. These infections can severely affect quality of life and reproductive health, particularly when contracted at a young age. This review provides an overview of STIs’ recent epidemiology data, clinical trends, and diagnostic challenges in Italian adolescents and young adults, focusing on the Chlamydia trachomatis, Neisseria gonorrhoeae, Treponema pallidum, Thricomonas vaginalis, and Mycoplasma/Ureaplasma species. Worrying new evidence indicates that young women are at a higher risk of contracting STIs than men and multidrug-resistant strains have increased in young heterosexuals. This evidence shows a general change in lifestyle, where a lack of awareness about the risks of STI reflects a significant educational gap. To address the rising STI rates, targeted school educational interventions and innovative multidisciplinary healthcare models, such as the hub-and-spoke approach, are needed. Full article

Wastewater-based epidemiology (WBE) offers a promising tool for sexually transmitted infection (STI) surveillance, especially in settings where underdiagnosis or social stigma complicates conventional reporting. To assess its utility, we conducted a year-long study examining six STIs, Chlamydia trachomatis, Treponema pallidum, Neisseria gonorrhoeae, human immunodeficiency virus (HIV), hepatitis C virus (HCV), and herpes simplex virus (HSV), in weekly composite samples from the primary influent of a small-sized Midwestern wastewater treatment plant. Pathogen detection and quantification were performed via digital PCR. Among the tested targets, Gonorrhea, HIV, HCV, and HSV were detected at the highest frequencies, often in 40–50% of the samples, while Chlamydia and Syphilis appeared less frequently. Despite the variability in detection patterns, this study demonstrates that even infrequent signals can reveal community-level shedding of poorly reported or asymptomatic infections. Although month-to-month wastewater data were not strongly correlated with corresponding clinical records, which could potentially reflect delayed healthcare seeking and pathogen-specific shedding dynamics, the overall findings underscore WBE’s ability to complement existing surveillance by capturing infections outside traditional healthcare channels. These results not only advance our understanding of STI prevalence and population shedding but also highlight the practical benefits of WBE as an early warning and targeted intervention tool. Full article

Background: The current economic and social crisis in Latin America has caused migration to the USA, bringing with it Public Health challenges due to the importation of various infectious diseases. Migrants, particularly those with chronic conditions, such as HIV infection and other sexually transmitted infections (STI), are at greater risk due to pharmacological interruption and access to medical care, so the timely detection of diseases acquired during their migration, such as malaria, is crucial to avoid health complications. Objective: To outline by a multidisciplinary approach (Infectology, Parasitology, Epidemiology, molecular Biology, Venereology, and Public Health) the diagnosis and management of a male case with malaria imported to Mexican territory, HIV chronic infection, and latent syphilis. Methods: A male migrant of Venezuelan nationality attended the Clínica Especializada Condesa Iztapalapa in Mexico City for health complications. A comprehensive analysis of laboratory and molecular tests was performed to confirm HIV infection. During the STI diagnostic algorithm, latent syphilis was detected and microscopic observation of blood smears revealed parasitic forms compatible with malaria. Standard and molecular tests were applied under the operational definition for malaria cases for identification, diagnosis, and treatment. Finally, study of clinical history and migration route by questioning for the investigation of the imported case was performed. Results: The immigrant was diagnosed with HIV chronic-stage infection with interrupted antiretroviral therapy (ART), latent syphilis, and malaria by Plasmodium vivax. The ART administered was chosen based on the possible drug interaction with antimalarials and genetic barrier to the HLA-B* allele. Finally, antimicrobial therapy against syphilis was penicillin. From the analysis of the migratory route, incubation time of imported malaria, and questioning, we speculated that the migrant acquired the P. vivax infection in Panama. Conclusions: This case highlights the complex health problems faced by migrants with HIV infection, particularly when they contract additional infections such as malaria during migration and highlights the need for comprehensive access to healthcare and ART, antimalarial and antimicrobial treatments to mitigate the health risks of this vulnerable population. Full article