Venereology doi: 10.3390/venereology5020014

Authors: Anjali Pandit Sandeep K. Shrivastava Sonia Sethi

Sexually transmitted diseases (STDs) continue to represent a substantial burden on public health and society worldwide. With significant implications for social, economic, and public health, STDsare a major global health concern. Despite advances in treatment, the global control of STDs is increasingly threatened by high prevalence of asymptomatic infections, delayed diagnosis and the rapid emergence of antimicrobial resistance (AMR). This emergence includes the value of asymptomatic screeningand the ensuing collateral damage resulting from the overuse of our declining potent antimicrobial resources. This review article critically examines current trends in the epidemiology, clinical significance, and laboratory diagnosis of major sexually transmitted pathogens, including Treponema pallidum, Chlamydia trachomatis, Trichomonas vaginalis, human papillomavirus, herpes simplex virus, and emerging sexually transmissible infections. Major emphasis is focused on contemporary diagnostic technologies and strategies, with a major focus on nucleic acid-based and point-of-care testing and their applicability in routine testing. The review also highlights evolving AMR patterns, resistance-guided therapy, and the role of global and national surveillance systems in informing treatment guidelines, with the integration of diagnostic strategies with resistance-guided therapy and surveillance systems. Strengthening diagnostic capacity, antimicrobial stewardship, and integrated surveillance is essential to mitigate resistance, improve patient outcomes, and advance effective STD management in venereology practice.

Venereology doi: 10.3390/venereology5020013

Authors: Grazia Vivanet Federica Perra Alberto Murtas Luca Medda Natalia Aste Laura Atzori

Background: In older people, syphilis diagnosis might be undervalued due to both clinical conditions and age-related changes that obscure symptom presentation and physician discomfort with sexual history-taking, creating a dual barrier to timely recognition. Methods: Case presentation with literature review. Results: An 80-year-old woman was referred to the Dermatology Department of Cagliari University by her oncologist, with a 2-month history of intermittent episodes of pruritus associated with papular–nodular skin lesion eruptions, accompanied with asthenia, night sweats, and unintentional weight loss, indicative of a paraneoplastic syndrome or an adverse drug reaction. Careful evaluation indicated the need to perform serological testing, which confirmed secondary syphilis (RPR 1:64 and TPHA 1:5120). Specific questioning regarding sexual behaviors pointed out oral and anal intercourse. The 83-year-old husband did not have active lesions at visit but reported a self-healing generalized skin rash, episodes of asthenia, arthralgia, and headache he had never suffered before. Blood tests showed positive RPR 1:64 and TPHA 1:5120. Targeted sexual history assessment disclosed patient’s engaging with commercial sex workers, clarifying the chain of transmission in this conjugal STI case. Treatment with Benzathine penicillin G 2.4 million units IM in a single dose resulted in complete recovery in both patients. Conclusions: The observation highlights the importance of maintaining a high index of suspicion for syphilis even at advanced age. Persistent stigma regarding elderly sexuality should be faced, and targeted interventions are necessary to improve the clinician’s ability to identify STIs in older adults, but also to reduce sexual stigma and taboo persistence in the general population.

Venereology doi: 10.3390/venereology5020012

Authors: Sebastien Pietri Bouchra Ladjouze Mihayl Varbanov

Background/Objectives: Human papillomaviruses (HPVs) are the most common sexually transmitted viruses worldwide and are strongly associated with multiple cancers, including cervical cancer. In France, HPV prevention relies on a combination of organized cervical cancer screening and prophylactic vaccination; however, coverage remains below international targets. Methods: This narrative review summarizes recent advances in HPV prevention in France, with a focus on screening strategies, including the integration of high-risk HPV testing and vaginal self-sampling, as well as vaccination policies that now include both girls and boys, notably through school-based programs. Results: International comparisons, particularly with Australia and several European countries, are used to highlight successful strategies and transferable lessons that could enhance the effectiveness of French prevention efforts. The review also discusses persistent barriers to uptake, including social, organizational, and cultural factors, and considers opportunities to reduce inequalities in access to prevention. Conclusions: Overall, this work provides a comprehensive overview of the current landscape of HPV prevention in France and situates national efforts within a global public health context, offering insights for policy development and future research directions.

Venereology doi: 10.3390/venereology5020011

Authors: Maria Gabriella Donà Alessandra Latini

Background/Objectives: Early diagnosis of HIV remains a key objective of global health strategies; however, nearly half of HIV infections in Europe (47.0%) continue to be diagnosed at a late stage. Individuals with undiagnosed HIV infection frequently present initially to dermatology services with inflammatory or pruritic dermatoses. Indicator condition-guided (IC-guided) HIV testing has been reaffirmed by recent guidelines as a central pillar of differentiated testing services, with explicit recommendations to systematically offer testing when defined conditions are present. Methods: This narrative review compares current HIV testing and IC-guided testing recommendations with major dermatology guidelines. Results: This comparison highlights a persistent misalignment. Although certain conditions, such as herpes zoster in younger adults, crusted scabies and selected forms of chronic pruritus, carry clear recommendations to offer HIV testing, most dermatology guidelines for chronic inflammatory dermatoses do not include HIV testing as part of routine assessment. Observational data and implementation studies indicate that integrating IC-guided testing into dermatology pathways can identify previously undiagnosed HIV infections, often in patients without recognised risk factors. Conclusions: Our observations highlight the need to integrate HIV testing recommendations into dermatology clinical guidelines. Aligning these guidelines with IC-guided testing strategies is not only feasible but can also reduce late HIV diagnoses arising from dermatology services.

Venereology doi: 10.3390/venereology5010010

Authors: Jim Abi Frem Peter Soliman Colin Fitzpatrick Deborah Williams Daniel Richardson

Background: Epididymo-orchitis can be caused by sexually transmitted pathogens, including Neisseria gonorrhoeae, Chlamydia trachomatis, and Mycoplasma genitalium, or entero-bacteria. The aim of this study was to explore the demographics, microbiological findings, and treatment outcomes of patients presenting to a tertiary sexual health clinic with epididymo-orchitis. Methods: We reviewed the clinical notes of 200 randomly selected patients seen in the clinic with a diagnosis of epididymo-orchitis between 2021 and 2025. We extracted data on demographics, microbiological findings, follow-up, and clinical response rate to treatment. Results: The median age was 33 years (Interquartile range (IQR) = 24–44), 97 (49%) identified as MSM, 11 (6%) were living with HIV (all MSM), and 55 out of the 86 HIV-negative MSM (64%) were using HIV pre-exposure prophylaxis. In total, 35 (18%, 95% confidence intervals = 12.5–23.5%) people were diagnosed with a causative organism: 17 (9%) C. trachomatis, 10 (5%) N. gonorrhoeae, 7 (4%) M. genitalium, 3 (2%) Escherichia coli. Overall, 91 out of 200 (46%) had a documented partner notification plan. Conclusions: A minority of men attending our sexually transmitted infection clinic with clinical epididymo-orchitis have positive microbiology, including M. genitalium. More work is needed to understand the clinical pathophysiology of epididymo-orchitis to streamline treatment algorithms.

Venereology doi: 10.3390/venereology5010009

Authors: Molly Spence Clare Fowler Saxon Absalom Tom Roper Deborah Williams Daniel Richardson

Objective: To explore healthcare professionals’ beliefs and concerns about doxyPEP by systematically reviewing the literature. Method: A systematic review of three bibliographical databases (CINAHL, EMBASE and MEDLINE) and MedRxiv in August 2024, updated in February 2026 explored healthcare professionals’ beliefs and concerns about doxyPEP. Three researchers independently reviewed full-text manuscripts for eligibility and narratively synthesized data. We used the Joanna Briggs Institute toolkit to assess risk of bias. This review was registered on PROSPERO (ID:CRD42024570646). Results: Eight manuscripts were included in the final review: five cross-sectional studies, two qualitative studies, and one mixed method study from the USA (n = 5), Australia (n = 1), Kenya (n = 1), and the UK (n = 1) published between 2020–2025 and including 1840 healthcare professionals. Healthcare professionals recognised the high burden of bacterial STIs and believed that doxyPEP should be made available to MSM. There was a strong willingness to provide doxyPEP to MSM with the support of national guidelines. Healthcare professionals suggest that implementing doxyPEP would be feasible with educational support, but were concerned about antimicrobial resistance, drug–drug interactions, pill burden, cost, implementation logistics and the effect on clinical service demands. They acknowledged the lack of research and access to doxyPEP for other groups, specifically trans people and cis-gendered women. They also highlighted the need for community involvement in the implementation of doxyPEP. Conclusions: This review highlights that healthcare professionals were willing and ready to provide doxyPEP; however, they have concerns including antimicrobial resistance, the effect on service capacity, and the lack of research on cis-gendered women and trans people. Patients and health professionals need to be involved in the implementation of doxyPEP.

Venereology doi: 10.3390/venereology5010008

Authors: Enos Moyo Hadrian Mangwana Endalkachew Melese Simon Takawira Bernadette Harases Rosalia Indongo Perseverance Moyo Ntombizodwa Makurira Nyoni Pricilla Mbiri Tafadzwa Dzinamarira

Background: Since the onset of the HIV epidemic, over 40 million individuals have died from AIDS-related illnesses, leading to nearly 14 million children aged 0–17 losing one or both parents to AIDS by 2022. In 2023, Namibia had 250,000 vulnerable children and 72,000 children aged 0–17 orphaned due to HIV and AIDS. Without parental support, orphaned and vulnerable children (OVC) face heightened risks, including neglect, distress, and compromised decision-making. These vulnerabilities can increase their susceptibility to risky behaviors, such as sexual experimentation. This study used data from the Project HOPE Namibia (PHN) OVC program to assess HIV testing rates and associated factors among OVC. Methods: This retrospective cross-sectional secondary analysis study used data from PHN’s OVC program implemented from 1 August 2023 to 30 November 2024. Data were analyzed using Chi-square tests and binomial and multinomial logistic regression. Results: Among the 16,995 participants included in this analysis, 15,014 (88.3%) participants had ever been tested for HIV (95% confidence interval (CI): 87.8–88.8%). Participants with an increased likelihood of having ever tested for HIV included those who had been in the program for 0–6 months (adjusted odds ratio (AOR) = 1.31, 95% CI (1.17–1.47)), and those from households experiencing little or moderate hunger (AOR = 1.29, 95% CI (1.12–1.50), AOR = 1.51, 95% CI (1.33–1.72), respectively. Conclusions: A multi-pronged approach involving all stakeholders is required to increase HIV testing among OVC. Such an approach should include community-based HIV testing, providing male-friendly healthcare services, and reducing household hunger through economically empowering vulnerable households.

Venereology doi: 10.3390/venereology5010007

Authors: Sofya Prakhova

Background: The surveillance of antimicrobial-resistant (AMR) gonorrhea in the United States is conducted under the Gonococcal Isolate Surveillance Project (GISP). Its protocol involves the collection of urethral isolates from the symptomatic men diagnosed with urethral gonorrhea at designated surveillance sites and the estimation of the percentage of cases resistant to current and former gonorrhea antibiotics. A switch to a new antibiotic is typically made when this percentage for a current first-line drug reaches 5%. However, the cost-effectiveness of this surveillance strategy has never been assessed. Methods: We utilized our previously developed agent-based model of gonorrhea transmission among the US men who have sex with men (MSM) population and estimated the total number of gonorrhea cases, total number of discounted quality-adjusted life years (QALYs) and total discounted costs over 25 years under the current surveillance strategy and under a scenario with no surveillance. Results: The maintenance of the current surveillance strategy is projected to avert 104,108 (95% uncertainty interval: 9163, 213,238) gonorrhea cases, gain 192.9 (95% uncertainty interval: 6, 458.3) QALYs and save $38.6 million (95% uncertainty interval: $1 million, $68.2 million) in the simulated cohort of 10,000 US MSM over a 25-year period (2023–2048) when compared to a scenario with no surveillance. Conclusions: The current US surveillance strategy for AMR gonorrhea is cost-saving. However, the low-bound estimate indicates limited savings of $1 million, which is relatively modest at a national scale.

Venereology doi: 10.3390/venereology5010006

Authors: Hasan Selcuk Ozkan Stefania-Cristina Rogoveanu Damla Isman-Haznedaroglu

Background/Objectives: Chemsex is defined as the intentional use of psychoactive substances to enhance or prolong sexual activity, predominantly observed among men who have sex with men. It has emerged as a notable behavioral and public health concern due to its association with high-risk sexual practices, psychiatric morbidity, and somatic complications. Despite increasing recognition, global prevalence estimates vary widely (3–52.5%) due to differences in study populations and methodology. Commonly used substances include synthetic cathinones, amphetamines/methamphetamines, MDMA, GHB/GBL, ketamine, alkyl nitrites, and PDE-5 inhibitors. Methods: A narrative review was conducted using PubMed through 11 December 2025. Search terms combined chemsex-related terminology, substance names, and health outcomes. Recent English-language publications (2020–2025) were prioritized. Evidence was synthesized thematically across epidemiology, health complications, motivations, and interventions. Results: Chemsex is strongly associated with unprotected sex, multipartner encounters, and prolonged intercourse, leading to significantly increased rates of HIV, syphilis, gonorrhoea, and chlamydia. Psychiatric complications include depression, anxiety, compulsive sexual behavior, and psychosis, with higher risks in individuals engaging in slamming or polysubstance use. Somatic complications vary by substance and include cardiovascular disease, hyponatremia, rhabdomyolysis, ulcerative cystitis, methemoglobinemia, and overdose. Motivational factors extend beyond sexual enhancement and include minority stress, internalized and externalized stigma, and maladaptive coping mechanisms. Integrated interventions combining harm reduction, cognitive–behavioral therapy, peer-led services, and pharmacotherapy, alongside digital health tools to support PrEP adherence and risk reduction, show promise in mitigating these harms. Conclusions: Chemsex represents a complex interplay of biological, psychological, and sociocultural factors that contribute to elevated STI risk and psychiatric and somatic morbidity. Addressing chemsex requires destigmatized, multidisciplinary approaches that integrate behavioral, pharmacological, and community-based interventions. Digital health innovations can further enhance engagement, risk reduction, and access to timely care.

Venereology doi: 10.3390/venereology5010005

Authors: Yanru Jiang Yiu-Wing Kam

Background/Objectives: This study investigates the potential association between the sharp increase in syphilis cases in Japan and the growing popularity of dating apps, with a specific focus on the dynamics during the COVID-19 pandemic. Syphilis, a sexually transmitted infection (STIs) caused by Treponema pallidum, presents a significant global public health challenge despite being curable with antibiotics. In Japan, the incidence of syphilis has risen dramatically since 2013, surpassing 10,000 reported cases annually by 2022. Methods: To examine this trend, we analyzed the quarterly reported syphilis cases alongside active user data from three major dating apps (App1, App2, and App3) and conducted a stratified linear correlation analysis by gender and age group. Results: The results reveal that syphilis cases showed accelerated growth starting in the first quarter of 2021, and App 3 demonstrated the strongest positive correlation with new syphilis cases. The association was particularly significant among males aged 20–29 (R2 = 0.70, p = 0.0007) and 30–39 (R2 = 0.82, p < 0.0001). Conclusions: These findings suggest that the widespread use of dating apps may contribute to the rise in sexually transmitted infections, including syphilis, by facilitating extensive new sexual contacts. Notably, this trend became increasingly evident during the COVID-19 pandemic. Future STI prevention strategies should consider integrating dating apps as a potential medium for public health interventions. Additionally, strengthening sexual health services is essential to ensure that responses to global crises do not inadvertently undermine STI prevention and control efforts.

Venereology doi: 10.3390/venereology5010004

Authors: Alberto Sineque Célia Nhambe Júlia Sebastião Nilza Cossa Cacilda Massango Zita Sidumo Susanna Ceffa Fausto Cicacci Jahit Sacarlal Maria Clara Bicho

Background/Objective: High-risk Human papillomavirus (hrHPV) is the leading cause of premalignant lesions and cervical cancer (CC), affecting disproportionally women living with HIV. Mozambique is among the countries with a heavy triple-burden of HIV, hrHPV infections and CC which accounts for more than 5300 new cases and 3800 deaths each year. In this study, we assessed the age-specific distribution and factors associated with hrHPV and cervical lesions among HIV-positive and -negative women from HPV-ISI (HPV Innovative Screening Initiative) study in Maputo, Mozambique. Methods: This cross-sectional study included 1248 non-pregnant women aged ≥18 years who attended CC screening at the DREAM Sant’Egídio Health Centre between July 2021 and April 2022. Screening involved visual inspection with acetic acid (VIA) and high-risk HPV DNA testing. Sociodemographic, lifestyle, and reproductive data were collected through a routine questionnaire. Logistic regression assessed associations between risk factors and hrHPV infection or cervical lesions. Age-specific hrHPV prevalence, partial HPV16/18 genotyping, and abnormal cytology rates were further analyzed by HIV status. Results: The mean age of participants was 43.0 ± 8.6 years. Overall hrHPV prevalence was 28.0%, being higher among HIV-positive women (46.8%) than HIV-negative women (23.8%). Non-16/18 hrHPV genotypes predominated across all age groups. VIA positivity was 11.1%, most frequently involving less than 75% of the cervical area and was more common among younger women (30–45 years) and those living with HIV. Increasing age was associated with lower odds of hrHPV infection (OR = 0.98, 95% CI: 0.97–1.00; p = 0.017), as was higher parity (≥3 deliveries vs. nulliparity: OR = 0.58, 95% CI: 0.36–0.94; p = 0.029). Contraceptive use (OR = 1.65, 95% CI: 1.15–2.38; p = 0.007) and a partially or non-visible squamocolumnar junction (SCJ) (OR = 2.88, 95% CI: 1.74–4.79; p < 0.001) were associated with higher odds of VIA positivity. Conclusions: hrHPV infection and cervical lesions were more frequent in younger and HIV-positive women, highlighting the need for strengthened targeted screening within HIV care services in Mozambique.

Venereology doi: 10.3390/venereology5010003

Authors: Md. Ahsanul Haque Rahima Begum Md. Zulfekar Ali Dewan Zubaer Islam Ashikur Rahman Ismail Khalil Shahad Saif Khandker

Background: In Bangladesh, a number of sex workers are involved in commercial sex work in different brothels in both legal and illegal settlements due to reasons such as lack of social support, depression, forced sex, abuse, violence, polyamory, being kidnapped, and unemployment. In this study, we tried to evaluate the demographic characteristics and prevalence of viral and sexually transmitted diseases (STDs) among the study population. Methods: A total of 250 female sex workers were interviewed and tested from the Daulatdia brothel of Rajbari district, Bangladesh, who had been working there for at least 1 month. Through questionnaires, demographic data were collected. Primarily, lateral flow immunoassay (LFIA) tests were used to investigate HCV (Hepatitis C Virus), HBV (Hepatitis B Virus), and Syphilis, which were reconfirmed using enzyme-linked immunosorbent assay (ELISA) in cases of positive results. Results: The mean age was 27.51 ± 6.69 years with a range of 18–50 years. Most of them (n = 243, 97.98%) had elementary knowledge of STDs. We determined that overall, 96 (38.40%) were positive for either of these diseases. Individually, 10 (4.00%), 18 (7.20%), and 68 (27.20%) were positive for HCV, HBV, and syphilis, respectively. Conclusions: Our observation indicates that females of all ages should be strictly protected from forced sex work. Current sex workers should be educated regarding the dangers and protective mechanisms of STDs. In addition, as a public health concern, regular clinical check-ups and STD associated diagnoses are necessary to ensure the safety of FSW from these highly infectious and concerning diseases. Due to their socio-economic condition, proper treatment and rehabilitation are highly recommended.

Venereology doi: 10.3390/venereology5010002

Authors: Alemayehu Godana Birhanu Yalemsew Tefera Fitsum Tigu

Background: HIV is one of the deadliest viruses in the world and the leading cause of mortality and morbidity in the Sub-Saharan African countries, including Ethiopia. Millions of new HIV infections are reported every year among the population in the 15–24 age group. Particularly, adolescents are vulnerable to HIV infection due to a lack of adequate information and engagement in risky sexual practices. Thus, the assessment of knowledge, attitudes, and practices (KAPs) is one of the cornerstones in the fight against HIV/AIDS for designing appropriate prevention strategies. This study aimed to assess the KAPs regarding HIV/AIDS among high school students in Burayu town, Ethiopia. Methods: A cross-sectional study design was conducted on students from three higher secondary schools in Burayu town from February to June 2022. A total of 394 students were selected using a stratified proportional sampling technique. Data were collected using pre-tested and self-administered questionnaires and analyzed by SPSS version 26. Descriptive statistics were conducted, and logistic regression was used to determine the associations between variables. A p-value ≤ 0.05 was considered significant in all cases. Results: Out of the 394 students, the majority of respondents (70%) had sufficient knowledge about HIV/AIDS transmission and prevention, while only 61% demonstrated a positive attitude towards people living with HIV/AIDS (PLWHA). In bivariate analysis, a higher level of knowledge was significantly associated with a positive attitude towards PLWHA at OR 23.4, 95% CI, 2.9–185.5, p = 0.003, and not having had sexual practice at OR 4.1, 95% CI, 1.2–13.9, p = 0.025. In multivariate analysis, sexual practice was significantly (p ≤ 0.05) associated with the level of knowledge, age, gender, and places of residence at AORs values of 5.5, 9.7, 3.4, and 5.5, respectively. Conclusions: This study suggests that students with high levels of knowledge had a positive attitude towards PLWHA and less sexual practice compared to students with low levels of knowledge. Furthermore, students’ sexual practice was significantly associated with knowledge level, age, gender, and place of residence. This underscores the urgent need for targeted education to empower vulnerable groups, foster positive attitudes and practive, and curb HIV/AIDS transmission for improved health outcomes.

Venereology doi: 10.3390/venereology5010001

Authors: Ali Alsaeed Reda Kazem Aleid Mohammed Hashem Abo Alraahi Arafa Ali Almahroos Bader Kazem AlEid

Background: Oral manifestations are common among people living with HIV (PLWH) and serve as important clinical indicators of immune status and disease progression. Despite extensive global research, data from the Gulf Cooperation Council region, particularly Saudi Arabia, remain limited. Aims: In this study, we aimed to determine the prevalence of oral manifestations, and their associations with immunological parameters, in a large cohort of PLWH in the Eastern Province of Saudi Arabia. Methods: In this cross-sectional study, we enrolled 1500 adult PLWH who attended the Dammam Medical Complex HIV Clinic between January and December 2023. Demographic, clinical, and laboratory data were collected through medical record review. Standardized oral examinations were performed once per participant by two calibrated dentists using World Health Organization criteria. Statistical analyses included descriptive statistics, chi-square tests, and independent t-tests, with significance set at p < 0.05. Results: The cohort had a mean age of 38.3 ± 11.5 years and was predominantly male (78.3%). Most patients (89.6%) were receiving antiretroviral therapy (ART), with 75.7% achieving viral suppression. The mean CD4 count was 527 ± 221 cells/μL. Common co-infections included hepatitis C virus (11.7%), tuberculosis (17.2%), and hepatitis B virus (4.3%). The prevalence of any HIV-related oral manifestation was 72.9% (n = 1093); the most common findings were xerostomia (subjective dry mouth sensation, 48.1%), oral candidiasis (21.6%), and periodontitis (42.7%). Among severely immunosuppressed patients (CD4 < 200 cells/μL, n = 114), 89.5% had oral manifestations, with oral candidiasis affecting 66.7%. Severe immunosuppression was strongly associated with ART-naive status (92.0% vs. 8.0%, χ2 = 864.55, p < 0.001). The presence of HIV-related oral manifestations was significantly associated with CD4 count < 200 cells/μL (χ2 = 15.96, p < 0.001). Conclusions: HIV-related oral manifestations remain highly prevalent in our large Saudi cohort, despite high ART coverage, with xerostomia and oral candidiasis as the predominant findings. Severe immunosuppression was strongly associated with both ART-naive status and opportunistic oral infections. The association between oral manifestations and immunosuppression underscores their continued clinical relevance as accessible indicators of disease status. Integration of routine oral health screening into HIV care is essential for comprehensive patient management in the region.

Venereology doi: 10.3390/venereology4040016

Authors: Gabriel Kaleb Martins Sophia Cyane Souza Carvalho Maria Eduarda Dantas Reis Grazielly Ferreira Dias Gabriela Lopes Jesus João Victor Lima Cláudio Firmino Dantas

Background: Syphilis, a major sexually transmitted infection, may contribute to cardiovascular complications, impacting hospital outcomes and costs. This study evaluates the association between syphilis burden and hospitalization outcomes (cost, length of stay, and aneurysm mortality) across Brazilian regions from 2010 to 2024. Methods: Using Brazil’s national healthcare database (n = 405 state-year observations), we classified states by syphilis burden (high, low, intermediate) based on hospitalization rates. Outcomes included average hospitalization cost (R$), length of stay (days), and aneurysm mortality rate (per 100,000). Descriptive statistics, non-parametric tests, ANCOVA models adjusted for hospital complexity and year, and sensitivity analyses (alternative thresholds, outlier removal) were conducted. Regional trends and economic impacts were assessed. Results: High syphilis burden was associated with shorter hospital stays (β = 2.11, p = 0.0008, Cohen’s d = −0.484, power = 0.937) but not with cost (β = 37.6, p = 0.758) or mortality (β = −0.077, p = 0.951). Syphilis incidence correlated moderately with hospitalizations (r = 0.422) but not with aneurysm mortality (Spearman ρ = −0.065, p = 0.193). Total costs (2010–2024) were R$17.7 M (high burden), R$1.9 M (low), and R$12.0 M (intermediate). Regional analyses revealed significant interactions in Nordeste and Norte for length of stay (p = 0.013–0.033). Sensitivity analyses confirmed robustness (Adjusted R2 = 0.049–0.273). Conclusion: High syphilis burden is linked, ecologically, to reduced hospital stays, potentially reflecting fewer complex cases, with substantial economic costs. Regional disparities highlight the need for targeted STI prevention. These findings inform health policy to mitigate syphilis-related hospital burdens in Brazil.

Venereology doi: 10.3390/venereology4040015

Authors: Patricia Setsile Rantshabeng Nametso Dire Andrew Khulekani Ndlovu Ishmael Kasvosve

Background/Objective: High-risk human papillomavirus (hrHPV) is an established causative agent for the malignant transformation of cervical cells that can be detected using the Papanicolaou (Pap) smear test. A call by the World Health Organization (WHO) for global collective efforts towards eliminating cervical cancer has endorsed hrHPV DNA testing as an alternative screening test. The objective of this study was to determine the diagnostic utility of hrHPV DNA testing in detecting high-grade cervical intraepithelial lesions (HSILs) in unvaccinated women with abnormal Pap smears and histopathologically confirmed CIN3 and carcinoma. Methods: This study included 111 cervical tissues with a histopathological confirmation of the cervical intraepithelial neoplasia grade (CIN3) and malignancy. Tissues were sectioned, dewaxed, and digested, and DNA was extracted and tested for hrHPV using the Abbott RealTime HR HPV assay. Pap smear results associated with the tissue samples were extracted from corresponding clinical records, and data was analyzed using R-statistical software. Results: Extracted Pap smear records for the 111 cervical tissue samples indicated that 89 (80.2%) had a high-grade intraepithelial lesion (Pap-HSIL), 20 (18%) had squamous cell carcinoma (Pap-SCC), and two (1.8%) had Pap-adenocarcinoma. A total of 68/89 (76.4%) of Pap-HSIL, 15/20 (75%) of Pap-SCC, and ½ (50%) of Pap-adenocarcinoma cases had detectable hrHPV DNA. Conclusions: This study’s findings demonstrate that the Pap smear is still a valuable screening test especially for detecting both hrHPV-dependent and -independent cervical dysplasia in unvaccinated populations. While considerations are made to improve cervical cancer screening, including the introduction of hrHPV DNA testing in national cervical cancer screening programs, there is a need for the careful interpretation of molecular testing results for clinical intervention. This is especially important for hrHPV-independent cervical dysplasia screening, since this can have dire implications for clinically asymptomatic women.

Venereology doi: 10.3390/venereology4030014

Authors: Jyoti Taneja Ravi Kant Daman Saluja

Background: The increasing prevalence of antibiotic-resistant Mycoplasma genitalium poses a significant challenge to global public health, necessitating the exploration of alternative therapeutic strategies, including vaccine development. Methods: In this study, we employed an immuno-informatics-based reverse vaccinology approach augmented with artificial intelligence-driven tools, to identify and characterize potential B-cell and T-cell epitopes from the hypothetical proteins (HPs) retrieved from the genome of the MG_G37T strain, a previously uncharacterized yet promising vaccine target. Using multiple softwares, a systematic pipeline was utilized to assess the sub-cellular localization, antigenicity, and allergenicity of the selected proteins. Results: Sub-cellular localization analysis identified the presence of several outer membrane and extracellular proteins in the genome of MG_G37T, indicating their surface association and accessibility to immune surveillance. Antigenicity and allergenicity prediction tools led to the identification of two top-scoring hypothetical proteins (fig|2097.71.peg.1 (UniProt ID: P22747) and fig|2097.70.peg.33 (UniProt ID: Q57081)) that demonstrated strong antigenic potential, non-allergenic properties, and suitability as vaccine candidates. Epitope mapping and structural modeling analyses further validated the immunogenic potential of these epitopes, highlighting their ability to interact with host immune components effectively. Comparative analyses with mouse allelic regions indicated the potential translational relevance of these predicted epitopes for preclinical studies. Conclusions: In particular, this study highlights the potential of these two hypothetical proteins as a promising vaccine candidate and provides a strong reason for experimental validation towards the design and development of effective vaccines to combat M. genitalium infections in the era of antimicrobial resistance.

Venereology doi: 10.3390/venereology4030013

Authors: Izumo Kanesaka Saïd Abdellati Sheeba Santhini Manoharan-Basil Chris Kenyon

Background: There is an urgent need for novel treatment options for Neisseria gonorrhoeae. Methenamine is an interesting urinary antiseptic with a very low propensity to induce antimicrobial resistance. Methods: We assessed the MICs of methenamine-hippurate for 18 N. gonorrhoeae isolates. We then assessed the in vivo efficacy of methenamine-hippurate against N. gonorrhoeae using the Galleria mellonella infection model. Results: We found that all the gonococcal isolates had a methenamine-hippurate MIC of 300 mg/L. This MIC was not higher in isolates with higher ceftriaxone MICs. No toxicity of methenamine at the doses tested was found, and doses as low as 200 mg/kg were effective in the G. mellonella model. Conclusions: Further studies in mice and humans are required to assess if methenamine-hippurate could be used to treat gonococcal urethritis alone or in combination with other agents such as ceftriaxone.

Venereology doi: 10.3390/venereology4030012

Authors: Sofia Lírio Santos Silva Larissa Vieira do Amaral Raissa Vieira do Amaral Maria Isabel Figueiredo Sousa Mauricio Freitas Batista Maria Betânia Toralles Caroline Alves Feitosa Galileu Barbosa Costa Viviane Matos Ferreira

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.

Venereology doi: 10.3390/venereology4030011

Authors: Dominic Chu Kim Engler Tibor Schuster Romain Palich Joel Ishak Bertrand Lebouché

Background/Objectives: An optimal approach to addressing oral antiretroviral therapy (ART) adherence remains unclear in the research literature. This review aimed to identify definitions and thresholds of adherence, proposed methods and frequencies of evaluating adherence levels, barriers to adherence, and interventions to address adherence problems. Methods: A scoping review of HIV guidelines drew on guidance from the Joanna Briggs Institute. Eligible English and French guidelines and their updates concerned adults with HIV and oral ART from developed countries and international health organizations from 2017 to May 2023. Three databases were systematically searched, along with the gray literature. Then, a targeted search for omitted developed countries was conducted. Document selection and data charting were performed with two reviewers for 20% of records and full texts, followed by an independent review. Inductive–deductive content analysis of extracted data was performed using NVivo 14 software. Results: Twenty-four guidelines were identified from seven countries and two international health organizations. Only two defined ART adherence, and none offered a threshold for adequate adherence. Most guidelines (n = 22/24) reported adherence interventions, 20 guidelines (83%) identified adherence barriers, 20 guidelines (83%) noted variable methods to evaluate adherence, and 17 guidelines (71%) proposed a range of frequencies for assessing adherence. Conclusions: This review underscored a lack of consensus around adherence and its management. Very few guidelines defined adherence, none proposed an optimal threshold, and there was no agreement on how to gauge adherence. These gaps and variability raise questions about how clinicians manage adherence in practice. More systematic and preventative approaches to monitoring adherence may be needed.

Venereology doi: 10.3390/venereology4030010

Authors: Shukai Yuchi Noa Slotky Laurence Moore Rob Striker

Multidrug-resistant (MDR) Mycoplasma genitalium (M. genitalium) presents a significant risk of treatment failure in many sexually transmitted infections (STIs) and can result in persistent and recurrent urethritis or cervicitis. This case report describes a recurrent M. genitalium urethritis resistant to sulfamethoxazole-trimethoprim (TMP-SMX), doxycycline, and moxifloxacin. The infection was ultimately cured after both the removal of a nidus of infection and through the use of Lefamulin. Lefamulin is a novel agent approved for use in community-acquired bacterial pneumonia and bacterial skin infections that may be useful in difficult sexually transmitted infections. Background/Objectives: Deciding whether or not to treat M. genitalium can be challenging as it can be a colonizer, or present with a symptomatic pathogen, and even if it is causing symptoms, it can be drug-resistant. Our objective here is to highlight important considerations on whether or not to treat and, if so, what options exist. Conclusions: In a world of increasing drug-resistant STIs, this case highlights the challenges of managing MDR M. genitalium and how foreign bodies can allow reoccurrence. Also highlighted in this case, Lefamulin appears to be a viable alternative line of treatment of MDR M. genitalium that defies other first-line antibiotics.

Venereology doi: 10.3390/venereology4020009

Authors: Tatiana Ordóñez-Rodríguez Luis Antonio Leyva-Alejandro José Manuel Reyes-Ruiz Gustavo Martínez-Mier Roberto Carlos Cortes-Balán Oscar Faibre-Álvarez Judith Quistián-Galván Wendy Marilú Ramos-Hernández Víctor Bernal-Dolores

Background/Objectives: In Mexico, there is very little data on the prevalence of metabolic syndrome in people living with human immunodeficiency virus (HIV) receiving antiretroviral therapy (ART), so, determining the number of people with this condition will help to establish measures to treat it promptly. Methods: A descriptive, observational, prospective, cross-sectional study was conducted in a cohort of people living with HIV who signed the informed consent form and were stratified according to the criteria established by the Adult Treatment Panel III (ATP-III) and the Latin American Diabetes Association (ALAD) for the diagnosis of metabolic syndrome. Results: According to the ATP-III and ALAD criteria, 26.5% and 36.3% of people living with HIV receiving ART were diagnosed with metabolic syndrome, respectively. Metabolic syndrome was more prevalent in men than in women, using both classification criteria (ATP-III: 58 men [67.4%] vs. 28 women [32.6%]; ALAD: 84 men [71.2%] vs. 34 women [28.8%]). The median time since HIV diagnosis of the participants with metabolic syndrome was longer than for the participants without metabolic syndrome, using the ALAD criteria (p = 0.023). The time spent on ART among participants with metabolic syndrome was longer than among those without, using the ATP-III criteria (p = 0.011). The CD4+ T-cell count and HIV-RNA detection showed no significant difference between participants with and without metabolic syndrome (p > 0.05). No statistical significance was found concerning ART and metabolic syndrome; it is noteworthy that for participants with dolutegravir/abacavir/lamivudine (DTG/ABC/3TC), the frequency was similar regardless of the criteria used, and different for those who were taking bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) or were in other schemes (etravirine, darunavir/ritonavir, raltegravir). Conclusions: Our results suggested that 26.5% and 36.3% of the people living with HIV receiving ART included in this study had metabolic syndrome according to ATP-III and ALAD criteria, respectively. These results are consistent with results reported in the Latin American population. Interestingly, both criteria showed a higher frequency of metabolic syndrome in men living with HIV compared to women.

Venereology doi: 10.3390/venereology4020008

Authors: Richmond Nketia Daniel Atta-Nyarko Ebenezer Gyamfi Rostand Dimitri Messanga Bessala Naomi Adotei Benjamin Asare-Kyei Faustina Ameyaa Marfo Prosper Tonwisi Luri Charles Limula Abubakr Ahmed Farhan Michele Castelli Austin Gideon Adobasom-Anane

Background/Objectives: The recent Executive Order suspending the United States Agency for International Development (USAID) programmes, including Development Assistance for Health (DAH), has sparked serious debates about the sustainability of ongoing HIV/AIDS control programmes, particularly in Africa. In this study, we examined HIV/AIDS-specific DAH allocation to Africa from 1990 to 2022, and the potential effects of funding cutbacks on disease outcomes. Methods: We nested 54 countries within five sub-regions of Africa and applied linear mixed-effects models to estimate the effects of DAH on HIV/AIDS incidence and mortality rates, accounting for clustering by sub-region and potential variability due to baseline incidence and mortality and other sources of heterogeneity. Results: Total DAH allocated to Africa increased from US$534,343 in 1990 to US$5,273,264 in 2022. The United States (U.S.) public sector contributed nearly two-thirds (US$58,399,088; 63.01%) of the total funding. Most of these funds were disbursed to Southern and Eastern Sub-Saharan Africa (SSA), particularly countries with the highest HIV/AIDS burdens, including South Africa and Kenya. The fixed effects results and predicted margins indicate that, in addition to having a direct effect, U.S. public sector-specific DAH moderates the effectiveness of other international donor funding and domestic general government health spending (GHES) on HIV/AIDS incidence and mortality. Conclusions: Based on the historical trends and funding interactions, the cutback in U.S. DAH could be associated with weakening of the overall effectiveness of other donor funding and GHES. However, any future effects are contingent on African countries’ resilience to evolving challenges and resource allocation.

Venereology doi: 10.3390/venereology4020007

Authors: AKM Ahsan Ullah

Forced displacement exacerbates health vulnerabilities, particularly regarding HIV prevention, diagnosis, and treatment. Refugees often experience heightened exposure to HIV due to precarious living conditions, sexual violence, and healthcare access barriers. Background: Structural inequalities, legal precarity, and stigma hinder HIV care for refugees, especially in resource-limited settings. Excluded from national health programs, refugees often depend on underfunded humanitarian aid. Cultural stigma, limited awareness, and mobility constraints further heighten their vulnerability. Methods: This study draws on a review of peer-reviewed articles, policy documents, and case studies from refugee-hosting countries. It examines healthcare access, service provision gaps, and policy responses to HIV among displaced populations. Results: The article highlights systemic barriers to HIV services, including inadequate testing, inconsistent treatment availability, and cultural barriers to care. Policy frameworks often fail to integrate refugees into national HIV programs, exacerbating health disparities. Conclusions: The exclusion of refugees from national healthcare, compounded by stigma and mobility constraints, deepens health disparities and heightens HIV transmission risks. Without targeted interventions and inclusive health systems, refugees face disproportionate HIV-related morbidity, endangering broader public health in host communities.

Venereology doi: 10.3390/venereology4020006

Authors: Lusine Boryan Hovhannes Hovhannisyan Gennady Palozyan

Background/Objectives: Syphilis diagnosis in Armenia is unreliable due to inconsistent testing methods, limited access to confirmatory tests, and the underutilization of healthcare services due to stigma and lack of awareness. In 2022, 29% of cases were latent, 8.1% were late latent, 21% were secondary, and 1% were congenital. We assessed primary care physicians’ (PCPs) knowledge, attitudes, and practices regarding syphilis diagnosis and prevention to improve early detection. Methods: Between December 2023 and February 2024, we conducted a cross-sectional survey among outpatient physicians. We randomly selected 24 clinics in six regions. In each clinic, we randomly selected respondents from employee registries. We assigned one or two points to correct answers and zero points to incorrect or unknown answers; scores were categorized as Poor (0–<30%), Moderate (30–<70%), and Good (>70%). We used non-parametric tests to compare groups. Results: Of the 413 physicians contacted, 345 (83%) responded; 74% were female; the median age was 46 years; 54% had > 16 years work experience; and 47% worked as general practitioners. The respondents had moderate knowledge of risk groups (56%) and symptoms (49%) and poor knowledge of disease transmission (8%). As for practices, the respondents expressed difficulty in prescribing additional laboratory tests based on clinical symptoms (51%) and struggled with reporting diagnosed syphilis cases (66%); moderate opinions on pregnancy termination decisions (65%) were conveyed. The respondents’ knowledge did not correlate with their practice (r = 0.23) and attitude (r = 0.25) scores. Conclusions: PCPs’ knowledge was not positively associated with improved practices and attitudes regarding syphilis diagnosis and prevention. This highlights the need to improve healthcare workers’ post-graduate education and implement an efficient screening program to detect and treat asymptomatic, late latent, and congenital infections, as well as to prevent complications, transmission, and reinfection.

Venereology doi: 10.3390/venereology4020005

Authors: Jyoti Taneja Joyeta Ghosh Ravi Kant Myron Christodoulides

Sexually transmitted infections (STIs) are major global health challenges, disproportionately affecting women due to complex biological, social and economic factors [...]

Venereology doi: 10.3390/venereology4020004

Authors: Alessandra Latini

Over the past decade, the landscape of sexually transmitted infections (STIs) has evolved considerably [...]

Venereology doi: 10.3390/venereology4010003

Authors: Nyaradzo M. Mgodi Caroline Murombedzi Grant Murewanhema Enos Moyo Tafadzwa Dzinamarira

Sub-Saharan African (SSA) women experience a high prevalence of HIV, sexually transmitted infections (STIs), and unintended pregnancies, necessitating effective, integrated prevention strategies. Multipurpose prevention technologies (MPTs) offer a promising approach to address these overlapping health concerns by providing single products that simultaneously prevent HIV, other STIs, and/or unintended pregnancies. Given the persistent sexual and reproductive health (SRH) challenges faced by women in SSA, in this opinion piece, we explore practical considerations for MPT adoption and scale-up within the region. With this opinion article, we discuss the data on MPT development and identify key factors for successful MPT implementation in SSA. We examine the current MPT pipeline, product features, regulatory challenges, and structural, individual, and community barriers that impact MPT acceptance and usage among SSA women. Successful MPT uptake hinges on designing discreet, user-controlled products and engaging end-users, healthcare providers, and communities in product development and promotion. Structural factors such as robust supply chains, regulatory clarity, and financial support are also essential. Addressing socio-cultural norms, especially partner consent, and strengthening demand creation through community-driven, culturally sensitive strategies are critical for scaling MPTs. In conclusion, MPTs represent a transformative opportunity to reduce the burden of HIV, STIs, and unintended pregnancies in SSA. Strategic, culturally attuned approaches are essential to ensure the acceptability and accessibility of MPTs. Expedited pathways for regulatory approval, collaborative partnerships, and community-centered demand creation will be vital to realize the full potential of MPTs in advancing women’s SRH in SSA.

Venereology doi: 10.3390/venereology4010002

Authors: Enos Moyo Perseverance Moyo Leela Barham Derek Mangoya Malizgani Mhango Tafadzwa Dzinamarira

The World Health Organization (WHO) recommended the use of oral pre-exposure prophylaxis (PrEP) for HIV prevention in 2015. Although the number of countries with national PrEP recommendations increased from 2 in 2015 to 121 in 2019, there has been slow progress in Africa. The reason for this slow progress is that developing countries have budgetary constraints. Budget impact analysis (BIA) is an economic analysis that can help explore the affordability of oral PrEP. A rapid review was conducted to summarise the existing literature on the budget impact of adopting oral PrEP for HIV prevention. PubMed and Google Scholar databases were searched for relevant studies. Studies included in the review utilised primary data. Eleven studies met the inclusion criteria. This review reveals that most studies took a healthcare service provider perspective, targeted men who have sex with men (MSM), had time horizons of more than 10 years, used macro-costing, and performed univariate sensitivity analysis and discounting. If countries wish to perform a budget impact analysis of adopting oral PrEP for HIV prevention, we recommend that they select a target population that is most at risk of acquiring HIV. In addition, a time horizon of ten years or more should be used, and accurate values of the cost of oral PrEP and antiretroviral therapy (ART) and adherence to oral PrEP should be researched. Furthermore, deterministic sensitivity analysis should be carried out instead of probabilistic sensitivity analysis (PSA), as the degree of variability and the extent of the correlation among the parameters may not be known.

Venereology doi: 10.3390/venereology4010001

Authors: Lucy R. Mgopa Ever Mkonyi Mabula Kasubi Alan G. Nyitray Michael W. Ross

High-risk Human Papillomavirus (HPV) is a sexually transmissible virus that causes cancer. Vaccination against HPV is available up to age 45. Gay and bisexual men (GBM) are at high risk for oropharyngeal and anal cancers caused by HPV. As part of a larger study of HPV prevention in GBM, we obtained anal swabs for HPV and offered HPV vaccination to GBM in Dar es Salaam, Tanzania. Participants were recruited by an outreach worker experienced with the GBM subculture using Respondent-Driven Sampling (RDS) from seeds. Eighty-three of a possible one hundred participants (mean age 26) were enrolled, tested, and given a first vaccination dose. Anal swabs were tested for twenty-eight HPV genotypes, both high and low risk for carcinogenicity, and a median of seven different HPV genotypes was found in participants. A total of 87% of participants carried at least one HPV genotype, and 76% carried at least one high-risk genotype. As a result of harassment and unanticipated risk to participants and staff at the unmarked community-based site, this study was terminated before the sample size was reached. Since a full course of vaccine was the standard of care, participants were contacted using the contact method they had provided to arrange follow-up vaccination doses at an alternative clinical site. Twenty-nine percent received the additional vaccination. A further 6% made appointments but did not attend, and another 10% would have received the second vaccination if they were incentivized to attend. The rate of HPV in anal samples was significantly higher than in our study using the same recruitment method in the same city in 2011–2012. The HIV rate was 45%. Anal HPV rates, including high-risk HPV rates, were significantly higher than in a similar population of gay and bisexual men 12 years ago. It is possible to provide HPV vaccination to gay and bisexual men in Tanzania and have approximately 45% potentially re-attend for a second dose if they are incentivized. Great care must be used to situate vaccination to avoid stigma leading to harassment, especially where homosexuality is criminalized. We infer that the high-risk harassment faced by participants and lack of incentive for the second visit depressed the return rate for revaccination.

Venereology doi: 10.3390/venereology3040018

Authors: David F. Martín-García Julien Santi-Rocca

The COVID-19 pandemic disrupted routine healthcare services, including testing and treatment for sexually transmitted infections (STIs). At the same time, it fostered optimism about the potential of direct-to-consumer (DTC) self-testing solutions, fueled by remarkable progress in self-sampling practices, rapid testing technologies, and the adaptation of regulatory frameworks. Direct-to-consumer (DTC) self-testing and self-sampling for STIs became then still a more critical alternative, offering privacy, accessibility, and the potential to address testing gaps, especially for underserved, at-risk groups. This review critically analyzed the literature published since the onset of the COVID-19 pandemic. DTC testing has evolved significantly since the pandemic, with notable advances in technology, availability, and disease and geographical coverage. It has increased STI testing uptake among underserved or hesitant populations, including men who have sex with men and young adults. However, issues around cost, data reporting, and follow-up care persist, and many at-risk groups still lack access. While these solutions have improved testing uptake and public health outcomes, anticipated widespread adoption and advances have been slower than expected. Limited market options, weak research, and regulatory challenges have hindered growth. Research has often focused on potential user acceptance rather than real-world usage. Future directions should leverage trendy approaches in medical ethnography and transformational marketing to emphasize user- and data-driven innovation, affordability, and regulatory support based on private provider accountability.

Venereology doi: 10.3390/venereology3040017

Authors: Harris Onywera Zizipho Z. A. Mbulawa Adrian Brink Anna-Lise Williamson Lamech M. Mwapagha

Cervical cancer is more common in Sub-Saharan Africa (SSA) compared to developed countries, with persistent genital high-risk HPV (HR-HPV) infection identified as the cause. However, other factors contributing to this gap remain unclear. This review explores the potential role of cervicovaginal microbiota (CVM) in genital HPV infection and cervical cancer development among women in SSA. Many women of African descent, including those from SSA, lack lactobacilli dominance in their CVM, which is considered a biomarker of cervicovaginal health. Published literature has associated Lactobacillus-dominated CVM with a lower risk of HPV infection and cervical cancer. The converse is true for women with high diversity non-Lactobacillus-dominated CVM and bacterial vaginosis, the most common form of vaginal disorder. However, findings on the relationship between specific bacterial abundance and cervical disease severity are inconsistent and inconclusive due to differences in study design, study population, sampling, and potential confounders. Thus, there is a need to form consensus to advance research on CVM and HPV-associated cervical disease. Despite the exact mechanisms by which CVM influence HR-HPV persistence and cervical carcinogenesis being unknown, the backbone of the mechanisms appears to be mediated in part by the following: cervicovaginal dysbiosis, elevated vaginal pH, high ratio of L-to-D-lactic acid, cohesive biofilm formation, chronic inflammation, and immune dysregulation. Consequently, these promote cellular proliferation, genetic instability, and evasion of immune surveillance. This review calls for larger, prospective studies to unravel causal links, identify protective features, and integrate CVM interventions into HPV and cervical cancer prevention strategies in SSA.

Venereology doi: 10.3390/venereology3040016

Authors: Victor Abiola Adepoju Donald Chinazor Udah Chinonye Alioha Ezenwa Jamiu Ganiyu Qorinah Estiningtyas Sakilah Adnani

Background: Hepatitis C virus (HCV) infection presents a significant public health challenge globally, particularly in high-burden countries like Nigeria, where an estimated 2.4 million individuals are living with HCV. HCV self-testing (HCVST) can potentially bridge the significant diagnosis gap and help individuals to determine their HCV status in the privacy of their homes. It offers a solution to overcome barriers related to stigma and limited access to healthcare. In Nigeria, Self-testing for hepatitis C has only been implemented in a pilot research context. This study aimed to assess stakeholder and community awareness and perceptions of HCVST in Nigeria. The findings will provide insights that could inform effective policies and future scale-up programs for HCV control. Methods: A cross-sectional descriptive study was conducted using an online social media survey administered through SurveyMonkey. The survey was disseminated across social media platforms and groups between October–November 2023. Participants included Nigerians (both health professionals and non-health professionals) aged 18 years or older residing in any of the 36 states and the Federal Capital Territory (FCT). Data collected include sociodemographic characteristics, awareness and perceptions of HCVST, and perceived benefits and barriers. Results: Of 321 respondents, 94% perceived HCVST as highly important. While 77% of respondents knew about HIVST, only 58% had prior knowledge of HCVST. The analysis also showed that healthcare workers had greater awareness of HIV self-testing (82.3%) compared to non-healthcare workers (50.0%). Most respondents (88%) were highly likely to recommend HCVST and perceived it as a cost-effective alternative to traditional testing. Key perceived benefits included increased disease detection and control (67%), improved access to testing (21%), and reduced stigma (11%). In the unadjusted model, geographical zone (Southern Nigeria: cOR = 0.49, 95% CI: 0.30–0.77, p = 0.002), work experience (more than 20 years: cOR = 2.79, 95% CI: 1.11–8.07, p = 0.039), and prior awareness of HIV self-testing (cOR = 5.24, 95% CI: 3.00–9.43, p < 0.001) were significant predictors of HCVST awareness. However, in the adjusted model, only prior awareness of HIV self-testing remained significant (aOR = 4.77, 95% CI: 2.62–8.94, p < 0.001). Conclusions: The strong support for HCVST among stakeholders in Nigeria highlights its potential to enhance HCV control, especially within the broader context of infectious diseases like STIs. The greater awareness of HIV self-testing among healthcare workers compared to non-healthcare workers indicates the need for targeted awareness campaigns for non-healthcare populations. Addressing these awareness gaps, leveraging lessons from HIVST, and using existing infrastructure will be crucial. Prioritizing public education, outreach, and effective linkage to care will drive the impact of HCVST in achieving HCV elimination goals and position it as a model for expanding similar STI interventions in Nigeria.

Venereology doi: 10.3390/venereology3040015

Authors: Sushama Jadhav Aishwarya Nair Pratik Mahajan Vijay Nema

Extensive research on tuberculosis (TB) and HIV co-infection reveals the diverse prevalence and co-epidemic patterns across populations, necessitating tailored public health strategies. Co-infection is bidirectional; individuals with HIV are more susceptible to TB, and vice versa. Antiretroviral therapy (ART) and antituberculosis treatment (ATT) are critical for managing these conditions, but pose risks due to drug–pathogen and drug–drug interactions, potentially leading to immune reconstitution inflammatory syndrome (IRIS) in patients with HIV/AIDS. IRIS, often triggered by highly active antiretroviral therapy (HAART), can exacerbate HIV progression, increase drug resistance, and deteriorate patients’ quality of life. Approximately one-third of the global population with HIV is also infected with TB, with extensive drug-resistant (XDR) and multidrug-resistant (MDR) strains posing significant challenges. Latent TB infection (LTBI) further complicates the scenario, as it can progress to active TB, particularly in individuals with both conditions. The global and Indian mortality rates for TB-HIV co-infection remain high, emphasizing the need for new strategies. Additionally, unreported cases and inadequate post-treatment monitoring contribute to the high mortality rate, particularly among patients with LTBI. The complexity of managing HIV-TB co-infection, especially with LTBI, underscores the urgency of addressing these challenges to improve the outcomes for the affected populations.

Venereology doi: 10.3390/venereology3040014

Authors: Ana María Mejía Domínguez María de los Ángeles Soster-Contreras Nayelli Campos-Morales María del Rocío Sánchez-Díaz Gabriel Chavira-Trujillo Luis Pablo Cruz-Hervert María Eugenia Jiménez-Corona

The prevalence of transfusion-transmissible infections (TTIs) among blood donors is critical for ensuring blood safety. Aim: To provide an updated assessment of TTIs at a tertiary care hospital in Mexico over a ten-year period. We conducted a retrospective cross-sectional study. Blood samples were analyzed from potential donors at tertiary care hospital between 2012 and 2022. Donors completed a questionnaire and were screened for HIV, syphilis, hepatitis B, and hepatitis C using nucleic acid testing and serological tests. Prevalence and trends were estimated. Among the 117,756 donors analyzed, 0.48% were positive for syphilis, with a significant annual decrease of −5.9% (p < 0.001), although notable fluctuations occurred, including a peak in 2021. HIV showed a significant annual increase of 9.8% (p = 0.029), with a peak in approximately 2019–2020. Hepatitis C maintained a stable trend, with a slight annual decrease of −5.6% (p = 0.170). Hepatitis B consistently decreased, with an annual decrease of −11.3% (p = 0.06). This study highlights the importance of continuous monitoring and screening of blood donors to ensure blood safety. These findings underscore the need for localized public health interventions, particularly to address the increasing incidence of HIV. Further research should focus on enhancing donor screening practices and public health strategies to reduce the prevalence of TTIs.

Venereology doi: 10.3390/venereology3040013

Authors: Vidhushan Sivachandran Natasha Wahab Vaibhav Dubey Daniel Richardson Carrie Llewellyn

Background: The sexual transmissibility of enteric pathogens, including Salmonella spp., has been described in men who have sex with men (MSM). However, the factors seen in MSM with Salmonella spp. are poorly understood. Method: We aimed to systematically review the literature to explore any factors seen in MSM with Salmonella spp. (MSM). We searched six databases—Medline, PubMed, CINAHL, Embase, Emcare, and Global Health—in April 2024 for manuscripts which contained primary peer-reviewed data in English and the measurement of any risk factors observed in MSM with Salmonella spp. This review was registered on PROSPERO (CRD42023472864). Results: Eleven manuscripts were included in the final review and highlighted demographic (living with HIV), behavioural (oral–anal sex, receptive and penetrative anal sex, hand licking to stimulate their partner, group sex, non-condom use), and biological (co-infection with CMV, Mycobacterium avium complex, Strongyloides stercoralis, Blastocystis hominis, Klebsiella spp. Herpes simplex virus, Cytomegalovirus, Cryptosporidium, Histoplasmosis, Shigella spp.; previous infection with Treponema pallidum, Neisseria gonorhoeae, Chlamydia trachomatis and hepatitis B; and antimicrobial treatment failure) factors seen in MSM with Salmonella spp. Conclusion: Despite a limited number of manuscripts and individuals, this review highlighted some potential demographic, behavioural, and biological factors implicated in the transmission of Salmonella spp. in MSM. These data will provide insights for future guidelines, public health control strategies, and research.

Venereology doi: 10.3390/venereology3030012

Authors: Brian Otim Jerom Okot Christine Nannungi Ritah Nantale Winnie Kibone Grace Madraa Christopher Okot Felix Bongomin

Background: Condoms have proven to be an effective contraceptive barrier method of family planning and have played a vital role in preventing sexually transmitted diseases including HIV. However, existing evidence shows that utilization of condoms remains low, especially among youth and adolescents. We aimed to determine the condom use rate and associated factors among the students of Gulu University in Uganda. Methods: A cross-sectional study was conducted among undergraduate students of Gulu University between June and December 2023. The students were accessed from their respective faculties and chosen using a simple random sampling method. Data were collected using a pretested self-administered structured questionnaire. Condom use was defined as use of either male or female condom in any sexual encounter within the previous six months. Results: A total of 404 participants, with a median age of 23 years (interquartile range (21.5–24) years) were enrolled in this study, 54.2% (n = 219) of whom were men. The response rate of the respondents was 94.1%. Overall, 81.4% (n = 329) of the participants were in senior classes (year 2, 3, 4, and 5), and 18.6% (n = 75) were in their first year of study. The condom use rate was 53.7% (n = 217). Condom use rate was 50.2% (n = 109) among male and 49.8% (n = 108) among female students. Sex (men) (aPR = 0.82, 95% CI = 0.71, 0.95, p = 0.01), nature of sexual relationship (married) (aPR = 1.4, 95% CI = 1.07, 1.85, p < 0.015), place of HIV testing (University health unit) (aPR =1.22, 95% CI = 1.06, 1.41, p = 0.005), and having sex in the absence of condoms (aPR = 1.22, 95% CI = 1.01, 1.46, p = 0.021) were significantly associated with consistent condom use. Conclusions: Just over half of undergraduate students of Gulu University used condoms in their sexual encounters in the past six months. There should be heightened campaigns on condom use to prevent unintended pregnancies and sexually transmitted infections.

Venereology doi: 10.3390/venereology3030011

Authors: JohnBosco Chika Chukwuorji Chinonso Perpetual Odi Adaeze Chike-Okoli Nwando Maryann Morah Oluchi Miracle Osondu Dwi Kartika Rukmi Vera Victor-Aigbodion John E. Eze

Living with chronic health conditions such as HIV has implications for health-related quality of life (HRQoL) and improving the HRQoL of people living with HIV (PLWH) is becoming increasingly important for researchers, policymakers, and health practitioners. However, there is limited research on factors that help to explain HRQoL among persons with HIV in sub-Saharan Africa. We examined the contributions of emotion regulation and self-compassion in the HRQoL of 187 PLWH (56.1% female) drawn from the HIV clinic in a specialist hospital in southeast Nigeria. They completed the Brief Version of the Difficulties in Emotion Regulation Scale (DERS-18), Self-compassion Scale, and Patient-Reported Outcome Quality of Life-HIV (PROQOL-HIV). While controlling for participants’ demographic variables, the regression results showed that self-compassion was positively associated with HRQoL. Higher difficulties in emotion regulation were not associated with HRQoL in the presence of self-compassion. The findings extend the outcomes of previous research in other parts of the world and support the notion that enhancing self-compassion interventions may shore up the HRQoL of people living with chronic health conditions. HRQoL interventions that embody culturally informed self-compassion strategies and developmental level approach are needed for the health system in sub-Saharan Africa.

Venereology doi: 10.3390/venereology3030010

Authors: Eduarda Guimarães Sousa Andrei Giacchetto Felice Fabiana Vieira Dominici Arun Kumar Jaiswal Mariana Letícia Costa Pedrosa Luiza Pereira Reis Lucas Gabriel Rodrigues Gomes Vasco Ariston de Carvalho Azevedo Siomar de Castro Soares

Gardnerella vaginalis is a Gram-variable bacillus capable of causing bacterial vaginosis, a condition prevalent in reproductive-age women, this bacterium is present in almost 100% of cases and is also considered a gateway to various sexually transmitted infections. This organism exhibits high pathogenicity linked to virulence and resistance genes acquired throughout evolution, showcasing elevated resistance to a broad spectrum of drug classes. This study conducted comparative genomic analyses to identify these genes and correlate their presence with positive Darwinian selection. Additionally, new drug targets were selected through docking and molecular modeling, guided by the heightened antimicrobial resistance exhibited by this microbial species. The available genomes of G. vaginalis were analyzed, and the orthologous genes were delineated and positively selected, whereby 29 groups were found. Of these genes, one of great importance was predicted, Mef(A), which is related to resistance to the macrolide group of antibiotics, which are one of the main choices for the treatment of sexually transmitted infections. Additionally, two potential protein candidates were selected as drug targets. These proteins were linked with a natural compound each and are considered good potential drug targets. The analyses in this study contribute to analyzing the evolution of the species and how resistance genes are related to their permanence as a potential pathogen.

Venereology doi: 10.3390/venereology3030009

Authors: Anna Victória Bernardes e Borges Hugo Felix Perini Eliete Almeida Alvin Anielle Christine Almeida Silva Marcos Vinicius da Silva

Trichomonas vaginalis infection represents the most prevalent non-viral, curable parasitic sexually transmitted infection (STI) worldwide. The demand for precise and cost-effective point-of-care (POC) tests is paramount in the pursuit of STI epidemic control, ensuring expeditious patient diagnosis and therapeutic interventions. In the present study, we searched academic databases, including PubMed (US National Library of Medicine and the National Institutes of Health), Scopus, and Web of Science, employing the following keywords: “Trichomonas vaginalis”, “diagnosis”, “point-of-care tests”, and “rapid diagnosis”, to provide information about the development and effectiveness of POC tests to identify T. vaginalis. Present assays for T. vaginalis exhibit suboptimal performance, and the integration of advanced technologies, notably nanotechnologies, emerges as a formidable instrumentality for augmenting diagnostic precision while curtailing expenditure. In this review, we provide an encompassing survey of cutting-edge POC tests for T. vaginalis diagnosis and offer an outlook on future prospects in this domain.

Venereology doi: 10.3390/venereology3020008

Authors: Tariku Shimels Arebu Issa Bilal Desta Samuel Desalew Gedamu Eden Solomon Zewdneh Shewamene

Introduction: The development of antiretroviral therapy (ART) has immensely improved the quality of life of people living with HIV/AIDS. Despite such a change, concerns continue to persist regarding the safety of the latest drugs added to the regimens. This study aims to evaluate the incidence of type 2 diabetes mellitus (T2DM) and weight gain in individuals receiving antiretroviral therapy containing dolutegravir at a general hospital in Addis Ababa, Ethiopia. Methods: A retrospective cohort study was conducted at RDDMH from 1 February to 30 March 2022. The study included PLHIV who had dolutegravir substituted into their combined regimen in November 2019. Collected data underwent cleaning, entry, and analysis using Statistical Package for Social Sciences (SPSS) v. 26.0 and R programing. Descriptive statistics were employed for univariate and bivariate analysis. The Kaplan–Meier model in R was used to illustrate the hazard function. A significance level of p < 0.05 and a 95% confidence interval were employed for statistical reporting. Results: The study followed 185 PLHIV who were on ART who either substituted their previous regimens or initiated a new dolutegravir-based regimen for 12 months. Most were females (59.5%), aged over 38 years (57.5%), married (50.8%), and had lived with HIV for 7 or more years (51.9%). The incidence proportion of T2DM in this sample was 7.0% (95% CI: 3.8–10.3). The age category (X2(1, N = 185) = 12.29, p < 0.001) exhibited a statistically significant relationship with the incidence of T2DM. The cumulative rate of T2DM in the age group over 38 years was approximately 15.4%. The pairwise Wilcoxon signed rank test revealed statistically significant differences in BMI scores between time points. Conclusion: This study observed a noteworthy incidence of T2DM among PLHIV receiving a dolutegravir-based first-line ART. Healthcare providers should prioritize early follow-up and management options for PLHIV who are on dolutegravir-based ART regimens.

Venereology doi: 10.3390/venereology3020007

Authors: Omar Aboudawoud Shahrukh Chaudhry Pallavi Dubey Ghislain Hardy

Congenital syphilis, a preventable and deadly disease, has witnessed an alarming resurgence in the US in recent years, posing a vital public health challenge. Historically, effective prevention and treatment strategies led to a decline in congenital syphilis, and some believed that it could be eradicated. However, inadequate prenatal care, limited access to healthcare services, and gaps in syphilis screening programs have led to a resurgence of congenital syphilis. In this narrative review, we aim to highlight the key factors contributing to the reemergence of congenital syphilis and its implications on maternal and child health.

Venereology doi: 10.3390/venereology3020006

Authors: Marine Chlebus Laurence Boyer Sébastien Doerper Tristan Hergot Mihayl Varbanov

The burden of morbidity and mortality caused by sexually transmitted infections (STIs) has serious consequences on the quality of life of populations. Nowadays, despite numerous prevention campaigns, sexually transmitted infections have been on the rise in France for several years. It remains important to transmit the right information in order to better educate and support patients. Where then remains the problem, and how can we improve the involvement and awareness of the general population regarding the risks of these STIs? It is imperative to work upstream on the training of health professionals and students because they are the first interlocutors and the only ones to transmit the knowledge acquired during their initial training to the individuals concerned. The objective of this work is to identify the areas where health professionals and students do not yet have all the notions acquired via a multiple-choice questionnaire on the different STIs and their major characteristics. These results will contribute to the implementation of additional training at the Health Centers in France.

Venereology doi: 10.3390/venereology3010005

Authors: Cyprian Mostert

Background: This study seeks to understand the empirical nature of macro-financial factors associated with the worsening of HIV infections and the risks that need to be carefully monitored for a sustainable improvement in HIV outcomes as developing countries seek to achieve the United Nations 95-95-95 targets. Methods: The author used a panel VAR model to study the long-term endogenous relationships between percentage changes in the annual spot price of the most traded commodities, GDP per capita, health spending, and the HIV infection rate of developing countries. Results: The author discovered that shocks of global commodity prices negatively impact GDP per capita, real government health spending, and real private health spending. These shocks have adverse spillover effects characterized by worsening HIV infections. The reactions from price shocks suggest that GDP per capita contract immediately when a commodity price shock hits developing economies. Real government health spending and real private health spending also contract instantly. HIV infections begin worsening three years after the shock in the energy and precious metal blocks of countries. HIV infections also begin to worsen two years after shocks in the agricultural block of counties. These impacts are statistically significant and can potentially reverse the positive HIV infection gains achieved in the previous years. Emergency funds, insurance schemes, and international aid for HIV need to discharge more funds to counter these shocks. Conclusions: There is a significant risk of reversing HIV infection outcomes arising from commodity price shocks. Funding agencies must protect HIV prevention services from global macro-economic shocks as countries move closer to the United Nations 95-95-95 targets.

Venereology doi: 10.3390/venereology3010004

Authors: Fernanda Gomes Cardoso Mariana Dicki Freitas Tiana Tasca Graziela Vargas Rigo

Trichomoniasis is the most common non-viral sexually transmitted infection (STI) in the world. The estimated global prevalence in 2016 was 156 million adults aged 15–49. However, these data are underestimated, since the most used diagnostic method is the wet mount, which has low sensitivity, the information regarding the estimated duration of infection is limited and there is evidence of undiagnosed asymptomatic cases in both sexes. Currently 80% of cases—including both sexes—are asymptomatic, which makes the disease silent and chronic in course, leading to complications. The aim of this review was to discuss the diagnostic methods for T. vaginalis detection that are currently available and applicable in the clinical laboratory routine. Overall, nucleic acid amplification techniques are the best option for T. vaginalis detection, with higher sensitivity and specificity than other tests. Although these techniques present higher cost, their implementation should be supported to ensure correct trichomoniasis diagnosis and treatment beyond contributing to questions on epidemiology and control.

Venereology doi: 10.3390/venereology3010003

Authors: Eliška Vrbová Helene Zondag Sylvia Bruisten David Šmajs

The Arg753Gln polymorphism in Toll-like receptor 2 has been associated with an increased risk of bacterial infections as well as with protection from the late stages of Lyme disease and the acquisition of syphilis. In this study, we determined the presence of this polymorphism in samples collected from men having sex with men/men with women in the Amsterdam Cohort Studies. The presence of the polymorphism was determined by nested PCR, followed by Sanger sequencing. A set of 90 syphilis-seronegative individuals was compared to 95 syphilis-diagnosed participants. A polymorphism allele frequency of 3.9% was found in the control group and 2.63% in the syphilis case group, respectively. None of the individuals showed a homozygous Arg753Gln polymorphism. The number of self-reported sexual contacts was higher in the group of syphilis patients compared to the control group (p = 0.0063). Moreover, in the syphilis case group (n = 49), participants heterozygous for the TLR2-Arg753Gln reported higher numbers of sexual contacts (p = 0.037) compared to wild-type homozygotes. Our findings suggest a possible protective effect of TLR2-Arg753Gln in the acquisition of syphilis. In addition, the determination of the number of self-reported sexual contacts can be used in an evaluation of the protective effect of polymorphism in a population with a low prevalence of it.

Venereology doi: 10.3390/venereology3010002

Authors: Nícolas Luiz Feijó Silva Patrícia de Brum Vieira Márcia Vanusa da Silva Alexandre José Macedo Tiana Tasca

Women living in the semi-arid region of Caatinga in the northeast of Brazil report the use of plant mixtures to treat diseases in the genitourinary tract. Plant extracts were obtained from barks to simulate traditional use. The anti-trichomonads activity as well as the cytotoxic effect of plant extracts were tested. Herein, we confirmed this traditional knowledge by testing plants aqueous extracts against Trichomonas vaginalis and Tritrichomonas foetus, the etiologic agents of human and bovine trichomoniasis. All plant extracts were active individually against at least one trichomonads species except for Prosopis juliflora and Amburana cearensis. Cedrela sp. was the most active against both trichomonads species. Finally, a mixture of plants used in traditional medicine was evaluated for activity. A mixture containing extracts of the plants Ximenia americana, Anadenanthera colubrina var. cebil, Myracrodruon urundeuva, Sideroxylon obtusifolium, and Amburana cearensis was active against the two trichomonads. This finding confirms the traditional practice by women living in the Caatinga region of using a mixture of plants during sitz baths to treat vaginal infections. Altogether, these results highlight the ethnopharmacological use of Cedrela sp. and of the plant mixture for the treatment of venereal diseases by Caatinga residents.

Venereology doi: 10.3390/venereology3010001

Authors: Andrzej Załęski Mariusz Sapuła Agnieszka Lembas Alicja Wiercińska-Drapało

Background: Since the implementation of pre-exposure prophylaxis (PrEP) in HIV prevention, a significant increase in the prevalence of other sexually transmitted infections (STIs) has been reported, especially among men who have sex with men (MSM). Doxycycline is being examined as a potential pharmacological agent in preventing these infections. This review aims to summarize available data on the effectiveness and potential side effects of doxycycline for the prevention of bacterial STIs. Methods: We reviewed the National Library of Medicine and the National Center of Biotechnology Information in order to find clinical trials and relevant observational studies regarding doxycycline usage in STI prophylaxis. Results: Doxycycline prophylaxis reduced the risk of acquiring chlamydia, syphilis, and, in a majority of the trials, the risk of gonorrhea. The clinical trials on doxycycline STI prophylaxis were underpowered to determine if doxycycline promotes the selection of resistance in Neisseria gonorrhoeae and Chlamydia trachomatis. Additionally, no serious side effects of this preventive measure have been reported. None of the studies aimed to compare the efficacy of post- and pre-exposure prophylaxis of STDs with doxycycline. Conclusions: The preliminary results regarding STI prophylaxis with doxycycline seem to be promising. Further research is needed to determine the potential risk of doxycycline prophylactic prescription.

Venereology doi: 10.3390/venereology2040016

Authors: Michael W. Ross Sarah L. Bennis Niles Zoschke Brian R. Simon Rosser Cyndee L. Stull Alan G. Nyitray Samir S. Khariwala Mark Nichols Charlene Flash Michael Wilkerson

Oropharyngeal cancers (OPCa) caused by HPV have emerged as one of the leading causes of malignancies caused by HPV infection. They are also significantly more likely to occur in males and in people with a history of oral sex with multiple partners. Gay and bisexual men are disproportionately affected by HPV-positive oropharyngeal cancers. We studied 1699 gay and bisexual men on 2 major dating sites in the US to assess their knowledge about HPV-related OPCa, attitudes toward screening for it, beliefs about oropharyngeal cancer screening based on the Health Belief Model, and attitudes toward possible screening approaches for OPCa. Knowledge on a 12-item scale was low, with a median of 5 items correct: 72% knew of the benefits of HPV vaccination. Significant predictors of needing OPCa screening included perception of risk for OPCa, seeing it as severe, having lower barriers, fewer reasons to avoid screening, higher knowledge, and being HPV vaccinated were significant predictors, explaining half the total variance. Most participants would accept routine, virtual/online doctor or dental appointments, and over half would accept an in-person screening. Nearly two-thirds stated that they would accept getting checked for OPCa if they could do self-screening at home, and half were prepared to use an online screening tool or app, where they could take an “oral selfie” and send it to a healthcare provider for examination. One-third stated that they would trust the results of a home screening completed by themselves and posted to a website equally as cancer screening completed online by a healthcare provider. Data indicate that despite low OPCA knowledge levels, the risk of HPV-associated OPCa was known. Being at personal risk and having knowledge of disease severity had 70% of the sample thinking about, or preparing to get, screening. Self-screening by a smartphone “oral selfie” transmitted to a screening website was acceptable to many gay and bisexual men, and online screening by a doctor or dentist was acceptable to most. OPCa screening in this population using electronic technology, together with the increasing incidence of HPV-associated OPCa in gay and bisexual men, brings together an opportunity to detect OPCa early.

Venereology doi: 10.3390/venereology2040015

Authors: Peter D. Ahiawodzi Cydney Nicholson Briana Williams Dorothea K. Thompson

Sexually transmitted infections (STIs) constitute a major public health issue in the United States. North Carolina (NC) in the southeastern U.S. ranks among the highest in STI incidence. We aimed to describe the incidence rates and identify potential risk factors of STIs in NC. The STI data reported by the NC Department of Health and Human Services for 2018 were compiled for chlamydia, gonorrhea, syphilis, and HIV infections for all 100 NC counties. Linear regression modeling was used to assess the association of STIs with predefined county-level variables. The mean STI incidence rates per 100,000 persons were highest for chlamydia (592.43 ± 30.02), followed by gonorrhea (212.06 ± 13.75), HIV (12.66 ± 0.947), and syphilis (3.33 ± 0.439). For chlamydia, higher risk was significantly associated with income (β = −0.008, SE = 0.003; p = 0.006), education (some college; β = 10.02, SE = 3.15, p = 0.002), race (Black; β = 12.17, SE = 1.57, p < 0.0001), and number of truck stops (β = 20.20, SE = 6.75, p = 0.004). The same variables, except for education, were associated with higher gonorrhea risk. Only race (being Black) was significantly associated with higher syphilis risk. Racial disparities in STI burden were significant, with race (being Black) constituting a risk factor for all four STIs. Interventions targeted to identified risk factors may help to reduce the STI burden in NC.

Venereology doi: 10.3390/venereology2040014

Authors: Ifueko Mercy Moses-Otutu Nosawema Franklyn Ojo Ogochukwu Janet Nzoputam Chimezie Igwegbe Nzoputam

Background: Human cytomegalovirus (HCMV) is an important pathogen in immunocompromised individuals where it causes end organ diseases leading to increased morbidity and mortality. The aim of this study was to determine the prevalence of HCMV infection and its associated risk factors among HIV patients in Edo State, Nigeria. Methods: A total of 150 HIV patients consisting of 80 males and 70 females were enrolled for this study. About 4 mL of venous blood was aseptically collected from each participant by venipuncture and was centrifuged to obtain serum. The serum was screened by ELISA for HCMV IgG and IgM antibodies. Results: The results obtained were analyzed using SPSS version 20 for data analysis. An overall prevalence of 32.7% for HCMV IgM antibodies was recorded among the HIV patients. Males had a higher prevalence of 55.1% HCMV IgM antibodies than their female counterparts with 44.9% HCMV IgM antibodies. HCMV was more prevalent among the age group <19 years (51.0%), followed by the age group 20–39 years (30.6%), while the age groups >60 years, and 40–59 years recorded a prevalence of 12.2% and 6.1%, respectively. Conclusions: The co-occurrence of HCMV IgG and IgM antibodies, religion and location significantly influenced the acquisition of HCMV infection among HIV patients. Integrating HIV prevention by spreading awareness and early diagnosis of HCMV is key to reducing complications from these viral infections in HIV disease patients.

Venereology doi: 10.3390/venereology2040013

Authors: James Oluwagbamigbe Fajemiroye Andre Luis Elias Moreira Célia Regina Malveste Ito Elson Alves Costa Rafaella Misael Queiroz Ogbu John Ihayi Caroline Vitória Moreira Rafael Fernandes Costa Claudia Carneiro Teixeira Miguel Júnior Sordi Bortolini Osmar Nascimento Silva

In recent years, the global resurgence of syphilis has posed significant challenges to public health. This sexually transmitted infection, caused by the bacterium Treponema pallidum, can have severe consequences if left untreated, including neurological and cardiovascular complications. Diagnosing syphilis is complex due to its diverse clinical presentations, necessitating a multifaceted approach, including serological, molecular, and direct techniques such as dark-field microscopy. Penicillin remains the primary and effective treatment, but emerging macrolide-resistant strains have spurred investigations into alternative antibiotics. Syphilis vaccine development faces unique hurdles, yet promising strategies are under investigation. Targeted prevention strategies focus on high-risk populations such as men who have sex with men, pregnant women, and individuals with multiple sexual partners. The integration of syphilis services into primary healthcare enhances accessibility, early detection, and treatment. Innovative point-of-care diagnostics offer rapid, sensitive testing, while ongoing vaccine research holds the potential for long-term prevention. Addressing the global burden of syphilis requires a multifaceted approach, encompassing immunological advancements, innovative diagnostics, targeted prevention, and primary healthcare integration. Collaborative efforts between governments, healthcare systems, researchers, and communities are essential to effectively combat syphilis, striving toward a syphilis-free future that promotes better sexual health and overall well-being.

Venereology doi: 10.3390/venereology2040012

Authors: Andrei Giacchetto Felice Eduarda Guimarães Sousa Fabiana Vieira Dominici Vasco Ariston de Carvalho Azevedo Siomar de Castro Soares

The genus Gardnerella comprises Gram-variable, anaerobic, hemolytic, and non-motile bacilli, with four known species, where Gardnerella vaginalis is the main species responsible for bacterial vaginosis (BV). However, quantifying this species is challenging due to a lack of data and underreporting. Despite its significance, particularly for women, and the availability of several genomes in online databases, genomic analyses and studies on effective treatments still lack details. This study aimed to conduct bioinformatic analyses focused on pangenomics to investigate the complete gene repertoire of the species. Genomes of the bacterium available in online databases were used for comparative genomics, genomic plasticity, gene synteny, and pangenome prediction analyses. The results revealed considerable genome variability, indicating a highly diverse pangenome. The low number of genes in the core genome and similarity analysis confirmed this variability. Three pathogenicity islands, two resistance islands, and nine genomic islands were identified, suggesting horizontal gene transfer events during evolution. These findings underscore the need for sequencing new G. vaginalis genomes to better comprehend its variability and adaptation patterns.

Venereology doi: 10.3390/venereology2030011

Authors: Benjamin Silverberg Chad Sethman Jonathan Williamson Mary Craft Melinda Sharon Amie M. Ashcraft

Syphilis is a sexually transmitted infection caused by the bacterium Treponema pallidum. Currently, rates of infection are increasing across all populations worldwide, with disproportionate impact on men who have sex with men, adolescents, and young adults. Syphilis is well-known for its variability in disease progression and clinical presentation, which complicates prompt and accurate diagnosis. Acute care settings have become the frontline in the battle against this syphilis surge, and providers must be prepared to recognize syphilis presentation, initiate appropriate testing, and establish contact tracing for individuals who may have been exposed. The purpose of this manuscript is to serve as a teaching tool for syphilis diagnosis and treatment, and we present four cases that showcase the risks and variable clinical presentation, discussing the challenges involved in managing each case. The authors then summarize key learning points related to diagnosis, treatment, and follow-up.

Venereology doi: 10.3390/venereology2030010

Authors: Felix Bongomin Winnie Kibone Pebalo Francis Pebolo Fiona Gladys Laker Jerom Okot Felix Ocaka Kaducu Grace Madraa Constantine Steven Labongo Loum Silvia Awor Agnes Napyo David Musoke Simple Ouma

Background: Female sex workers (FSWs) are at a higher risk of contracting and transmitting HIV and other sexually transmitted infections (STIs). We aimed to explore the sexual behaviour, knowledge and attitudes towards STIs, barriers, support and intervention for STI screening. Methods: In this community-based, concurrent quantitative–qualitative, exploratory mixed-methods study, we administered 87 semi-structured quantitative and six in-depth interviews to purposively select FSWs in Gulu City, Uganda. The qualitative methodology was based on descriptive phenomenology. Results: The quantitative study included 87 FSWs, with a median age of 28 years. Overall, 87.4% (n = 76) participants reported condom use during their last sexual encounter. Eighty-three (95.4%) participants were aware of their HIV status, with 6% (n = 5) reporting being HIV-positive. Seventy-six (87.4%) participants reported contracting at least one STI during sex work. In addition, 66.7% (n = 58) of the participants reported being screened for STIs in the past three months, with vulvovaginal candidiasis (55.3%, n = 42) and syphilis (32.9%, n = 25) being the most common STIs. However, only 2.3% (n = 2) of the participants reported current STIs symptoms. In the qualitative study, the main themes encompassed sexual behaviour, including condom-use negotiation strategies and challenges, as well as screening facilitators and barriers. Condom-use negotiation tactics involved leveraging health-risk information, increased charges for unprotected sex, and outright refusal. Complex challenges included limited agency in promoting safe sex due to economic reliance, vulnerability to violence, and difficulties in controlling the sexual environment. Facilitators for regular screening included social influences, emotional relief, established testing habits, and accessible clinics, while barriers encompassed cost, stigma, doubts about test accuracy, and inconvenient clinic hours. Conclusions: FSWs face significant vulnerabilities in Gulu City, Uganda, regarding STIs. While encouraging trends such as high HIV awareness and condom usage were observed, persistent challenges in STI screening, negotiation of safe sex practices, and access to prevention and treatment remain evident. To address these concerns, targeted interventions should be developed to enhance STI screening accessibility, empower sex workers with effective negotiation skills, and provide comprehensive support for STI prevention and treatment, thereby contributing to improved overall sexual health and well-being among this marginalized population.

Venereology doi: 10.3390/venereology2030009

Authors: Venkatesan Chakrapani Smitha Nair Sudharshini Subramaniam Ketki Ranade Biji Mohan Ruban Nelson Sajeesh T. Sivaraman Murali Shunmugam Jasvir Kaur Shruta Rawat Theranirajan Ethirajan Chinmoyee Das Shobini Rajan Anoop Kumar Puri Bhawani Singh Kushwaha Bhawna Rao Utpal Das Vinita Verma Neha Kapoor

Reducing the stigma and discrimination faced by men who have sex with men (MSM) and transgender women (TGW) in healthcare settings is key to improving health outcomes. Using a one-group pre- and post-test design, we tested the efficacy of a theory-informed, multi-level pilot intervention (“Harmony”) among 98 healthcare workers (HCWs) to reduce sexual orientation and gender identity (SOGI)-related stigma and discrimination faced by MSM and TGW in two public hospitals. The intervention contained group-level (a half-day workshop) and individual-level (four videos) components. Using multi-level modelling, we compared knowledge, attitudes, and comfort level among HCWs across three timepoints: pre-intervention, post-intervention, and follow-up (2 months after the intervention). Client surveys were conducted among 400 MSM/TGW (two independent samples of 200 MSM/TGW) attending the intervention hospitals, before the intervention among HCWs and three months after the intervention. Generalised estimating equations assessed service users’ satisfaction with hospital services, discrimination experiences, and positive interactions with HCWs. Significant changes were observed in primary outcomes: 30% increase in positive attitude scores (incidence rate ratio (IRR) = 1.30, 95% CI 1.13–1.49) and 23% increase in the proportion of HCWs reporting being comfortable in providing care to MSM/TGW (IRR = 1.23, 95% CI 0.03–1.68). Similarly, there was a significant improvement in secondary outcomes (scores): support for non-discriminatory hospital policies (IRR = 1.08, 95% CI 1.004–1.15), the importance of asking SOGI questions in clinical history (IRR = 1.17, 95% CI 1.06–1.29), and perceived self-efficacy in providing clinical care (IRR = 1.13, 95% CI 1.01–1.27). Service users’ data provided corroborative evidence for intervention efficacy: e.g., 14% increase in the proportion of MSM reporting overall satisfaction with hospital services and 6% and 15% increase in the scores of positive interactions with HCWs in the combined sample of MSM/TGW and TGW, respectively. The Harmony intervention showed preliminary evidence for improving positive attitudes, comfort level, and understanding of the healthcare issues of MSM/TGW among HCWs, warranting large-scale implementation research.

Venereology doi: 10.3390/venereology2030008

Authors: Jude Ogechukwu Okoye Anthony Ajuluchukwu Ngokere Chinedum Charles Onyenekwe Olaposi Idowu Omotuyi Samuel Ifedioranma Ogenyi Chioma Maureen Obi Samuel Ayobami Fasogbon

Identifying immunocompromised women who are at risk of developing cervical cancer remains a challenge for clinicians. In an effort to identify the role of HIV in cervical carcinogenesis, this study evaluated the levels of normally downregulated oncomirs (miR-21, miR-146a, miR-155, miR-182, and miR-200c) and normally upregulated tumor suppressors (miR-let-7b, miR-125b, miR-143, miR-145, and p53 expression) associated with cervical cancer in the serum of women living with HIV (HIV+) and without HIV (HIV. Method: This case-control study included 173 women; confirmed HIV+ (n = 103) and HIV− (n = 70). Serum levels of miRNAs and p53 were determined using reverse transcriptase PCR. t-test and Pearson’s correlation analyses were carried out on the generated data. Result: A higher level of miR-21 was observed among HIV+ women compared with their HIV− counterpart (p = 0.028), whereas lower levels of miR-125, and p53 gene were observed among HIV+ women compared with HIV− women at p = 0.050 and 0.049, respectively. Significant direct relationships were observed between miR-21 and other oncomirs (p < 0.05) among HIV+ women. Conclusion: This study revealed that HIV contributes to cervical carcinogenesis by modulating circulating levels of miR-21, p53, and miR-125b. It suggests that these biomarkers could be used to identify at high risk for developing cervical cancer.

Venereology doi: 10.3390/venereology2020007

Authors: Karan Varshney

Antimicrobial resistance (AMR) has become one of the most pressing public health crises, with sexually transmitted infections (STIs) of all types rapidly becoming resistant to treatments [...]

Venereology doi: 10.3390/venereology2020006

Authors: Shahrukh Chaudhry Idris Akinlusi Ted Shi Jorge Cervantes

The subspecies T. pallidum pallidum is the cause of the most infamous sexually and congenitally transmitted disease, syphilis. This disease has an estimated incidence of six million infections every year. Multiple studies have noted that the prevalence of syphilis has been steadily increasing worldwide in recent decades, especially among MSMs and HIV-positive patients. Clinically, syphilis presents in four stages with multiple different clinical manifestations. In this paper, we examine the current literature to determine the history and progression, pathogenesis, clinical features, and testing of secondary syphilis. Secondary syphilis is a stage of the disease with the most exuberant local and systemic clinical manifestations. The basis of the pathogenesis of SS underscores the unique mechanisms by which Treponema pallidum utilizes to escape immune recognition while simultaneously induces inflammation. SS can affect multiple organ systems and become more than just an STD. The most common presentation of secondary syphilis is rash, which manifests as a copper-colored maculopapular lesion on the trunk, palms, and soles. Although the RPR, VDRL, and FTA-ABS tests are perhaps the most commonly used diagnostic tools for syphilis and make up the traditional and reverse algorithms, there are other methods, including morphology and immunohistochemistry.

Venereology doi: 10.3390/venereology2020005

Authors: Noel C. Barragan Ranjana N. Wickramasekaran Frank Sorvillo Lisa V. Smith Tony Kuo

Rates of reported cases of syphilis have steadily increased since 2000 in the United States. However, despite the increase in cases, mortality from 2000–2014 declined. The following study examines the latest trends in syphilis-related deaths using 2015–2020 Multiple Cause of Death data. A total of 925 syphilis-related deaths were identified during the study period, 30% of which listed syphilis as the underlying cause of death. On average, age-adjusted syphilis mortality increased by 9.51% annually (95% CI = 5.41%–13.77%). Study findings indicate a marked increase in deaths attributed to syphilis, underscoring the need to more systematically and comprehensively address the growing sexually transmitted infection epidemic in the United States.

Venereology doi: 10.3390/venereology2010004

Authors: Jimoh Amzat Kehinde Kazeem Kanmodi Kafayat Aminu Eyinade Adeduntan Egbedina

School-age youth constitute a neglected but highly vulnerable group concerning sexual health risks in low-resource countries. Robust evidence concerning the research landscape of school-based interventions on human papillomavirus in Africa is currently lacking. Therefore, this systematic scoping review (SSR) aims to map evidence about school-based HPV interventions and identify emerging themes, gaps and lessons learned in Africa. This review was guided by Joanna Brigg’s Institute’s guidelines for SSRs and reported based on the Preferred Reporting Items for Systematic Reviews and Metanalysis for Scoping Reviews. Five databases—PubMed, CINAHL, PsycINFO, SCOPUS, and Allied and Complementary Medicine—were searched for relevant literature using appropriate search terms and Boolean operators. The retrieved literature was extracted, deduplicated and screened using the Rayyan software. Only those articles which met the eligibility criteria were included for data charting, collation, and summarization. Ten articles were included in this review. The articles demonstrate that a life-course approach is significant in health intervention. School-based health interventions help reach adolescents in a dynamic life stage, affecting their vulnerability to sexual health risks. The school-based interventions serve as an ideal platform to offer HPV peer education, improving their HPV knowledge and subsequent testing services and enhancing their acceptability for screening and vaccination. Cervical cancer education and screening can be effectively combined in HPV health services for women. While the studies are geographically diverse, such effective interventions, which help reduce bottlenecks in accessing HPV screening and vaccination, are very few in Africa. In conclusion, school-based intervention is a viable strategy that can be adopted for adolescent protection from HPV-induced diseases. However, the current evidence on the impact of these interventions, particularly HPV vaccination, is inadequate.

Venereology doi: 10.3390/venereology2010003

Authors: Venkatesan Chakrapani Pushpesh Kumar Jasvir Kaur Murali Shunmugam Debomita Mukherjee

Transgender women (TGW) in India, especially those who engage in sex work, are at high risk for HIV. Guided by the information-motivation-behavioral skills model and qualitative formative research findings, Sakhi (girlfriend), a 3-week smartphone-based pilot intervention consisting of short videos (one/week) and text messages (two/week), was implemented using a one-group pre- and post-test design to test its efficacy in promoting condom use and HIV testing among TGW (n = 50) who engage in sex work in Chennai. Changes in outcomes were assessed by conducting multivariable analyses using generalized estimating equations. Participants’ mean age was 26 years, and the mean monthly income was INR 21700 (USD 292). About one-third completed college, and 96% were HIV-negative. Significant changes in the desired direction were observed in the primary outcomes: condom use – decrease in the engagement of condomless anal sex with male partners (12% to 2%, p < 0.05) and HIV testing – increase in intentions to undergo HIV testing every 6 months (34% to 86%, p < 0.001); and in some of the secondary outcomes: decrease in alcohol use before sex, increase in intentions to use condoms consistently and increase in the well-being score. This study demonstrated the feasibility, acceptability, and preliminary efficacy of the Sakhi intervention and warrants a larger randomized trial among diverse subgroups in diverse settings.

Venereology doi: 10.3390/venereology2010002

Authors: Abdulai Abubakari Habibu Issah M. Awell Olives Mutaka Mubarick Nungbaso Asumah

Background: Even though highly active antiretroviral therapy (HAART) for HIV (Human Immune Deficiency) patients has considerably improved viral load suppression, more people still struggle to reduce viral loads. The aim of the study was to determine the associated factors of virological failure in HIV patients on antiretroviral therapy (ART) in the Upper East Region of Ghana. Methods: A retrospective cross-sectional study involving 366 participants aged 15 years and above who were on HAART for six (6) months or longer with viral load results in 2020. Bivariate and multiple logistic regression analyses were conducted to identify the determinants of virological failure among HIV patients at 95% confidence interval (C.I.) with a significant level pegged at a p value less than 0.05. Results: The prevalence of viral load failure was 47.0% and adherence to antiretroviral therapy was 62.6% among patients on HAART. The significant predicators of virological failure were basic education (AOR (adjusted odds ratio) = 7.36, 95% C.I = 4.91–59.71), High school/Vocational /Technical education (AOR = 4.70, 95% C.I. = 1.90–9.69), monthly salary/income ˂ GHS 375.00 (AOR = 7.20, 95% C.I. = 1.73–29.95), duration on ART for ˂1 year (AOR = 0.27, 95% C.I. = 0.10–0.75), ART regimen (Tenofovir + Lamivudine + Efavirenz) (AOR = 3.26, 95% C.I. = 1.95–11.25), 3–5 times missed medication per month (AOR = 2.86, 95% C.I. = 1.34–6.08) and ≥6 missed medication per month (AOR = 23.87, 95% C.I. = 10.57–53.92). Conclusion: Educational status, salary/income, ART duration, ART combination regimen, and number of doses missed were statistically significantly associated with virological failure in patients on antiretroviral therapy. The majority of the respondents adhered to ART, which led to moderate viral load suppression but lower than the target for 2020. There is the need to strengthen the ongoing accelerated social behavior change communication among patients on ART to enhance adherence in order to attain the new UNAIDS target of 95% viral load suppression by 2030 in the Upper East Region of Ghana.

Venereology doi: 10.3390/venereology2010001

Authors: Kingsley Aseye Hattoh Bryan Aapentuo Sienso Eugene Dogkotenge Kuugbee

Human Immunodeficiency Virus (HIV) is a chronic infectious disease, and without antiretroviral therapy (ART), it is associated with comorbidities. The prevalence of comorbidities, adherence to ART and quality of life (QoL) of HIV patients were studied. A cross-sectional study design involving 360 HIV patients from two ART clinics across the Tamale metropolis was employed. Socio-demography, adherence to therapy, and QoL data were taken with the help of a questionnaire and analyzed using SPSS version 24. The prevalence of comorbidities was 30.3% (109), with Hepatitis B infection (73, 20.3%) being the most prevalent. Adherence levels were high (192, 53.3%), moderate (108, 30.0%) and low (60, 16.7%). Overall, QoL was excellent amongst 149 (41.4%), good in 169 (46.7%), and poor in 42 (11.7%) respondents. Marital status, presence or absence of HIV symptoms, adherence level to ART and overall QoL, especially Physical, Psychological, and independence domains (p < 0.05), were factors associated with the presence of comorbidities. There is a high level of comorbidities among persons living with HIV (PLWH) in the Tamale metropolis influenced by QoL and adherence to ART. We recommend a multifaceted approach to the management of PLWH.

Venereology doi: 10.3390/venereology1030019

Authors: Onalethata Ntshadi Sonny Alfred Musekiwa

HIV/AIDS is prevalent among adolescent girls and young women (AGYW) in Lesotho, and among the top five infectious diseases causing a high mortality rate in Africa. The paramount management of HIV is based on screening, prevention, and therapeutic interventions, of which HIV testing and counselling (HTC) is the gateway. The utilization of HTC services among AGYW is limited owing to numerous barriers encountered by this population group. The aim of this study was to assess trends and factors associated with HTC among AGYW in Lesotho. A secondary data analysis was used to analyze data sets extracted from the 2004, 2009, and 2014 Lesotho Demographic Health Surveys (LDHS). The LDHS was conducted using a cross-sectional study design and samples drawn were representative of the whole population of Lesotho. We used descriptive analysis to determine trends in HTC. In determining factors associated with the uptake of HTC, univariate and multivariable logistic regression models were applied on the 2014 LDHS. All analyses were adjusted for unequal sampling probabilities using survey weights. The number of AGYWs analyzed were 2743 in 2004, 2393 in 2009, and 2842 in 2014. The overall prevalence estimates of HTC uptake were 12%, 62.2%, and 72.5%, respectively. For the 15–19 years AGYW, HTC uptake rose from 6.2% (2004), 46.3% (2009), to 57.9% (2014), while for the 20–24 years age group, the rates were 18.7%, 80.2%, and 88.3%, respectively. For the 2842 AGYW in 2014, the odds of ever having an HIV test were significantly higher for those aged 20–24 years (aOR 2.15, 95% CI 1.61 to 2.87, p < 0.001), in a union (aOR 3.21, 95%CI 2.25 to 4.58, p < 0.001), with Mother-to-child transmission of HIV (MTCT) knowledge (aOR 1.53, 95%CI: 1.21 to 1.94, p < 0.001), with HIV non-discriminatory attitudes (aOR 2.50, 95%CI 1.87 to 3.34, p < 0.001), and those who had ever been pregnant (aOR 11.53, 95%CI 7.46 to 17.84, p < 0.001). HTC uptake among AGYW in Lesotho is below expected targets, hence we recommend optimizing access to HTC services, especially for AGYW aged 15–19 years.

Venereology doi: 10.3390/venereology1030018

Authors: Michael Ekholuenetale Chimezie Igwegbe Nzoputam Osaretin Christabel Okonji

Sexually transmitted infection refers to a group of clinical syndromes that can be acquired and transmitted through sexual activity and are caused by a variety of pathogens such as bacteria, fungi, viruses, and parasites. Methods: Demographic and Health Survey data involving women aged 15–49 years were analyzed for this study. The surveys were conducted between 2006–2021. Statistical significance was determined at p < 0.05. Results: From the results, Liberia (33.0%), Mali (14.0%), Guinea (13%), Uganda, and Sierra Leone (12.0% each) had the highest STI prevalence. Prominently from Western sub-Saharan Africa sub-region, Liberia (40.0%), Guinea (31.0%), Mali (28.0%), Cote d’Ivoire (24.0%), Ghana (23.0%) and Mauritania (22.0%) have the highest prevalence of reporting a bad smelling or abnormal genital discharge. In addition, Liberia (30.0%), Uganda (13.0%) and Malawi (10.0%) have the highest prevalence of reporting genital sores or ulcers. Liberia (48.0%), Guinea (34.0%), Mali (32.0%), Ghana and Mauritania (25.0% each) and Uganda (24.0%) reported the leading prevalence of STI, genital discharge, or a sore or ulcer. Conclusion: The prevalence of vaginitis varied according to women’s characteristics. In many countries, younger women, urban dwellers, educated women, rich and unmarried women reported a higher prevalence of STI, genital discharge, or a sore or ulcer. Women should be educated on the advantages of proper hygiene, and prevention and control of STIs. Program planners and policymakers should assess and improve the collaboration and coordination of nutritional and family health programs aimed at addressing women’s health issues.

Venereology doi: 10.3390/venereology1030017

Authors: José Luis Rodrigues Martins Emerith Mayra Hungria Pinto Salomão Antonio Oliveira Fernanda Almeida Costa Gomes Osmar Nascimento Silva

The gonorrhoea caused by the bacterium Neisseria gonorrhoeae remains a major global public health problem with high morbidity. Gonorrhoea can affect both women and men, being more prevalent in sexually active young individuals. Even after infection from N. gonorrhoeae, many patients may remain asymptomatic, making the diagnosis and adequate treatment of the disease difficult. The treatment and control of gonorrhoea have been difficult in recent years in most populations, being an example of how behavioural, social, and demographic factors can influence the epidemiology of an infectious disease. The emergence of strains of N. gonorrhoeae resistant to multiple antimicrobials, especially to extended-spectrum cephalosporins, indicates that gonorrhoea has the potential to become untreatable in the current reality of treatment options, especially in places that have a high prevalence of gonococcal infections. The loss of available and effective treatment options can lead to significant increases in new cases of the disease, as well as increased morbidity and mortality. This review provides an overview of current therapeutic options for gonorrhoea, as well as ongoing experimental studies and clinical trials with new antigonococcal agents.

Venereology doi: 10.3390/venereology1030016

Authors: Ricardo Araújo da Silva Luís Augusto Vasconcelos da Silva Fabiane Soares Inês Dourado

Background: The illicit use of industrial liquid silicone (ILS) is a common practice among travesti and transgender Women (TrTW) in the process of bodily change. The “pumped ladies” apply the ILS without any preparation regarding biosafety, and this practice poses serious risks to the health of TrTW, including death. This study aims to describe the prevalence of ILS use and estimate the associated factors among TrTW in a Brazilian city. Methods: This behavioral and serological survey employed the Respondent-Driven Sampling (RDS) recruitment technique. Participants who declared themselves to be travesti or transgender women over 15 years were considered eligible. The sample consisted of 127 TrTW. The bivariate analysis estimated the prevalence of ILS use by sociodemographic, cultural, and behavioral variables. Multivariate analysis used Poisson regression for adjusted estimates with respective 95% confidence intervals. Results: Approximately 31.6% of the TrTW (n = 44) used ILS and 57.2% (n = 67) were under 25 years old. Most (73.2%, n = 79) had access to more than eight years of schooling. Nine percent (n = 15) tested positive for HIV, and 31.6% (n = 48) tested positive for syphilis. The TrTW who felt more comfortable with their body image had a threefold higher prevalence of ILS use and those who performed an HIV test before the study had a 4.5 times higher prevalence of ILS. Conclusion: ILS is widely used by TrTW in Brazil. Although public policies for the transgenderizing process exist, this process still occurs illicitly.

Venereology doi: 10.3390/venereology1020015

Authors: Mispa Tepe-Mensah Joseph Osarfo Evans Kofi Agbeno Gifty Dufie Ampofo

Voluntary counselling and testing (VCT) is key in HIV prevention. Young people aged 15–24 years carry a significant burden of new infections globally, but VCT uptake is low in this population. The study assessed university freshmen’s willingness to test for HIV now, among others, in a cross-sectional study as university campuses are places of risky sexual behaviour. Structured questionnaires were used to collect data on age, sex, marital status, HIV/AIDS knowledge, previous history of testing, willingness to test now, and others. Summary statistics were reported while chi-square and logistic regression methods were used to assess the association between dependent and independent variables with p-values < 0.05 held significant. About 90% (374/412) of respondents had good HIV/AIDS knowledge based on criteria defined by the study, but only 23.3% (96/412) had ever tested and 66.3% (266/401) were willing to test now for HIV. Respondents’ sex, previous sexual intercourse, and whether respondents’ educational support was from parents or non-parents influenced willingness to test for HIV now. The study highlights what appears to be personal beliefs that can potentially hinder HIV testing and control efforts. Relevant stakeholders must address these gaps to improve testing. Further qualitative investigation will improve understanding of the dynamics informing willingness to test for HIV among young people generally.

Venereology doi: 10.3390/venereology1020014

Authors: Kritika Srinivasan Rajsri Mana Rao

Monkeypox, once a rare zoonotic disease, has been endemic to some African countries since its original identification among humans in 1970. Since then, cases in non-endemic regions have been linked to returning travelers or those who had contact with transported animals. The causative agent, Monkeypox virus, belongs to Orthopoxviruses, the same family as Variola—the causative organism for smallpox. Although most monkeypox outbreaks until recently were linked to zoonotic transmission, secondary human–human transmission in smallpox-unvaccinated individuals was observed in a small proportion of overall cases. Smallpox was declared to be eradicated in 1980, and since its eradication, Monkeypox virus has been the most significant poxvirus to cause human disease. The 2022 monkeypox outbreak marks a significant paradigm shift in the human and poxvirus association, with new modes of transmission and concerns of viral evolution and entrenchment as a sexually transmitted disease. Monkeypox clinically resembles smallpox but is far milder. At this time, there are no approved therapies for monkeypox, and antiviral agents effective against smallpox are being utilized. Additionally, preventive strategies being utilized include smallpox vaccinations such as JYNNEOS and ACAM2000. In this narrative review, we discuss the virology, epidemiology, transmission, clinical manifestations, diagnosis, management, and prevention strategies associated with monkeypox.

Venereology doi: 10.3390/venereology1020013

Authors: Cyprian M. Mostert

Background: South Africa recently adopted HIV self-test technology (HIVST) to improve HIV testing and encourage earlier treatment initiation in working populations with a low uptake of conventional testing approaches. This study investigates the impact of HIVST on testing outcomes, focusing on both frequent and infrequent working-class testers. The paper also examines the spillover effect of HIVST on antiretroviral (ART) treatment initiation. To identify these effects, the author focused on South Africa and exploited the HIVST distribution data of 6259 beneficiaries of HIVST. Methods: The author used a two-stage least-squared model to quantify the impact of the HIVST on these vulnerable working populations. Results: The results show that HIVST fosters a 27.6% higher testing uptake in infrequently testing workers compared to frequently testing workers, and that the uptake of HIVST is 11.5% higher in rural regions than in urban settings, as well as 14.5% more prominent in infrequent male testers than infrequent female testers. Notably, the positive effects of HIVST are also confirmed by the presence of positive spillover effects in workers screening positive for HIV. The paper documents a 7.6% increase in ART initiation in infrequent testers. Conclusions: There is a case for adopting this technology to improve the uptake of HIV testing and ART initiation as the country seeks to attain the UNAIDS 95–95–95 targets by 2030.

Venereology doi: 10.3390/venereology1020012

Authors: Nour Mammari Michael R. Hamblin Pauline Rauger Laurence Boyer Mihayl Varbanov

New therapeutic strategies are urgently needed to overcome drawbacks in the treatment of some infections, particularly sexually transmitted infections (STI). STIs are easily spread by the transmission of various bacteria, viruses, and parasites with some of the infections being incurable or even lethal, leading to a serious impact on reproductive health worldwide. Phototherapy (PT) is a major therapeutic approach based on the controlled administration of light in the visible, near infrared, or UV spectrum, with or without the application of an external photosensitizer. Despite the fact that PT has not been explored to its full potential in the control of STIs, it has already demonstrated good clinical response rates and lower recurrence rates in genital infections. For instance, increasing evidence has demonstrated that 5-aminolevulinic acid photodynamic therapy (5-ALA-PDT) is effective in the treatment of condyloma acuminatum (CA), by eliminating the causative latent human papillomavirus (HPV) infection, and also in the antiviral treatment of recurrent genital herpes simplex virus (HSV) infections. The clinical application of PDT is a new treatment for oral fungal infection caused by Candida albicans in adult acquired immune deficiency syndrome (AIDS) patients, with human immunodeficiency virus (HIV), and could also be used for genital fungal infections. Another antimicrobial PT strategy, water-filtered infrared A combined with visible light irradiation, has been shown to be effective against genital Chlamydia trachomatis bacterial infection, and an optical nano-genosensor has been designed for the diagnosis of trichomoniasis, a parasitic Trichomonas vaginalis infection. This review aims to summarize the published evidence for the effectiveness of PT in the treatment of STIs, and for the suppression of STI-related pathogens of various types.

Venereology doi: 10.3390/venereology1020011

Authors: Jalikatu Mustapha Enanga Sonia Namanga Baimba Idriss Daniel Sesay Darlinda F. Jiba James B. W. Russell Mathew J. Vandy Gibrilla F. Deen George A. Yendewa Sulaiman Lakoh

Ophthalmic diseases are common among people living with HIV (PLHIV) in developing countries. However, there are currently no published studies on ophthalmic complications among PLHIV in Sierra Leone. We conducted a cross-sectional study of PLHIV presenting at Connaught Hospital in Freetown, Sierra Leone from January through March 2020. Logistic regression was used to identify associations between ophthalmic manifestations and potential risk factors. A total of 103 PLHIV were studied (78.6% female, median age 41 years, 100% treatment-experienced). The median CD4 cell count was 374 cells/mm3 and 76.7% were virologically suppressed. Overall, 44.7% of study participants had at least one ophthalmic complication and 51.5% had poor visual acuity in at least one eye. The most common conditions were dry eye (21.4%), cataract (20.4%), blepharitis (10.7%), nucleosclerosis (6.8%), conjunctivitis (5.8%), penguecula (5.8%), toxoplasmic retinochoroiditis (3.9%), and posterior vitreous detachment (2.9%). In multivariate logistic regression analysis, poor visual acuity (adjusted odds (aOR) 2.75, 95% confidence interval (CI) [1.12–6.78]; p = 0.040) and CD4 cell count < 100 cells/mm3 (aOR 3.91, 95% CI [1.07–14.31]; p = 0.028) were independently associated with ophthalmic disease. A high proportion of PLHIV in this study had ophthalmic complications. This calls for greater integration of HIV and ophthalmologic care.

Venereology doi: 10.3390/venereology1010010

Authors: Arun Kumar Jaiswal Syed Babar Jamal Lucas Gabriel Rodrigues Gomes Rodrigo Profeta Helioswilton Sales-Campos Carlo Jose Freire Oliveira Flávia Figueira Aburjaile Sandeep Tiwari Debmalya Barh Marcos Vinicius da Silva Siomar de Castro Soares Vasco Azevedo

Treponema pallidum subspecies pallidum causes syphilis, a sexually transmitted disease that infects more than 2.1 million pregnant women every year. Due to its maximum death rates and augmented risk of human immunodeficiency virus (HIV) infection, the disease is still a matter of debate in many low- and high-income countries. The infection has three stages that lead to several complications if left untreated and can lead to many tertiary complications in the brain, eyes, ears, heart, and pregnancy. Neurosyphilis is also known as the clinical result of infection of the central nervous system by Treponema pallidum subspecies pallidum. It can evolve at any time and from any stage of syphilis exposure. This review briefly explains the severe and multiple neurosyphilitic complications and recently identified cases related to neurosyphilis. We also explained computational neuroscience, neuroinformatics, and in silico models and techniques based on artificial intelligence and other computational and mathematical methods. These techniques have already been applied to several neurological and psychological brain complications and can be applied to neurosyphilis to better understand the persistence of the disease related to the brain that causes neurosyphilis.

Venereology doi: 10.3390/venereology1010009

Authors: Oluchi Mary-Cynthia Aniche Ibuchukwu Nkeonyenasoya Orabueze Ifeyinwa Nkiruka Nwafia Justina Uchechi Ihezuo Chinwe Blessing Chinaka Kingsley Andrew Egbe Anthony Chibuogwu Ike

Hepatitis B virus (HBV) is a sexually transmitted virus with a wide range of terminal complications. As such, female sex workers (FSWs) are an important group in the epidemiology of the virus. This study was aimed at evaluating the seroprevalence of HBV markers and the exposure rate of the virus among FSWs in Enugu State, Nigeria. A cross-sectional study was carried out among brothel-based FSWs, involving 200 participants recruited using a consecutive sampling method. Blood specimens were collected and tested for HBV markers using chromatographic immunoassay rapid test kits. Additional information was obtained through the administration of a well-structured pre-tested questionnaire. Data were entered into Statistical Package for Social Sciences (SPSS) version 20.0 and analyzed using the Descriptive Statistics and Chi-Square test in SPSS. Out of the 200 sampled individuals, 82(41%) tested positive for at least one seromarker, with 44(22%) showing evidence of natural infection and 38(19%) indicating a vaccine response. Hepatitis B core antibody (total anti-HBc) was present in 42(21%) of the participants, while 8(4%) had hepatitis B surface antigen (HBsAg), which is indicative of current infection. This study revealed intermediate prevalence, a high exposure rate and a low vaccination rate among the study population. There is a need for more effective intervention strategies among FSWs in the study area.

Venereology doi: 10.3390/venereology1010008

Authors: Lauryn Nsenga Felix Bongomin

Vulvovaginal candidiasis (VVC), predominantly caused by Candida albicans, is estimated to affect about 138 million women each year worldwide and 492 million over their lifetimes. Recurrent VVC (RVVC), defined as four or more episodes of VVC in a year, is increasingly recognized and constitutes up to 10% of the cases of VVC. RVVC is an important clinical and global public health challenge project that will affect about 160 million per year by 2030. RVVC significantly affects the quality of life of the affected women. Host factors, such as underlying immunosuppressive conditions and genetic predisposition, are suggested key risk factors for recurrence. However, an increasingly higher prevalence of non-albicans Candida (NAC) species, such as C. glabrata, C. tropicalis, C. krusei, C. parapsilosis, C. dubliniensis, C. guilliermondii, and others, which are either intrinsically resistant to azoles or have higher minimum inhibitory concentrations to most antifungal agents, such as fluconazole, which are commonly used for the treatment of VVC/RVVC, has been reported. Therefore, treatment remains a challenge. Long-term maintenance antifungal is required to avoid recurrence of symptoms. Alternative treatment includes boric acid and topical amphotericin B; however, they are associated with serious side effects, limiting their use. The oral echinocandin ibrexafungerp is well-tolerated and efficacious against Candida vulvovaginitis. RVVC presents a unique area for continued research and development.

Venereology doi: 10.3390/venereology1010007

Authors: Karan Varshney Alexander Ikanovic Prerana Ghosh Pavan Shet Marcus Di Sipio Chirag Khatri Malik Quasir Mahmood

Human immunodeficiency virus (HIV)–syphilis co-infection poses a threat to certain populations, and patients may have considerably poorer health outcomes due to these infections. Our objective was therefore to provide a scoping review of the literature regarding the factors associated with HIV–syphilis coinfection. We searched PubMed, Scopus, and Web of Science, and produced a total of 1412 articles. After completing the screening process as per the Preferred Items for Systematic Review and Meta-Analysis extension for Scoping Review (PRISMA-ScR) guidelines, a total of 109 articles were eligible for inclusion. A total of 68,634 co-infected patients were included in our review. Findings from studies across 40 countries demonstrated that males—particularly men who have sex with men—compose the overwhelming majority of co-infected cases. Additional risk factors include a low CD4 cell count, current or past sexually transmitted infections, and a high number of sexual partners. Our findings have important implications in guiding public health programs across the globe that aim to lower the rates of HIV–syphilis co-infection. More research is also needed on the role of educational attainment, comorbidities, and consistent condom usage regarding the risk for co-infection.

Venereology doi: 10.3390/venereology1010006

Authors: Chimezie Nzoputam Vincent Yakubu Adam Ogochukwu Nzoputam

Background: Globally, over 40 million people are estimated to be living with sexually transmitted infection/diseases (STI/Ds), including HIV/AIDS. It is said that sub-Saharan Africa accounts for over a half of that figure, making it the continent most affected with HIV/AIDS and other STI/Ds. This study was designed and conducted to assess the knowledge and prevalence of sexually transmitted diseases, and factors that are associated with it, among female students of a university in southern Nigeria. Methods: This cross-sectional analytical study was conducted among female students in five faculties in the University of Benin, Benin City. The instrument used for the collection of data was a self-administered questionnaire. Data were analyzed with the aid of SPSS, version 22.0. A level of significance was set at p < 0.05 and descriptive statistics were used to summarize the data. An odds ratio with a 95% confidence interval for prevalence and factors associated with STI/Ds was computed using binary and multinomial logistic regression models. Results: A total of 423 female students participated in the study. Over half (224, 53.0%) of the participants have had sexual intercourse. The results show that majority of the respondents (95.3%) were aware of STIs and 83.1% had good knowledge of STIs. The prevalence of STI/Ds among the participants was 27.7%, with gonorrhea being the most frequent STI/D that the respondents reported testing positive for. Conclusion: The present study was able to ascertain a higher prevalence of sexually transmitted diseases among female students. To this end, it is imperative that families and agencies (both government and private agencies) should synergize to remove the embargo seemingly placed on women by our cultures and faith-based institutions regarding sexuality. This may help to improve access to sexual and reproductive health education and commodities for women, thereby play a vital role in reducing the transmission of STI/Ds.

Venereology doi: 10.3390/venereology1010005

Authors: Graziela Vargas Rigo Luiza Abrahão Frank Giulia Bongiorni Galego André Luis Souza dos Santos Tiana Tasca

The multistep translational science behind new drugs comprehends the entire process through laboratory, clinical, and community observations turned into health interventions. The development of new drug options from discovering targets and leading compounds in basic research for implementing therapeutic guidelines contributes to the emergence of health policies essential for infection control. This review updates the translational research in the scenario of the most common non-viral sexually transmitted infection (STI), trichomoniasis. Paradoxically to its high occurrence, it is considered neglected since notification is not mandatory. It turns into a stable disease with health complications, and receives little emphasis from public health programs to control STI. Although related to curable STIs, the current drugs, metronidazole and tinidazole, present therapeutic failures. The need for new options to treat trichomoniasis is established by basic research studies and patents revealing novel synthetic compounds and natural products presenting anti-Trichomonas vaginalis activities, mainly based on in vitro findings. Clinical trials are still focused on new routes of administration for conventional drugs. In addition, nanotechnology approaches are in their infancy, shedding light on potential possibilities for creating more effective, targeted, and safe delivery systems. Overall, the novel proposed approaches need, in addition to pharmaceutical development and efficacy assessments, to ensure that the quality requirements for their use as medicines are met. It is essential to overcome these issues to cross the “Death Valley” of drug discovery and to advance in the translational science criteria in the trichomoniasis drug development field.

Venereology doi: 10.3390/venereology1010004

Authors: Benjamin Silverberg Amy Moyers Tate Hinkle Roanna Kessler Nancy G. Russell

The Centers for Disease Control and Prevention (CDC) recently updated their Sexually-Transmitted Infection (STI) Treatment Guidelines with a revision to the approach to gonococcal infections in December 2020 and other STIs in July 2021. This article reviews the new recommendations and highlights important updates from the 2015 iteration that are crucial for primary care and community health practice.

Venereology doi: 10.3390/venereology1010003

Authors: Lourence Misedah Michael W. Ross Solomon Wambua Vanessa Schick

Refugees are often without financial support and some resort to survival sex. Some of these men are gay or bisexual who fled their countries because of actual or fear of death and other persecution, exacerbated by the criminalization of consensual same-sex practices by life imprisonment or death in extreme cases. We conducted qualitative interviews with 12 gay and bisexual men within a larger sample in Nairobi, Kenya, who engaged in survival sex. Thematic analysis indicated eight main themes: Physical dangers, sexual assault, lack of rights and recourse to justice; Emotional difficulties of sex work; Seeing treatable STIs as “normal”, but others like Hepatitis B and C as abnormal, and HIV as the most feared; Recognition of penile symptoms but concerns about sexual health including anal symptoms, such as fistulas and bleeding; good knowledge about HIV but confusions over PEP and PrEP, self-testing, health access to NGO clinics and some hospital clinics but concerns about stigma and discrimination in public clinics generally; and as a result of concerns about public healthcare settings, use of pharmacies for treatment. The data indicate that male refugees from gay repression, as found for refugees from other repressions, face many of the same issues with local variations.

Venereology doi: 10.3390/venereology1010002

Authors: Luigi Santacroce Marica Colella Ioannis Alexandros Charitos

Sexually transmitted diseases (STDs) have been known about since ancient times. Today, however, STDs are on the rise in young people around the world. Interventions and sex education are being utilized in attempt to prevent STD spread in individuals who are the greatest risk of infection. Young people should be provided with easy and accessible health services. There should be anonymity as well as investigations into the reasoning behind unsafe behavior.

Venereology doi: 10.3390/venereology1010001

Authors: Maria Noguera Shu-Kun Lin

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