Sexual and reproductive health and rights (SRHR) remain critically underfunded and underresearched in humanitarian settings. Existing global research agendas are outdated, lack an implementation focus and often exclude perspectives from frontline practitioners. This exercise aims to identify and rank actionable research priorities globally and by region. We conducted a cross-sectional global, multiphase prioritisation exercise with information from frontline practitioners. The process included a scoping review and 11 regional consultations (informed by 91 SRHR experts), resulting in a long list of 101 SRHR research needs. Using these, we systematically listed and refined the SRHR research questions. A budget-weighted research prioritisation (BWRP) method was used for a global, multilingual survey to score 73 SRHR implementation questions across nine SRHR topical domains and three crosscutting domains. Domains were weighted equally, and regional priorities were identified. A total of 271 experts contributed to the prioritisation ranking. Themes prioritised within the domains included the delivery of community-based care, self-care strategies, the integration of mental health into SRHR services and the improvement of adolescent access to contraception. A strong consensus emerged on the need to research topics such as human papilloma virus (HPV) vaccination, emergency obstetric and newborn care, and resilient SRHR service delivery amid climate shock. Substantial regional variation underscores the need for locally contextualised agendas, e.g., Europe and Central Asia prioritised quality of care and noncommunicable disease integration, whereas Latin America and the Caribbean emphasised gender-transformative approaches and community leadership. This stakeholder-informed research agenda responds to calls for context-specific SRHR research in humanitarian settings. The importance of tailoring research to local realities, including health system capacity, legal constraints and cultural norms, was a recurrent theme across all regions. The BWRP method enables clear prioritisation while reducing respondent burden, offering a practical model for future exercises. As global funding for SRHR contracts, aligning research with frontline needs is critical to ensuring effective, equitable service delivery.

This paper explores the profound physical, psychological and emotional challenges experienced by women who are subjected to forced marriage in the Ganderbal district of the Kashmir division of the Union Territory of Jammu and Kashmir in India. It argues that the forced marriage of women significantly impacts their physical and mental well-being, and reduces their standard of living. It focuses mostly on the loss of autonomy, reproductive health, social stigma and other hard-to-adjust-to challenges that lead to their poor quality of life. This qualitative study involved 15 purposively selected respondents and was conducted between November and December 2024. Its findings reveal that forced marriages function as a site of ongoing emotional and bodily regulation, which placessevere restrictions on women's personal freedom, reproductive choice and access to healthcare.

Polycystic Ovary Syndrome (PCOS) is the most common endocrine disorder in women of fertile age. It is associated with somatic and psychological comorbidities and lower sexual function. To study which psychosocial factors predict sexual dysfunction, and dyadic and solitary sexual desire in women with PCOS. This is an observational case control study amongst healthy heterosexual women with (n= 68) and without PCOS (n= 67), aged 18-40years, in a steady relationship. All participants filled out questionnaires on sexuality (sexual function, sexual distress, sexual desire), psychosocial factors (general self-esteem, relationship satisfaction, body image, body self-consciousness, sexual esteem, sexual abuse), and mental health (anxiety and depression). Standard multiple regression analyses were performed to assess which factors predict sexual dysfunction and dyadic and solitary sexual desire. sexual dysfunction, dyadic sexual desire, solitary sexual desire. Women with PCOS reported significantly more often sexual dysfunction (41.2% vs. 11.9%, P< .001, φ: 0.331) and lower dyadic sexual desire (P: .005, η: 0.057), but no difference in solitary sexual desire (P: .160, η: 0.015) compared to women without PCOS. Also, women with PCOS reported significantly less positive body image (P: .012, η: 0.047), higher body self-consciousness (P: .011, η: 0.048), higher anxiety (P: .002, η: 0.072), higher depression scores (P: .006, η: 0.055), more sexual abuse experiences (P: .009, φ: 0.225), and less relationship satisfaction (P: .017, η: 0.042). No differences in general self-esteem (P: .169, η: 0.014) were found in contrast to sexual esteem (P: .021, η: 0.039). Body self-consciousness (P: .05, r= 0.242), depression (P: <.001, r= .357), relationship satisfaction (P: .05, r= -0.286), and sexual esteem (P: <.001, r= 0.644) showed significant correlations with sexual dysfunction; and sexual esteem (P: <.001, r= -0.475) and use of the combined oral contraceptive pill (P: .05, r= -0.270) with dyadic sexual desire. Regression showed the strongest associations (all P: <.001) between sexual esteem and sexual dysfunction and dyadic sexual desire, and between depression and sexual dysfunction with moderate explained variance. Sexual function should be discussed with women with PCOS and psycho-education on the association with sexual esteem and depression given. Other common psychosocial comorbidities in PCOS should be screened. Refer for psychotherapy or a tailormade psychosexual treatment including interventions targeted on sexual esteem and depression. Strengths are the broad assessment of psychosocial factors and sexual distress. A weakness is the relatively healthy population possibly underestimating the effect of psychosocial factors. Sexual dysfunction and dyadic sexual desire in women with PCOS are predicted by depression and sexual esteem suggesting psychosexual counseling might be helpful.

Robot-assisted gynecological surgery enhances precision, shortens recovery time, and reduces postoperative complications. However, its impact on patient-reported outcomes and their quality of life remains underexplored. This study evaluates the patient’s quality of life following robot-assisted gynecological surgeries, focusing on physical function, pain, vitality, and sexual health. A prospective non-randomized study was conducted, assessing quality of life using validated tools before and at multiple intervals post-surgery using the RAND-36 survey, the Brief Pain Index and the Female Sexual Function Index. Subgroups included patients undergoing robot-assisted hysterectomy, myomectomy, cystectomy or both myomectomy and cystectomy. Significant improvements in quality of life were observed as early as 3 weeks post-surgery, with continued gains at 12 and 24 weeks, where maximum quality of life was achieved. Pain scores decreased from baseline to week 3 and remained consistently low thereafter. Vitality scores returned to baseline within 3 weeks, indicating a faster recovery compared to laparoscopic and traditional open surgeries. Sexual health outcomes initially declined post-surgery but gradually improved over six months. These findings suggest that robot-assisted gynecological surgery enhances long-term quality of life and offers a quicker recovery compared to conventional surgical approaches. However, the non-randomized study design limits the generalizability of the results, underscoring the need for randomized controlled trials to validate these outcomes and further refine patient care strategies.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11701-025-03006-9.

Von Willebrand Disease (VWD) is the most common inherited bleeding disorder and is often diagnosed in the setting of heavy menstrual bleeding (HMB). Because estrogen upregulates von Willebrand factor synthesis, pregnancy and the management of menses may influence VWD testing and diagnosis. Throughout the lifespan, the management of women's reproductive health is frequently impacted by VWD. We seek to describe the interplay between VWD and women's reproductive health at three distinct phases in life: menarche and menstruation, maternal health and fertility, and menopause and aging. Planning for care requires screening for VWD in the setting of reproductive bleeding counseling patients about expectations, and monitoring for iron deficiency across all three phases. Hemostatic plans should be tailored to both factor levels and patient preference. Emphasis is placed on areas lacking vital data.

Background/Objectives: Silver nanoparticles (AgNPs), used in industry and medicine, can have a negative impact on the human organism, particularly on the reproductive system, while polyphenolic supplementation may reduce oxidative stress (OS) and enhance male reproductive potential. The aim of this study was to investigate the effects of anthocyanin-rich blackcurrant pomace (BC) on sex steroid hormone metabolism and the OS indicator in the testes of rats following exposure to AgNPs. Methods: Adult rats were fed with a control feed (CTR) or diet supplemented with a 2% BC (BC group). The rats from AgNano and AgNano+BC groups were treated with 20 nm AgNPs (30 mg/kg/day for 28 days by gavage). Results: The plasma testosterone (T) and plasma dihydrotestosterone (DHT) concentrations were decreased in all experimental groups compared to the control (CTR) animals. The co-treatment of animals with AgNPs and BC resulted in decreased oestrogen receptor (ESR2) levels in the testes as compared to rats fed with a diet with BC alone, and the up-regulation of mRNA level of genes involved in T synthesis and metabolism (StAr, Cyp11a1, Hsd17b3, Hsd3b3, Cyp19a1, and Srd5a1), and steroid hormone signalling (AR, ESR1, and ESR2) compared to the Ctr group. The addition of BC to the diet of rats treated with AgNPs resulted in decreased protein carbonyls in the testes as compared to AgNPs-treated animals. Conclusions: The study demonstrated that relatively low AgNPs administration to rats was associated with increased oxidative stress in the gonads. Incorporating BC into the animals’ feed mitigated AgNPs-induced oxidative stress and stimulated the expression of genes involved in steroid synthesis and metabolism in testes. The bioactive compounds in blackcurrant pomace have plausible mechanisms to influence reproductive health.

As people move through their life, different aspects of sexual health become important. Thoughts, expressions and outcomes of sexual health may be influenced by culture, friends and social media. They can also vary over time. This underlies the concept of sexuality. However, discussions about sexuality and sexual health can be difficult to have sometimes, due to embarrassment for both patients and health professionals. Nonetheless, it is important for health professionals to be knowledgeable enough to have these discussions and feel confident to initiate them with patients who are scheduled to have a stoma. This might include ways to explore sexual health with partners or how to manage sexual dysfunction should it occur. Staff with a greater understanding about this issue can increase confidence in initiating discussions with patients about sexual health.

Background Polycystic Ovary Syndrome (PCOS) and Recurrent Pregnancy Loss (RPL) are reproductive disorders frequently linked to psychological distress. This study compared the severity of depression, anxiety, and stress levels between women with PCOS and RPL and assessed their association with years of marriage. Materials and methods A cross-sectional study conducted a random sampling method on 157 women (PCOS: 70; RPL: 87) attending the Obstetrics and Gynecology OPD at IMS BHU, Varanasi. Psychological status was assessed using the DASS-21 scale, a reliable tool widely used in reproductive health research. Chi-square test and independent sample t-tests were used for statistical analysis. Results Mean scores were significantly higher in RPL than in PCOS: depression (10.7 ± 3.5 vs. 8.8 ± 4.3, p = 0.003), anxiety (13.3 ± 3.8 vs. 10.7 ± 5.5, p = 0.001), and stress (12.3 ± 4.4 vs. 10.3 ± 6.1, p = 0.007). Marriage duration was significantly longer among women with severe depression (RPL: 8.4 ± 5.2 yrs.; PCOS: 6.3 ± 3.1 yrs), anxiety (RPL: 8.6 ± 5.1 yrs.; PCOS: 7.1 ± 3.3 yrs), and stress (RPL: 9.0 ± 5.2 yrs.; PCOS: 6.3 ± 3.1 yrs), all p &amp;lt; 0.05. Age was higher in RPL patients (p = 0.024); LH was higher in PCOS (p = 0.000). No significant differences were observed in AMH or BMI. Psychological symptoms were more severe among women with RPL, and a longer duration of marriage was associated with greater symptom severity. Marriage duration was significantly higher in women classified with severe depression, anxiety, and stress based on DASS-21 scores, indicating a correlational rather than causal relationship. Conclusion Routine psychological assessment is recommended for women with PCOS and RPL. Early identification of psychological distress may help improve overall reproductive and emotional health outcomes in these patients.

Global amphibian populations are declining, driven by a complex interplay of stressors including habitat destruction, climate change, pollutants, invasive species, and emergent diseases. Understanding the physiological response of amphibians to these stressors is critical, and hormones offer a powerful lens into their reproductive health and stress resilience. However, our knowledge of amphibian physiology and endocrinology remains limited, largely due to the lack of suitable non-invasive monitoring tools. Here, we present an innovative, non-invasive hormone monitoring method using small, temporary dermal patches. First, we evaluated six patch materials and two extraction techniques for their effectiveness in measuring corticosterone and testosterone. Our results indicate that patch performance varied depending on both the hormone type and extraction method. Second, to biologically validate this approach for monitoring dermal androgens, we monitored changes in testosterone levels in the Blue Mountains tree frog ( Dryopsophus citropa ) following the administration of human chorionic gonadotropin (hCG). Dermal patches successfully detected biologically relevant increases in testosterone post-stimulation, confirming their utility for monitoring reproductive hormones. This novel technique provides a viable, non-invasive approach for assessing amphibian steroid hormones, creating new opportunities to advance amphibian physiological research, ecological monitoring, and conservation management.

Background: Antiretroviral therapy has markedly increased life expectancy among people living with human immunodeficiency virus (HIV), yet the long-term impact of chronic HIV infection on women's quality of life (QoL) and sexual functioning remains poorly understood. Female sexual dysfunction (FSD) is common in women and may impair psychological well-being and social relationships. Understanding how HIV infection intersects with FSD and QoL could inform holistic care for women in resource-limited settings.Objective: To compare QoL and FSD between women living with HIV and HIV-negative women and to identify socio-demographic predictors of poor QoL.Methods: We conducted a hospital-based cross-sectional study in 2024 among 200 women on antiretroviral therapy and 200 age-matched HIV-negative women attending the general outpatient clinic at Aminu Kano Teaching Hospital, Kano, Nigeria. Participants were recruited through systematic sampling; research assistants provided study information and obtained written informed consent. Quality of life was assessed with the World Health Organization Quality of Life 26-item Brief questionnaire (WHOQOL-BREF). Female sexual function was screened with the 19-item Female Sexual Function Index (FSFI); a total score ≤26.55 denoted FSD. Data were analyzed using chi-square tests, independent t-tests and multivariable logistic regression.Results: The mean (±SD) age of participants was 37.1 ± 9.4 years. Overall QoL was significantly worse among women with HIV than HIV-negative women (53% vs 63% reporting good QoL, p = 0.043). Mean QoL scores were lower in the HIV-positive group for the psychological (61 ± 18 vs 54 ± 14; p < 0.001) and environmental domains (69 ± 20 vs 65 ± 16; p < 0.001), while physical and social domain scores were comparable. FSD was highly prevalent in both groups (96% in HIV-positive and 98% in HIV-negative participants; p = 0.40), and FSFI scores were not associated with QoL. In multivariable analysis, rural residence (adjusted odds ratio 3.30, 95% CI 1.31-8.98) and primary-level education (aOR 3.06, 95% CI 1.50-6.38) independently predicted poor QoL.Conclusions: Women living with HIV experience poorer overall QoL than HIV-negative peers, particularly in psychological and environmental domains. Interventions that improve living conditions, strengthen psychosocial support and integrate sexual and mental health services into HIV care, are needed to improve the well-being of women in North-western Nigeria.

Structural model of sexual factors relating to sexual and reproductive health behaviors among Iranian women

Background Inspired by feminist theory and Durkheim's social perspective, this study used intersectionality to delve into the determinants of hysterectomy. Methods Using data from the Demographic and Health Survey (DHS) of India, we examined the determinants of hysterectomy, focusing on three key themes: society, women's empowerment, and biological factors. Results The overall hysterectomy rate in India increased from 31.5 per 1,000 women (age 15–49 years) during 2015–16 to 32.6 per 1,000 women during 2019–21. The results of bivariate and multivariate analyses echo the findings of the interaction analysis, indicating that, among women of the general caste, illiteracy and higher parity correlate with an increased likelihood of undergoing a hysterectomy. Illiterate women from the Other Backward Class also exhibited higher hysterectomy rates, regardless of parity. The second interaction result states that wealth influences hysterectomy, and illiteracy remains a significant risk factor across wealth statuses. The results of the third intersection indicate that higher education is a protective factor against hysterectomy, regardless of residence or parity. Conclusion From the intersection of variables, the study observed that illiteracy, residing in rural areas, and high parity increase the likelihood of undergoing hysterectomy among women of reproductive age. There is a need to establish a mechanism for disseminating reproductive health knowledge to women in rural areas.

Health care utilization around the time of pregnancy by extent of disability in the United States, 2018-2020.

Premarital sexual behavior among adolescents remains a sensitive public health concern in conservative societies, where cultural and religious norms strictly regulate sexuality. Despite these limitations, risky behaviors persist and are influenced by environmental, familial, and media factors. This review aimed to identify and synthesize factors related to premarital sexual behavior among adolescents in conservative societies using the Theory of Planned Behavior (TPB) as a guiding framework. A scoping review was conducted according to The 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Review (PRISMA-ScR) guidelines. Relevant studies were identified in PubMed, Scopus, Cochrane, and EBSCOhost, focusing on adolescents aged 10-24 years in conservative settings. The data were analyzed thematically based on the following TPB components: attitudes, subjective norms, and perceived behavioral control. Twenty-three studies met our inclusion criteria. The factors influencing premarital sex include religiosity, peer pressure, exposure to pornography, parental supervision, and substance use. Religiosity and family communication act as protective factors, whereas exposure to pornography and peer influence increases risk. Premarital sexual behavior among adolescents in conservative societies is shaped by individual attitudes, social norms, and perceived control. Culturally sensitive sex education programs, digital literacy, and family involvement are recommended to promote safer behaviors.

Melatonin is multifaceted neurohormone secreted by pineal gland during darkness which is regulated by a small region present in hypothalamus i.e. Suprachiasmatic nucleus (SCN). Although melatonin primarily regulates the sleep and wake cycles, its effects are not limited to sleep. It also contributes to a number of physiological processes, including hormone regulation, metabolism, reproduction and body temperature regulation. Research has consistently highlighted the potential of melatonin to support reproductive health by enhancing testosterone synthesis, promoting gametogenesis, and improving both sperm quality and motility. Moreover, it has been found that melatonin improves fertilization rate and oocyte quality, making it a valuable adjunct in fertility treatments for both men and women. Beyond its role in reproductive function, melatonin also possesses potent anti-apoptotic, antioxidant, anti-inflammatory and properties. These effects help safeguard reproductive cells from the harmful impacts of oxidative stress and DNA damage, further underscoring melatonin's importance in maintaining optimal fertility and overall reproductive health. Despite its potential benefits, melatonin utility in reproductive health remains controversial due to inconclusive evidence, unclear mechanism and scattered information. Additionally, the supplementation of dosage and duration of melatonin in infertility and reproductive health needs exploration. In this review, we have tried to summarize the findings from various clinical and pre-clinical studies demonstrating the therapeutic potential of melatonin in male and female fertility and reproductive health. Aim of this review is to provide a deep knowledge on the current status of melatonin's potential therapeutic effects on reproductive health with emphasis on the molecular mechanism and future directions in melatonin's utility in reproductive health.

This Community Service Program (PKM) aims to enhance youth awareness and empowerment in preventing stunting, child marriage, and promoting reproductive health education in East Lombok Regency. The program was implemented by the East Lombok GenRe Forum under the supervision of the Office of Women Empowerment, Child Protection, and Family Planning (DP3AKB) and the National Population and Family Planning Agency (BKKBN) from 2022 to 2024. A combination of methods was applied, including socialization, workshops, mentoring, the development of Youth Information and Counseling Centers (PIK-R), and mass campaigns involving adolescents across multiple districts. The initiative reached over 25,000 adolescents through the “INI GENTING” (Implementasi Nyata Cegah Stunting – Real Implementation to Prevent Stunting) program and resulted in the formation of 504 Village GenRe Ambassadors as local change agents. According to data from DP3AKB and RRI East Lombok, child marriage cases decreased by nearly 50% during the program period, indicating significant behavioral and awareness shifts among the youth. Furthermore, this initiative strengthened adolescents’ reproductive health literacy, increased understanding of balanced nutrition, and built collective awareness of their role in preventing stunting. The program’s success stems from strong collaboration among the GenRe Forum, local government, educational institutions, and community networks. Thus, this initiative serves not only as an educational platform but also as a sustainable model of community-based youth empowerment that can be replicated at regional and national levels.

Chamaelirium luteum (L.) Gray, commonly known as False Unicorn or Fairy Wand, is a perennial herb in the Melanthiaceae family, native to eastern North America. Traditionally used by Native American tribes, it has been especially valued for promoting women's reproductive health. Ethnobotanical records highlight its therapeutic properties, including anti-inflammatory, antioxidant, and cytotoxic effects. Phytochemical investigations have identified bioactive compounds, including steroidal saponins (e.g., diosgenin, ∼2.5% dry weight), phenolic acids (e.g., gallic acid, ∼1.2%), flavonoids (e.g., quercetin, ∼0.8%), and lignans, which exhibit anti-tumor, antibacterial, and immunomodulatory activities. Modern applications include managing gynecological disorders, though clinical evidence remains limited. This review critically evaluates the botany, phytochemistry, pharmacology, and toxicology of C. luteum, integrating traditional knowledge with recent scientific advances (2015-2024) to propose future research directions for its safe and effective use in medicine.

The COVID-19 pandemic negatively affected sexual and reproductive health and rights (SRHR) and increased unwanted pregnancies among young people, yet scant evidence documents SRH service-access trajectories and experiences of young people living with HIV during this time. We conducted a remote study, comprised of qualitative Facebook and telephonic data collection with adolescents living with HIV and young parents in South Africa (n = 41, ages 16-29) in 2020/2021. Following this, we conducted in-depth research through calls, WhatsApp and Facebook to explore narratives of two young people living with perinatally-acquired HIV who accessed SRH services and became parents during COVID-19 lockdowns. We engage a narrative approach to illustrate the trajectories of these two young people - documenting their biopsychosocial lives and experiences accessing SRH services - with attention to personal, structural and relational factors. Findings illustrate their agency while detailing gaps in provisions that significantly affected their health and well-being. This study applies practice theory, exploring how gendered, relational, social and geographic factors shaped young people's experiences and SRH. Despite being well-acquainted with the biomedical technologies and relationships governing their care, they struggled to navigate an altered health landscape. Findings document how they were subject to narratives of individual responsibility for their SRH amidst system-level shortcomings. Results highlight significant gaps in service provision and an imperative to enhance the material conditions for young parents living with HIV in South Africa. They underscore the need for resilient, shock-responsive health and social protection systems to maintain continuous SRH services for adolescents living with HIV during crises.

Monitoring the progression of human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs) is crucial for evidence-based decision-making in prevention and control strategies. This study aimed to delineate the global, regional, and national burden of these infections from 1990 to 2021 and forecast trends to 2030. We retrieved data from the Global Burden of Disease (GBD) study 2021, including incidence and disability-adjusted life-years (DALYs) of HIV and other STIs from 1990 to 2021. Trends were quantified using estimated annual percentage changes (EAPCs) in age-standardized incidence and DALY rates. The Bayesian age-period-cohort (BAPC) model was used to forecast the future burden from 2022 to 2030. In 2021, global epidemiological surveillance documented 1,645,333 incident cases of HIV and 722,752,642 incident cases of other STIs. Concurrently, the burden of disease analysis revealed 40,266,792 DALYs attributable to HIV and 7,953,311 DALYs linked to STIs worldwide. The global age-standardized incidence rate (ASIR) of HIV declined from 36.7 (95% uncertainty interval [UI]: 33.0-40.6) per 100,000 population in 1990 to 20.7 (95% UI: 17.7-24.4) in 2021 per 100,000 papulation, with an EAPC of -2.58% (95% confidence interval [CI]: -2.95% to -2.20%). In contrast, the ASIR of other STIs remained relatively stable, changing from 8692.6 (95% UI: 6256.5-11,811.2) per 100,000 in 1990 to 8871.7 (95% UI: 6388.4-12,055.1) per 100,000 in 2021, with an EAPC of -0.02% (95% CI: -0.07% to 0.03%). The BAPC model predicts a decline in the ASIR of HIV to 12.9 (95% UI: 4.3-21.5) per 100,000 by 2030, whereas the ASIR of other STIs is expected to increase to 9150.0 (95% UI: 7913.6-10,386.3) per 100,000. Regionally, Sub-Saharan Africa is projected to have the highest ASIRs of HIV and other STIs in 2030, with estimates of 38.4 (95% UI: 11.7-65.2) and 13,865.8 (95% UI: 11,915.6-15,816.0) per 100,000 population, respectively. Despite declining HIV ASIRs, DALY burdens remain high, with significant regional disparities. HIV and other STIs continue to pose major public health challenges, necessitating targeted interventions, early sexual health education, enhanced screening, and cost-effective policies informed by GBD 2021 data.

Doxycycline as bacterial sexually transmitted infection (STI) postexposure prophylaxis (DoxyPEP) has shown high efficacy in clinical trials. We evaluated the impact of DoxyPEP on chlamydia (CT), gonorrhoea (GC) and syphilis incidence among pre-exposure prophylaxis (PrEP) users in a sexual health clinic in San Francisco, California, USA. DoxyPEP was offered to all PrEP clients at routine clinical visits starting on 30 November 2022. We included PrEP clients who received DoxyPEP (DoxyPEP users) or never initiated DoxyPEP (non-DoxyPEP users). Among DoxyPEP users, the 'pre-DoxyPEP' period was from 1 June 2022 until DoxyPEP initiation, and the 'post-DoxyPEP' period started after DoxyPEP initiation through 7 September 2023. STI testing included three sites-GC, CT and early syphilis testing. STI incidence rate ratios (IRRs) per quarter were evaluated using a pre-analysis, post-analysis and a controlled interrupted time series (CITS) analysis, with mixed-effects Poisson regression used to evaluate intervention effects. Among 3081 PrEP clients, 1209 (39%) initiated DoxyPEP. During the pre-DoxyPEP period, any STI, CT, GC and syphilis mean quarterly positivity was 18.1%, 9.2%, 8.1% and 2.2% among DoxyPEP users and 7%, 3.2%, 3% and 0.7% among non-DoxyPEP users, respectively. In pre-implementation and post-implementation analysis of DoxyPEP users, DoxyPEP was associated with lower STI incidence for any STI (IRR 0.42, 95% CI 0.24 to 0.74, p=0.003), CT (IRR 0.33, 95% CI 0.23 to 0.46, p<0.001) and syphilis (IRR 0.22, 95% CI 0.07 to 0.54, p=0.001), but not GC (IRR 0.89, 95% CI 0.69 to 1.15, p=0.383). In a CITS analysis, DoxyPEP was associated with a significant decline in any STI incidence (0.67, 95% CI 0.46 to 0.96, p<0.030). Observed DoxyPEP uptake reflected strong demand among PrEP users when offered in a clinical setting. Overall, STI incidence declined rapidly after implementation, demonstrating the high impact of this intervention in a real-world setting. Continued evaluation of uptake, adherence and impact on bacterial STIs will be essential as DoxyPEP implementation expands.