Sexually Transmitted Infections Control Research Articles

Syphilis Elimination: Lessons Learned Again

It is estimated that approximately 20 million new sexually transmitted infections (STIs) occur each year in the United States. The federally funded sexually transmitted disease prevention program implemented by Centers for Disease Control and Prevention is primarily focused on the prevention and control of the three most common bacterial STIs: syphilis, gonorrhea, and chlamydia. A range of factors facilitate the transmission and acquisition of STIs, including syphilis. In 1999, Centers for Disease Control and Prevention launched the National Campaign to Eliminate Syphilis from the United States. The strategies were familiar to public health in general and to sexually transmitted disease control in particular: (1) enhanced surveillance, (2) expanded clinical and laboratory services, ((3) enhanced health promotion, (4) strengthened community involvement and partnerships, and (5) rapid outbreak response. This national commitment to syphilis elimination was not the first effort, and like others before it too did not succeed. However, the lessons learned from this most recent campaign can inform the way forward to a more comprehensive approach to the prevention and control of STIs and improvement in the nation's health.

Antibiotic resistance in Neisseria gonorrhoea and treatment outcomes of gonococcal urethritis suspected patients in two large hospitals in Bhutan, 2015

IntroductionGonorrhea is a major sexually transmitted infection (STI) globally with increasing trends. Despite limited data, gonorrhea remains an important public health problem in Bhutan.MethodsA descriptive study was carried out in two Bhutanese hospitals; Jigme Dorji Wangchuck National Referral Hospital and Phuentsholing General Hospital in 2015. Patients suspected of gonococcal urethritis were sampled, treated and followed up at two weeks. Gonococcal isolates were identified and tested for antibiotic susceptibility by the Calibrated Dichotomous Sensitivity Test (CDS) method.ResultsOf the 524 patients, 2.3% (12) were females. Most (46.6%) patients belonged to the 26–35 years age group. About 58% were lost to follow up; 62% (277) of males and all (12) females. N. gonorrhoea was positive in 76% (398) of microscopy and 73.1% (383) by culture. Resistance against ciprofloxacin, penicillin, tetracycline and nalidixic acid were 85.1%, 99.2%, 84.8% and 99.7% respectively. Nearly all the isolates were sensitive to cefpodoxime, ceftriaxone and azithromycin. Sixty-seven percent (350) were treated with injection ceftriaxone alone, 32% (169) with ceftriaxone and oral doxycycline and 1% (5) with ceftriaxone, doxycycline and metronidazole. Probable treatment failure was seen only in one patient (0.5%).ConclusionsGonococcal resistance to currently used antibiotics was low and there was a high clinical cure rate. Compliance to treatment guidelines need reinforcement addressing antibiotic regimen, tracing sexual partners and addressing the social stigma. National STI programs should be more women-friendly for effective management, prevention and control of STIs. Laboratories must adopt more reliable susceptibility testing methods, the Minimum Inhibition Concentration method.

Prevalence and predictors associated with sexually transmitted infections in patients in Southern Brazil

Background: Sexually transmitted infections (STIs) are now a global public health problem with growing socioeconomic burden, not only because of the high number of people infected but also because of their consequences on sexual, reproductive, and maternal-fetal health. The objective of this study was to estimate the prevalence of STIs and associated predictors in patients attending a referral center. Methods & Materials: A cross-sectional, descriptive, and retrospective study of 2,795 patients attending a health referral center in Southern Brazil was performed between 2012 and 2017. Results: The prevalences of condylomata acuminata, syphilis, urethral discharge syndrome, and genital herpes were 31.13%, 24.36%, 9.45%, and 5.15%, respectively. The number of genital herpes cases increased significantly during the study period. It was found that 90.41% of patients attending were heterosexual, 54.39% had more than one partner in the last 12 months, 53.80% reported not using a condom in the last year, and 31.71% reported using a condom irregularly. Conclusion: The population served had a high prevalence of STIs, especially condylomata. The predictors associated with STIs were male sex, heterosexuality, single status, younger than 39 years, sexual initiation between the ages of 13 and 19 years, and not using condoms on a regular basis. Knowledge of the characteristics of the affected population is useful in determining measures of prevention and control of STIs.

Examining unmet needs: a cross-sectional study exploring knowledge, attitudes and sexually transmitted infection screening preferences among persons who inject drugs in Camden, New Jersey

ObjectivesTo inform the development of targeted sexually transmitted infection (STI) control programmes for persons who inject drugs (PWID).MethodsWe recruited 116 PWID (aged ≥ 18 years) from a community-based syringe exchange...

Concurrency of partnerships, consistency with data, and control of sexually transmitted infections

Sexually transmitted infections (STIs) are a globally increasing public health problem. Mathematical models, carefully matched to available epidemiological and behavioural data, have an important role to play in predicting the action of control measures. Here, we explore the effect of concurrent sexual partnerships on the control of a generic STI with susceptible-infected-susceptible dynamics. Concurrency refers to being in more than one sexual partnership at the same time, and is difficult to measure accurately. We assess the impact of concurrency through the development of three nested pair-formation models: one where infection can only be transmitted via stable sexual partnerships, one where infection can also be transmitted via casual partnerships between single individuals, and one where those individuals in stable partnerships can also acquire infection from casual partnerships. For each model, we include the action of vaccination before sexual debut to inform about the ability to control. As expected, for a fixed transmission rate, concurrency increases both the endemic prevalence of infection and critical level of vaccination required to eliminate the disease significantly. However, when the transmission rate is scaled to maintain a fixed endemic prevalence across models, concurrency has a far smaller impact upon the critical level of vaccination required. Further, when we also constrain the models to have a fixed number of new partnerships over time (both long-term and casual), then increasing concurrency can slightly decrease the critical level of vaccination. These results highlight that accurate measures and models of concurrency may not always be needed for reliable forecasts when models are closely matched to prevalence data. We find that, while increases in concurrency within a population are likely to generate public-health problems, the inclusion of concurrency may be unnecessary when constructing models to determine the efficacy of the control of STIs by vaccination.

Adverse Drug Reactions Monitoring in Pentavalent Vaccination Program at a Tertiary Care Teaching Hospital VYAS

 IntroductionThe syndromic management has been the cornerstone of management of  sexually transmitted infections (STIs) over the last few decades especially in developing  countries. But due to its inability to treat asymptomatic cases leading to undesirable sequeale,  it has received a lot of criticism recently. On the other hand, Evidence based management of  patients of vaginal and cervical discharge has lead to effective and timely management of  these patient but has increased the financial burden.Objective:The goal of the study is to compare syndromic vs. Evidence based approach in the  management of vaginal and cervical discharge. Method:The present study was conducted in the outpatient department of dermatology,  venereology & leprology of a tertiary care teaching hospital. 354 patients of clinical  impression of vaginal and cervical discharge were included in the study. Detailed history and  examination was recorded. Patients selected for syndromic management were managed as per  NACO guidelines. For evidence based management special investigations were carried out  and patients were managed accordingly. Result:Out of total 342 cases of VD, treated with syndromic and evidence based approach, p  value is significant for 7,14 and 21 days follow-up which means evidence based approach is  better than syndromic approach. Similar findings were observed in patients of cervical  discharge.Also, among CVV patients managed on lines of syndromic approach only 10%  showed improvement by end of one week. Conclusion:The control of STIs in resource-poor settings remains a major  challenge.Focus is now shifting towards a diagnostic model of STI care, given the  improving economic status of developing countries and availability of affordable point-of care testing. Also, various changes in the syndromic approach are needed immediately  for it to still remain relevant.

Advancing point of care diagnostics for the control and prevention of STIs: the way forward

WHO recognises the global impact of sexually transmitted infections (STIs) on global public health and individual sexual and reproductive health and well-being. As a component of the WHO Global Health...

Macrolide Resistance in Mycoplasma genitalium in Singapore

Background Mycoplasma genitalium was first reported as a cause of non-gonococcal urethritis in 1980. It has progressed from being an ‘emerging’ sexually transmitted infection (STI) to an accepted STI. Prevalence of infection has been reported as the Netherlands 4.5%, Sweden 6.3%, UK 1.2% and France 4%. M. genitalium has the smallest known bacterial genome and was the second bacterial genome fully sequenced. It has minimal requirements and is said to approach the minimum possible for a living cell. It is extremely fastidious; only a few strains have been cultured worldwide. Diagnosis relies on direct detection. It does not have a cell wall so it is not susceptible to antibiotics such as penicillins and cephalosporins. Therapy depends on fluoroquinolones and macrolides but resistance to macrolides has been widely reported: 13% France, 18% Sweden, 40% UK, Australia and Denmark, 100% Greenland, 30% Japan.Methods Ethics approval was granted. DNA extracts left over after routine clinical diagnostics at the Department of STI Control (DSC) Clinic, Kelantan Lane, Singapore were harvested. DNA had been extracted on a Cobas 4800 instrument (Roche) from urine and urethral swabs collected for testing for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG). A 2-plex real-time PCR assay targeting the pdhD and mgpB genes was used to screen for M. genitalium. Samples were deemed positive if both targets were detected. If only one target was detected, the sample was retested; if reactive in either target upon retest, the sample was considered positive for M. genitalium. Positive DNA preps were then screened for macrolide resistance mutations after Sanger sequencing of the 23S rRNA gene.Results368 anonymised DNA elutes from 254 urines and 114 urethral swabs were collected between May and July 2016. One hundred eighty-four were CT/NG positive and 184 were CT/NG negative. Sixteen (4.3%) were positive for M. genitalium. Four (25%) of these 16 samples contained macrolide resistance associated mutations; A2058T (x2), A2058G (x1), and A2059G (x1).Conclusion M. genitalium was detected in 4.3% of samples. Macrolide resistance mutations were detected in 25%, similar to international rates. Some guidelines recommend testing for resistance to guide therapy and to perform a test of cure.Disclosures All authors: No reported disclosures.

Turning the spotlight on sexually transmitted infections

Sexually transmitted infections (STIs) represent a heterogeneous group of infections that affect millions of people, including key populations such as sex workers, men who have sex with men, and people who inject drugs. Among them, chlamydia infection and bacterial vaginosis are very common problems, especially in women; it is estimated that one of 12 people in the world has genital infection with herpes simplex virus; the number of cases of syphilis and gonorrhoea is increasing worldwide; and there is an intense debate on how interventions to prevent HIV infection, such as pre-exposure prophylaxis and post-exposure prophylaxis, might have a negative effect on risk taking when it comes to sexual behaviour. Moreover, besides the immediate effect on the health of the infected person, STIs can also lead to infertility, miscarriage, stillbirth, and transmission from mother to child. Overall, WHO estimated that one million new cases of STIs (chlamydia, gonorrhoea, syphilis, and trichomoniasis) occur every day. 1 Newman L Rowley J Vander Hoorn S et al. Global estimates of the prevalence and incidence of four curable sexually transmitted infections in 2012 based on systematic review and global reporting. PLoS One. 2015; 10: e0143304 Google Scholar Although this number should be hard to ignore, these infections remain a neglected issue in both the public health agenda and the research community. Sexually transmitted infections: challenges aheadWHO 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. Full-Text PDF Mycoplasma genitalium: yet another challenging STIIn The Lancet Infectious Diseases, Unemo and colleagues1 present a well written and comprehensive Commission on the “challenges ahead” for sexually transmitted infections (STIs). The authors address many issues around some of the most important STIs, such as Chlamydia trachomatis and Neisseria gonorrhoeae, the two most common bacterial STIs globally according to WHO estimates.2 They also address bacterial vaginosis, which is the most prevalent urogenital condition in women worldwide. Although not covered in the Commission because of the availability of recent reviews,3,4 Mycoplasma genitalium infection is a bacterial STI second in prevalence only to C trachomatis in most studies. Full-Text PDF Challenges in responses to syphilis epidemicA decrease in the global estimate of four curable sexually transmitted infections (STIs), including chlamydia, gonorrhoea, trichomoniasis, and syphilis, was observed in 2012 by comparison with that of 2008, but 2015 saw an estimated 357 million new cases for the four infections combined.1 This overall decrease mainly reflects the contribution of the reduction of syphilis seropositivity among pregnant women over time in countries that consistently report seropositivity data to WHO.2 Full-Text PDF Health systems and the new strategy against sexually transmitted infectionsThe Lancet Infectious Diseases Commission by Unemo and colleagues1 on sexually transmitted infections (STIs) is published at an important time in the global public health response to STIs. STIs are important causes of morbidity and mortality. WHO estimated that about 357·4 million new cases of chlamydia, gonorrhoea, syphilis, and trichomoniasis occur annually.2 Viral STIs are also highly prevalent with an estimated 417 million people infected with herpes simplex virus type 2 and approximately 291 million women with human papillomavirus (HPV) infections. Full-Text PDF

A randomised controlled trial to evaluate the impact of sexual health clinic based automated text message reminders on testing of HIV and other sexually transmitted infections in men who have sex with men in China: protocol for the T2T Study

IntroductionThe frequency of screening for HIV and other sexually transmitted infections (STIs) among men who have sex with men (MSM) is still low in China.Methods and analysisA sexual health clinic...

The magnitude of, and factors associated with, loss to follow-up among patients treated for sexually transmitted infections: a multilevel analysis

ObjectivesThe loss to follow-up (LTFU) among patients attending care for sexually transmitted infections (STIs) in Sub-Saharan Africa is a major barrier to achieving the goals of the STI prevention and...

Partner notification and treatment for sexually transmitted infections among pregnant women in Gaborone, Botswana.

Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and Trichomonas vaginalis (TV) are sexually transmitted infections (STIs) associated with adverse birth outcomes. Untreated partners contribute to high rates of STI reinfection; thus, partner notification and treatment remain important components of STI care and control. A prospective cohort study was conducted among 300 pregnant women presenting to the antenatal clinic at Princess Marina Hospital in Gaborone, Botswana who enrolled in an STI screening study. Following informed consent and sample collection for CT/NG/TV testing, participants were asked if they were willing to disclose their STI result and to deliver medications to their partner(s). Those who tested positive were asked at a follow-up appointment if they notified their partners. Among the 300 participants, 294 (98%) said they would be willing to tell their partner(s) about their test results if they tested positive, and 284 (95%) said they would be willing to give their partner(s) medication if the option was available. Of those who tested positive and returned for a test of cure, 27 of 32 (84%) reported that they told their partner about the results, and 20 of 32 (63%) reported that their partner received treatment. Almost all pregnant women reported willingness to tell their partner the STI test result and give their partner medications. At test of cure, most women reported informing their partner, although actual treatment receipt was lower. Our findings suggest that pregnant women are willing to utilize patient-based partner notification, but actual partner treatment might be lower than intended.

Costing of National STI Program Implementation for the Global STI Control Strategy for the Health Sector, 2016-2021

IntroductionIn 2016 the World Health Assembly adopted the global strategy on Sexually Transmitted Infections (STI) 2016–2021 aiming to reduce curable STIs by 90% by 2030. We costed scaling-up priority interventions to coverage targets.MethodsStrategy-targeted declines in Chlamydia trachomatis, Neisseria gonorrhoeae, Treponema pallidum and Trichomonas vaginalis were applied to WHO-estimated regional burdens at 2012. Syndromic case management was costed for these curable STIs, symptomatic Herpes Simplex Virus 2 (HSV-2), and non-STI vaginal syndromes, with incrementally expanding etiologic diagnosis. Service unit costs were multiplied with clinic attendances and people targeted for screening or prevention, by income tier. Human papilloma virus (HPV) vaccination and screening were costed for coverage increasing to 60% of 10-year-old girls for vaccination, and 60% of women 30–49 years for twice-lifetime screening (including clinical follow-up for positive screens), by 2021.ResultsStrategy implementation will cost an estimated US$ 18.1 billion over 2016–2021 in 117 low- and middle-income countries. Cost drivers are HPV vaccination ($3.26 billion) and screening ($3.69 billion), adolescent chlamydia screening ($2.54 billion), and antenatal syphilis screening ($1.4 billion). Clinical management—of 18 million genital ulcers, 29–39 million urethral discharges and 42–53 million vaginal discharges annually—will cost $3.0 billion, including $818 million for service delivery and $1.4 billion for gonorrhea and chlamydia testing. Global costs increase from $2.6 billion to $ 4.0 billion over 2016–2021, driven by HPV services scale-up, despite vaccine price reduction. Sub-Saharan Africa, bearing 40% of curable STI burdens, covers 44% of global service needs and 30% of cost, the Western Pacific 15% of burden/need and 26% of cost, South-East Asia 20% of burden/need and 18% of cost.ConclusionsCosts of global STI control depend on price trends for HPV vaccines and chlamydia tests. Middle-income and especially low-income countries need increased investment, innovative financing, and synergizing with other health programs.

The Risk of Sexually Transmitted Infection and Its Influence on Condom Use among Pregnant Women in the Kintampo North Municipality of Ghana.

Sexually transmitted infection (STI) affects the reproductive health of both men and women worldwide. Condoms are important part of the available preventive strategies for STI control. The lack of proper risk-perception continues to impede women's ability to negotiate condom use with their partners. This paper is the outcome of secondary analysis of data collected in a cross-sectional survey that explored the perception of risk of STI and its influence on condom use among 504 pregnant women attending antenatal clinic at two health facilities in the Kintampo North Municipality. Consecutively, three Focus Group Discussions were conducted among 22 pregnant women which was analyzed using thematic analysis technique. Multivariate logistic regression analysis was used to identify possible predictors of condom use and risk of STI. Respondents mean age was 26.0 ± 5.9 years. 47% of respondents self-identified themselves as high risk for contracting STI, 50% of whom were married. High risk status (OR = 2.1, 95% CI: 1.1–4.4), ability to ask for condoms during sex (OR = 0.3, 95% CI: 0.1–0.73), and partner's approval of condom use (OR = 0.2, 95% CI: 0.01–0.05) were independent predictors of condom use. Condom use (OR 2.9 (1.5–5.7); p = 0.001) and marital status (engaged, OR 2.6 (1.5–4.5); p = 0.001) were independent predictors of risk of STI. Women who self-identified themselves as high risk for STI successfully negotiated condom use with their partners. This is however influenced by partner's approval and ability to convince partner to use condoms. Self-assessment of STI risk by women and the cooperation of male partners remain critical.

Future prospects for new vaccines against sexually transmitted infections.

Purpose of reviewThis review provides an update on the need, development status, and important next steps for advancing development of vaccines against sexually transmitted infections (STIs), including herpes simplex virus (HSV), Neisseria gonorrhoeae (gonorrhea), Chlamydia trachomatis (chlamydia), and Treponema pallidum (syphilis).Recent findingsGlobal estimates suggest that more than a million STIs are acquired every day, and many new and emerging challenges to STI control highlight the critical need for development of new STI vaccines. Several therapeutic HSV-2 vaccine candidates are in Phase I/II clinical trials, and one subunit vaccine has shown sustained reductions in genital lesions and viral shedding, providing hope that an effective HSV vaccine is on the horizon. The first vaccine candidate for genital chlamydia infection has entered Phase I trials, and several more are in the pipeline. Use of novel technological approaches will likely see viable vaccine candidates for gonorrhea and syphilis in the future. The global STI vaccine roadmap outlines key activities to further advance STI vaccine development.SummaryMajor progress is being made in addressing the large global unmet need for STI vaccines. With continued collaboration and support, these critically important vaccines for global sexual and reproductive health can become a reality.

Knowledge and attitude about sexually transmitted infections other than HIV among college students.

Sexually transmitted infections (STIs) are the infections which are mainly transmitted through sexual intercourse. Young individuals in the age group of 16 to 24 years are considered to be at more risk for STIs compared to older adults. Young individuals are more likely to practice unprotected sex and have multiple sexual partners. If the STIs are not treated adequately, it can lead to various complications.Most of the people may be aware about HIV/AIDs because of the awareness created by media and the government programs, however knowledge about STIs other than HIV/AIDS is low in the developing countries. This study was a descriptive cross sectional study to assess the knowledge, awareness and attitude of college students about STIs other than HIV. A total of 350 engineering students from various semesters were included in the study. They were asked to fill up an anonymous questionnaire. Two hundred and fifty six (73%) males and 94 (27%) females participated in the study. 313 (90%) students had heard about sexually transmitted infections (STIs) and 223 (64%) students had heard about STIs other than HIV. 99% of students knew about HIV where as less than 50% of students knew about other STIs. Teachers, internet and media were the source of information for most of the participants. Almost 75% of the students knew about the modes of transmission of STIs. Less than 50% of the participants knew about the symptoms of STIs and complications. Also attitude of the students towards sexual health and prevention of STIs was variable. The findings of our study shows that it is important to orient the students about sexual health and safe sexual practices as it will go a long way in prevention and control of STIs. Also the morbidities and complications associated with STIs can be prevented.

Knowledge and attitude about sexually transmitted infections other than HIV among college students

Background:Sexually transmitted infections (STIs) are the infections which are mainly transmitted through sexual intercourse. Young individuals in the age group of 16 to 24 years are considered to be at more risk for STIs compared to older adults. Young individuals are more likely to practice unprotected sex and have multiple sexual partners. If the STIs are not treated adequately, it can lead to various complications.Most of the people may be aware about HIV/AIDs because of the awareness created by media and the government programs, however knowledge about STIs other than HIV/AIDS is low in the developing countries.Materials and Methods:This study was a descriptive cross sectional study to assess the knowledge, awareness and attitude of college students about STIs other than HIV. A total of 350 engineering students from various semesters were included in the study. They were asked to fill up an anonymous questionnaire.Results:Two hundred and fifty six (73%) males and 94 (27%) females participated in the study. 313 (90%) students had heard about sexually transmitted infections (STIs) and 223 (64%) students had heard about STIs other than HIV. 99% of students knew about HIV where as less than 50% of students knew about other STIs. Teachers, internet and media were the source of information for most of the participants. Almost 75% of the students knew about the modes of transmission of STIs. Less than 50% of the participants knew about the symptoms of STIs and complications. Also attitude of the students towards sexual health and prevention of STIs was variable.Conclusion:The findings of our study shows that it is important to orient the students about sexual health and safe sexual practices as it will go a long way in prevention and control of STIs. Also the morbidities and complications associated with STIs can be prevented.

Willingness to Disclose Sexually Transmitted Infection Status to Sex Partners Among College-Aged Men in the United States.

Disclosure of sexually transmitted infections (STIs) to sexual partners is critical to the prevention, treatment, and control of STIs. We examine personal intra and interpersonal influences on willingness to disclose STI status among college-aged men. Participants (n = 1064) were aged 17 to 24 years and recruited from a variety of university and community venues. Using independent-samples t test, Pearson χ test, and binary logistic regression, we examined the relationship between willingness to disclose an STI and intrapersonal and interpersonal factors, including age, masculinity values, interpersonal violence, partner cell phone monitoring, alcohol and/or drug use, condom use, number and characteristics of sex partners, and previous STI. Results reveal that among college-aged men, type of sex partner and masculinity values are significant variables in predicting whether or not an individual is willing to disclose. These data can inform STI control programs to more effectively address the complex issues associated with STI disclosure to sex partners.

Sexually transmitted infections and pre-exposure prophylaxis: challenges and opportunities among men who have sex with men in the US.

Pre-Exposure Prophylaxis (PrEP) has shown high efficacy in preventing human immunodeficiency virus (HIV) infection among men who have sex with men (MSM) in several large clinical trials, and more recently in “real world” reports of clinical implementation and a PrEP demonstration project. Those studies also demonstrated high bacterial sexually transmitted infection (STI) incidence and raised the discussion of how PrEP may impact STI control efforts, especially in the setting of increasing Neisseria gonorrhoeae antimicrobial resistance and the increase in syphilis cases among MSM. Here, we discuss STIs as a driver of HIV transmission risk among MSM, and the potential opportunities and challenges for STI control afforded by expanded PrEP implementation among high-risk MSM.

Home-based versus clinic-based specimen collection in the management of Chlamydia trachomatis and Neisseria gonorrhoeae infections.

Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) are the most frequent causes of bacterial sexually transmitted infections (STIs). Management strategies that reduce losses in the clinical pathway from infection to cure might improve STI control and reduce complications resulting from lack of, or inadequate, treatment. To assess the effectiveness and safety of home-based specimen collection as part of the management strategy for Chlamydia trachomatis and Neisseria gonorrhoeae infections compared with clinic-based specimen collection in sexually-active people. We searched the Cochrane Sexually Transmitted Infections Group Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and LILACS on 27 May 2015, together with the World Health Organization International Clinical Trials Registry (ICTRP) and ClinicalTrials.gov. We also handsearched conference proceedings, contacted trial authors and reviewed the reference lists of retrieved studies. Randomized controlled trials (RCTs) of home-based compared with clinic-based specimen collection in the management of C. trachomatis and N. gonorrhoeae infections. Three review authors independently assessed trials for inclusion, extracted data and assessed risk of bias. We contacted study authors for additional information. We resolved any disagreements through consensus. We used standard methodological procedures recommended by Cochrane. The primary outcome was index case management, defined as the number of participants tested, diagnosed and treated, if test positive. Ten trials involving 10,479 participants were included. There was inconclusive evidence of an effect on the proportion of participants with index case management (defined as individuals tested, diagnosed and treated for CT or NG, or both) in the group with home-based (45/778, 5.8%) compared with clinic-based (51/788, 6.5%) specimen collection (risk ratio (RR) 0.88, 95% confidence interval (CI) 0.60 to 1.29; 3 trials, I² = 0%, 1566 participants, moderate quality). Harms of home-based specimen collection were not evaluated in any trial. All 10 trials compared the proportions of individuals tested. The results for the proportion of participants completing testing had high heterogeneity (I² = 100%) and were not pooled. We could not combine data from individual studies looking at the number of participants tested because the proportions varied widely across the studies, ranging from 30% to 96% in home group and 6% to 97% in clinic group (low-quality evidence). The number of participants with positive test was lower in the home-based specimen collection group (240/2074, 11.6%) compared with the clinic-based group (179/967, 18.5%) (RR 0.72, 95% CI 0.61 to 0.86; 9 trials, I² = 0%, 3041 participants, moderate quality). Home-based specimen collection could result in similar levels of index case management for CT or NG infection when compared with clinic-based specimen collection. Increases in the proportion of individuals tested as a result of home-based, compared with clinic-based, specimen collection are offset by a lower proportion of positive results. The harms of home-based specimen collection compared with clinic-based specimen collection have not been evaluated. Future RCTs to assess the effectiveness of home-based specimen collection should be designed to measure biological outcomes of STI case management, such as proportion of participants with negative tests for the relevant STI at follow-up.