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Sexually transmitted infections: challenges ahead
Magnus Unemo1, Catriona S Bradshaw2, Jane S Hocking3
1WHO Collaborating Centre for Gonorrhoea and Other Sexually Transmitted Infections, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
Insights
Sexually transmitted infections (STIs) like chlamydia and gonorrhoea affect nearly 1 million daily worldwide. This review highlights challenges and new strategies for STI treatment and control, focusing on antimicrobial resistance and improved case management.
Area of Science:
- Public Health
- Infectious Diseases
- Clinical Medicine
Background:
- Globally, nearly 1 million new sexually transmitted infections (STIs) occur daily, yet research remains underfunded.
- Common STIs include chlamydia, gonorrhoea, syphilis, and trichomoniasis, posing significant public health challenges.
- Antimicrobial resistance in gonorrhoea and recurrent bacterial vaginosis are growing concerns.
Purpose of the Study:
- To address key challenges in STI treatment and control.
- To explore novel strategies for managing common STIs, including chlamydia and gonorrhoea.
- To improve understanding and clinical management of STIs, particularly in vulnerable populations.
Main Methods:
- Review of current literature and data on STI prevalence, treatment, and control strategies.
- Analysis of challenges in managing specific STIs like chlamydia and bacterial vaginosis.
- Examination of emerging issues such as antimicrobial resistance and point-of-care diagnostics.
Main Results:
- Chlamydia control requires shifting focus from screening to managing diagnosed cases and morbidity.
- Antimicrobial resistance in Neisseria gonorrhoeae necessitates development of novel treatments.
- Bacterial vaginosis recurrence may be linked to sexual transmission, impacting management approaches.
- Point-of-care tests show promise for improving STI case management in low-resource settings.
- Increased STI rates in men who have sex with men are discussed in context of HIV prevention strategies.
Conclusions:
- Effective STI control requires innovative approaches beyond traditional screening.
- Addressing antimicrobial resistance and understanding transmission dynamics are crucial for future treatments.
- Point-of-care diagnostics and tailored public health strategies can enhance STI management globally.
Abstract:
WHO estimated that nearly 1 million people become infected every day with any of four curable sexually transmitted infections (STIs): chlamydia, gonorrhoea, syphilis, and trichomoniasis. Despite their high global incidence, STIs remain a neglected area of research. In this Commission, we have prioritised five areas that represent particular challenges in STI treatment and control. Chlamydia remains the most commonly diagnosed bacterial STI in high-income countries despite widespread testing recommendations, sensitive and specific non-invasive testing techniques, and cheap effective therapy. We discuss the challenges for chlamydia control and evidence to support a shift from the current focus on infection-based screening to improved management of diagnosed cases and of chlamydial morbidity, such as pelvic inflammatory disease. The emergence and spread of antimicrobial resistance in Neisseria gonorrhoeae is globally recognised. We review current and potential future control and treatment strategies, with a focus on novel antimicrobials. Bacterial vaginosis is the most common vaginal disorder in women, but current treatments are associated with frequent recurrence. Recurrence after treatment might relate to evidence that suggests sexual transmission is integral to the pathogenesis of bacterial vaginosis, which has substantial implications for the development of effective management approaches. STIs disproportionately affect low-income and middle-income countries. We review strategies for case management, focusing on point-of-care tests that hold considerable potential for improving STI control. Lastly, STIs in men who have sex with men have increased since the late 1990s. We discuss the contribution of new biomedical HIV prevention strategies and risk compensation. Overall, this Commission aims to enhance the understanding of some of the key challenges facing the field of STIs, and outlines new approaches to improve the clinical management of STIs and public health.