Sexual decision-making and sexually transmitted infection (STI) prevention are influenced not only by individuals' characteristics but also by those of their partners and their relationship with each other. To inform STI prevention and understand transmission dynamics, we aimed to understand sexual partnership demographic assortativity, sexual behaviour, communication and concurrency among UK-resident gay, bisexual and other men who have sex with men (GBMSM). With community members and organisations, we codesigned a sexual partnerships module for an annual online cross-sectional community-based survey of UK-resident GBMSM (cisgender/trans/non-binary assigned-male-at-birth) undertaken November-December 2023. We collected data about ≤3 most recent male sex partners since August 2023 and analysed variations in relative demographic characteristics (age, ethnicity), sexual behaviours (practices, condom use, HIV-pre-exposure prophylaxis (HIV-PrEP use)) and sexual health communication by partner type (one-time, established, casual and uncertain). 1106 participants described 2342 partners: 12.5%, 20.4%, 9.9% and 57.1% reporting 0, 1, 2 and 3 partners, respectively, of varying combinations. Casual partner types were most reported (43.2%) versus one-time (36.1%), established (13.9%) and uncertain partnerships (6.8%). Concurrency was common with the mean number of ongoing partnerships >1 (1.23, 95% CI 1.17 to 1.30). Age-mixing varied by partner type, from median 2 (established partners) to 10 (one-time partners) years difference.Sexual health communication was highest among established partners. It was two times as common to be unaware of one-time partners' HIV status (66.8%) and not to have discussed sexual health (65.7%) compared with casual partners (30.0% and 27.2%, respectively). Condom use was low across partner types. HIV-PrEP was always used by HIV-negative participants in two times as many one-time, causal and uncertain partnerships (49.2%, 50.0%, 42.0%) compared with established partnerships (23.3%) involving condomless anal intercourse. UK-resident GBMSM have diverse types of male sexual partners, varying in their demographic mixing, sexual behaviour and communication, which should be reflected in sexual health promotion and transmission dynamics analyses.

In remote Australian First Nations communities, the burden of curable sexually transmitted infections (STIs) is highest for young women and men aged 16-29 years and for women is associated with two-fold higher rates of hospitalisations for pelvic inflammatory disease (PID) than for non-First Nations women. Following a randomised trial, decentralised community-led molecular point-of-care (POC) testing for STIs has operated in remote primary care across Australia for more than 7 years, improving uptake and timeliness of treatment for chlamydia, gonorrhoea and trichomonas infections. However, cost-effectiveness remains unknown. A decision analytic model was devised to compare costs and outcomes associated with a POC testing programme for chlamydia, gonorrhoea and trichomonas infections in women and men aged 16-29 years seeking care, compared with standard care (laboratory-based testing). The analysis used a government payer perspective and 10-year time horizon. The primary outcome was the cost ($A) per quality-adjusted life year (QALY) gained. Sensitivity analyses examined uncertainty around the results. Based on a combined testing positivity rate of 36% and 29% for chlamydia, gonorrhoea and trichomonas for women and men, respectively, the POC testing programme, compared with laboratory testing, produced an estimated incremental cost per QALY ratio (ICER) of $A19 714 (95% CIs $A19 608 to $A19 821) over 10 years. Among those with an STI, the POC testing programme was predicted to reduce diagnosed PID by 30% and preterm/low birth weight babies by 17%. Sensitivity analyses indicated that the ICER was most sensitive to the probability of infection and receiving treatment within 2 days, based on a willingness-to-pay threshold of $A50 000. This health economic evaluation indicates that a scaled molecular POC testing programme for the management of STIs in remote primary care settings is cost-effective compared with standard care. Sustained POC testing in this setting is likely to improve reproductive health outcomes.

HIV pre-exposure prophylaxis (PrEP) programmes are associated with intensified sexually transmitted infection (STI) screening and increased incidence of bacterial STIs, resulting in repeated antibiotic exposure. The ecological impact of STI-driven antimicrobial use on resistance in commensal bacteria remains insufficiently characterised, particularly in populations with high antimicrobial exposure such as men who have sex with men (MSM). To evaluate differences in nasal Staphylococcus aureus antimicrobial resistance between MSM receiving PrEP and HIV-negative MSM not on PrEP and to explore behavioural and antibiotic exposure factors associated with resistance. In this exploratory cross-sectional study, 153 HIV-negative MSM attending an STI clinic in Italy were enrolled (80 PrEP users; 73 controls). Participants underwent nasal swabbing for culture-based isolation and antimicrobial susceptibility testing of S. aureus. Antibiotic exposure, behavioural variables and STI history were collected via structured questionnaire. PrEP users reported more sexual partners in the last 6 months (p=0.0009) and higher antibiotic use in the preceding year (p=0.004). Doxycycline postexposure prophylaxis (Doxy-PEP) use was more frequent among PrEP users (16% vs 7%; p=0.08). The cumulative 2-year STI burden was higher in the PrEP group (p<0.0001), driven by Neisseria gonorrhoeae infections. S. aureus colonisation prevalence did not differ significantly between groups (p=0.17). However, erythromycin (p=0.0008), clindamycin (p=0.004) and tetracycline resistance (p=0.03) were more frequent among PrEP users. Tetracycline exposure was independently associated with tetracycline resistance (p=0.03), whereas PrEP status was not. Among MSM, higher antimicrobial resistance in nasal S. aureus may be associated with antibiotic exposure rather than PrEP use per se. These exploratory findings should be interpreted with caution given the limited sample size and lack of detailed exposure quantification but support the need to integrate antimicrobial stewardship into PrEP and Doxy-PEP implementation frameworks. Longitudinal studies are needed to better disentangle the roles of antimicrobial exposure and transmission dynamics.

In remote Australia, where there is a substantial burden of sexually transmitted infections (STIs) among First Nations peoples, testing and timely treatment are key to reducing prevalence. We evaluated the impact of introducing molecular point-of-care (POC) testing for chlamydia/gonorrhoea and later trichomonas on STI testing (including syphilis) and positive tests. We conducted a retrospective interrupted time-series analysis of routinely collected data from First Nations peoples aged 15-54 years attending 20 remote/regional clinics participating in the Test, Treat and GO programme (2016-2019). We used segmented regression models to estimate the immediate level change (first month of POC) and after-period trends in monthly tests, positive tests and proportion of concurrent syphilis tests to assess sustainability. Before and after comparisons were estimated using linear regression models. There were 17 437 chlamydia/gonorrhoea and 14 173 trichomonas tests performed, mostly among women (69% and 64%) and individuals aged 15-34 years (72% and 68%). Following the introduction of molecular POC testing, there were immediate level increases in monthly tests: chlamydia/gonorrhoea by 26% (+154, p<0.001) and trichomonas by 21% (+116, p=0.004) and level increases of positive tests: gonorrhoea by 30% (+13, p=0.017) and trichomonas by 29% (+14, p=0.034); chlamydia was unchanged. The proportion of chlamydia/gonorrhoea tests with concurrent syphilis tests remained unchanged (-1.7%; -0.9%; p=0.531), while the proportion increased among positive chlamydia/gonorrhoea tests by 25% (+13%; p=0.013). Increased levels of testing were sustained for gonorrhoea/chlamydia (+2.7, p=0.118) and trichomonas (-3.5, p=0.400) and syphilis among those with positive chlamydia/gonorrhoea tests (-0.2%, p=0.593). Molecular POC testing led to immediate and sustained increases in STI testing and an immediate increase in positive tests in remote primary care. The use of POC testing is likely to result in earlier diagnosis and treatment and reduced onward transmission and sequelae, supporting a broader integration of POC testing in high-burden settings.

To determine the number of eligible people living with HIV (PLWHIV) in a London tertiary care centre receiving statins and cardiovascular health lifestyle advice; to determine whether age, sex or QRISK3 cardiovascular risk score influences statin prescription; to identify barriers to statin access in the HIV clinic to General Practice pathway; and to determine whether statin prescriptions were continued after 6 months. A retrospective review of clinic letters from consecutive patients attending specialist HIV clinic appointments in April 2024, and their 6-month follow-up appointments, was conducted via electronic patient records. Seven hundred and sixteen consultations were extracted, representing 358 participants, at two different time points: 195 (54%) patients were eligible for statin initiation at their initial appointment and 94 (48% of the eligible patients) had a recorded discussion around statin initiation in HIV clinic. Fifty (53% of patients who had a discussion) gave consent to begin statins. Only 28 (56% of consenting patients) were prescribed a statin. Smoking status was not up to date for 64 (33%) of PLWHIV eligible for statins and 141 (72%) did not have cardiovascular health lifestyle modification discussion. Multivariable regression found only QRISK3 score significantly affected statin discussion (OR: 1.137, 1.030 to 1.271) and initiation (OR: 1.244, 1.100 to 1.430). Many PLWHIV eligible for statins are not discussing this with their clinician; some willing patients are still not prescribed a statin. PLWHIV may be missing out on lifestyle advice for preventing cardiovascular disease. Further support for PLWHIV in both primary and secondary care would be useful to increase statin uptake.

Sexually transmitted infections (STI) testing is less frequently accessed in rural and regional Australian communities due to many barriers, including limited access to specialised services and stigma. To address this, we sought to pilot the implementation of STI test kit dispensing vending machines and assess their acceptability and use. We conducted a 12-month pilot, placing two free STI test kit vending machines in 4-month intervals across seven rural and regional towns/cities. We worked with each community to determine ideal placement locations and marketing strategies. We assessed utilisation rates, return rates, positive diagnosis rates and user satisfaction. The vending machines dispensed 176 STI test kits over a period of 836 days in situ across seven towns/cities. Users ranged from 17 years to 70 years of age-those over 30 years had a greater odds of travelling over 25 km to access a test compared with younger users (OR 0.53, 95%CI 0.28 to 1.01). A large number (43.9%) of users reported having never completed an STI test before. 32 users returned samples for analysis with 12.5% receiving a positive result. Of the users who rated the vending machine process, 94.0% (79/84) rated it as 'easy' or 'very easy' to use and 95.6% (86/90) rated the process as 'fast' or 'very fast'. Our pilot suggests that STI test kit vending machines are an acceptable testing option for a wide range of users in rural and regional communities. Further research is necessary to understand how to improve return rates in order to improve sustainability.

Adolescent girls and young women (AGYW) in Uganda experience a high burden of sexually transmitted infections (STIs), increasing vulnerability to HIV acquisition. Despite the WHO and Uganda's Ministry of Health recommendations, routine integration of STI screening into HIV testing services (HTS) remains limited. We assessed the prevalence of laboratory-confirmed STIs, associated factors and Neisseria gonorrhoeae antimicrobial resistance among AGYW seeking HTS in Entebbe, Uganda. We conducted a cross-sectional study among 321 AGYW aged 15-24 years attending HTS at the Uganda Virus Research Institute (UVRI) clinic. Endocervical swabs were tested for N. gonorrhoeae (culture and sensitivity), Trichomonas vaginalis (wet microscopy) and bacterial vaginosis (BV; Nugent scoring). Syphilis was assessed using the Treponema pallidum haemagglutination assay. Modified Poisson regression was used to estimate adjusted prevalence ratios (aPR) for factors associated with any STI. Overall STI prevalence was 35.2% (n=113, 95% CI 30.0 to 40.5), with 41.6% (47/113) of infections occurring among asymptomatic individuals, driven largely by BV at 31.5% (100/318), followed by T. vaginalis at 7.3% (23/316), syphilis at 5.0% (16/321) and N. gonorrhoeae at 1.3% (4/318). STI prevalence among AGYW who tested positive for HIV was 47.8% (11/23), while among those who tested negative was 34.2% (102/298). In multivariable analysis, having fewer sexual partners was associated with lower STI prevalence (one partner: aPR 0.07, 95% CI 0.03 to 0.14; 2-3 partners: aPR 0.73, 95% CI 0.58 to 0.90, compared with >3 partners); condom use was associated with lower STI prevalence (aPR 0.62, 95% CI 0.45 to 0.84), and intrauterine device use was associated with higher STI prevalence (aPR 1.61, 95% CI 1.24 to 2.08). Among four N. gonorrhoeae isolates, three showed resistance to ciprofloxacin, and all four were resistant to penicillin G; all were susceptible to cefotaxime. A high burden of STIs, including asymptomatic infections, was observed among AGYW seeking HTS in an urban Ugandan setting. These findings support the integration of diagnostic STI screening into HTS.

Following major changes to sexual health provision in England in the past decade, monitoring and evaluation of population-level interventions require re-examination to ensure quality and visibility of key communities. We make the case that sexual health data sources might be used synergistically to improve sexual health and tackle inequalities. We conducted a purposive narrative review to (1) describe national sexual health policy and provision changes in England in the past decade (2012 onwards), (2) map key sexual health data resources and (3) demonstrate how integrated data-driven approaches can be used to understand and evaluate population-level sexual health policy. There have been major changes at a national and regional level in the availability, targeting and implementation of HIV and sexually transmitted infection (STI) interventions, including through high-level shifts in funding structures, expansion of online services and pathogen-focused policies. Synergistic use of the many data sources available takes advantage of their different features. For example, for HIV, integration of nationally representative behavioural surveys that include people not accessing care (eg, National Surveys of Sexual Attitudes and Lifestyles), targeted surveys (eg, Reducing inequalities in Sexual Health surveys for gay, bisexual and other men who have sex with men (GBMSM)) and national STI/HIV surveillance for people accessing care (eg, GUMCAD STI Surveillance System) can be used to inform progress towards HIV elimination in England through assessment of online and postal-based self-sampling and inequalities in HIV testing uptake in populations and key communities such as GBMSM. In the face of rapid change, approaches that integrate complementary data sources have the potential to harness the strengths of individual assets and mitigate limitations to form a more complete assessment of population-level interventions and should guide sexual health policy and practice in the decade to come. Effective data integration requires addressing a range of methods, mandates and challenges to strengthen contemporary research, monitoring and evaluation.

Despite the transformative impact of direct-acting antivirals (DAAs) on hepatitis C control, acute/recent hepatitis C virus (HCV) infections continue to be diagnosed in contemporary clinical practice. We describe acute/recent HCV cases diagnosed at a tertiary hospital in Madrid among men who have sex with men (MSM), including people living with HIV (PLHIV) and pre-exposure prophylaxis (PrEP) users. We conducted a retrospective, single-centre descriptive study including acute/recent HCV cases reported between January 2023 and January 2025. Cases were defined by detectable HCV RNA following a previously negative HCV serology or after a cured HCV infection (reinfection). Chemsex was defined as intentional use of psychoactive substances in sexual contexts; slamsex as injecting drugs in sexual contexts. Patients initially managed with watchful waiting were reassessed at 12 weeks to assess spontaneous clearance. Ninety-two cases were included; median age was 43 years (IQR 36-52) and 24 (26.1%) were >50 years. In total, 91 out of 92 (98.9%) were MSM; 70 (76.1%) were PLHIV and 19 (20.7%) were PrEP users. Among 84 patients with genotype data, 55 (59.8%) had genotype 1a, 8 (8.7%) 1b, and 21 (22.8%) genotype 4. HCV RNA was >6 log in 41 (44.6%) and >7 log in 18 (19.6%). Chemsex was reported by 72 (78.3%); among them, 38 (52.8%) reported slamsex. Among those with available data, 17 out of 54 (31.5%) had another sexually transmitted infection. Watchful waiting was initially adopted in 73 (79.3%); 5 out of 73 (6.8%) achieved spontaneous clearance at 12 weeks. Of those observed, 68 (93.2%) initiated DAAs; 9 (9.8%) were treated at diagnosis. Ten (10.9%) were lost to follow-up before treatment initiation; sustained virological response was achieved in treated patients. Acute/recent HCV diagnoses occurred predominantly among MSM, including PLHIV and PrEP users, with frequent reporting of chemsex/slamsex. Low spontaneous clearance and losses before treatment initiation highlight the need for targeted HCV testing and linkage to care in HIV/PrEP and sexual health services, alongside harm reduction and substance use support.

Acute HIV infection (AHI) is the brief period between viral acquisition and the appearance of HIV antibodies and cannot be detected by routinely used HIV rapid diagnostic tests (RDTs). Its role is likely to become increasingly important in the rapidly changing context of HIV testing in high-burden countries. We describe the characteristics of individuals attending HIV testing services (HTS) in rural Eswatini and the prevalence of newly diagnosed HIV, including AHI. Adults aged ≥18 years were enrolled at six routine HTS between June 2022 and April 2023. Participants completed detailed questionnaires. Routine HIV testing was conducted using the national serial RDT algorithm (Determine and Uni-Gold). HIV viral load (VL) analysis was performed on the Xpert platform (Xpert HIV-1 Viral Load, Cepheid) in the central laboratory. Newly diagnosed HIV was defined as a positive HIV RDT algorithm with detectable VL (established HIV), or negative or discordant HIV RDT together with VL ≥10 000 copies/mL (AHI). Of 1095 participants with a median age of 27 years (IQR 22-33), 684 (61.5%) were women. Risk factors for HIV acquisition were common: >1 sexual partner (332, 30.3%), condomless sex (452, 44.5%), not knowing main partner's HIV status (437, 42.8%). Symptoms consistent with AHI (713, 65.1%) and genito-urinary (660, 60.3%) infections were common. Overall, 41 participants (3.7%, 95% CI 2.7% to 5.0%) were diagnosed with HIV; 31 (2.8%, 95% CI 1.9% to 3.9%) with established HIV and 10 (0.9%, 95% CI 0.04% to 1.7%) with AHI, representing 24.4% (95% CI 12.4% to 40.3%) of new diagnoses. All participants diagnosed with AHI reported symptoms consistent with AHI. Our study among a general adult population attending HTS revealed a high overall HIV prevalence with a substantial proportion of AHI, highlighting the decreasing sensitivity of routine HTS to detect all HIV infections. To address AHI, accurate and accessible diagnostic tools and AHI testing guidance are needed.