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Objectives: There is a growing body of evidence that in the absence of Chlamydia trachomatis and/or Neisseria gonorrhoeae, Mycoplasma genitalium and bacterial vaginosis (BV) are associated with cervicitis. We aimed to describe infections detected among cervicitis cases over a decade and establish how commonly M. genitalium and BV were detected among non-chlamydial/non-gonococcal cases to inform testing and treatment practices. Methods: We conducted a retrospective case-series to determine the number of cervicitis cases diagnosed with genital infections (C. trachomatis , N. gonorrhoeae, M. genitalium and BV) among women attending the largest public sexual health service in Australia from 2011 to 2021. We determined the proportion of cervicitis cases with one or more genital infections detected, and trends in testing and detection of each infection over time. Results: Over a decade 813 cervicitis cases were diagnosed; 421 (52%, 95%CI: 48%–55%) had no infection detected; 226/729 (31%, 95%CI: 28%–35%) had BV, 163/809 (20%, 95%CI: 17%–23%) C. trachomatis , 48/747 (6%, 95%CI: 5%–8%) M. genitalium , and 13/793 (2%, 95%CI: 1%–3%) N. gonorrhoeae. Of the 665 (82%) cases tested for all four infections, 268 (40%) had one infection and 73 (11%) had >1 infection detected. Of the 517/665 (78%) non-chlamydial/non-gonococcal cases , 164 (32%) had BV and 16 (3%) had M. genitalium as the sole infections detected; a further 13 cases (3%) were co-infected with BV and M. genitalium. The proportion of cases tested for BV (90%) did not change overtime, but detection increased from 32% to 45% (Ptrend < 0.001). The proportion of cases tested for M. genitalium increased from 84% in 2011 to 96% in 2019 (Ptrend = 0.006), with M. genitalium -detection in cervicitis increasing from 3% to 7% (Ptrend = 0.046). Conclusions: In our study population, chlamydia or gonorrhoea were not detected in ∼75% of cervicitis cases; 1 in 3 of these cases had BV and/or M. genitalium , and both increased in prevalence over time. These data highlight the need for clinicians to consider BV and M. genitalium when assessing and managing cervicitis. [ABSTRACT FROM AUTHOR]

Background Australia introduced a national human papillomavirus (HPV) vaccination program for girls in 2007 and boys in 2013, achieving high coverage. We assessed HPV prevalence among men who have sex with women (MSW) and men who have sex with men (MSM) aged 18–35 years and examined program effects. Methods Between 2015–2018, men self-collected a penile or intra-anal swab for HPV genotyping. Vaccination status was confirmed with the National Register. HPV prevalence was examined by age groups and vaccination status. Results Prevalence of quadrivalent vaccine–targeted HPV types (6, 11, 16, 18) was 10.6% (95% confidence interval [CI], 8.7%–12.8%) in unvaccinated MSW and 10.7% (95% CI, 5.7%–19.3%) in vaccinated MSW (P =.96). Prevalence was 40.3% (95% CI, 36.0%–44.8%) in unvaccinated MSM and 29.9% (95% CI, 23.1%–37.8%) in vaccinated MSM (P =.02). Among those with confirmed doses, quadrivalent types were detected in 0% (95% CI, 0%–7.7%; n = 46) of men who had their first dose at 13–19 years and 37.2% (95% CI, 27.5%–47.8%; n = 94) in those who received their first dose at 20 years or older. Conclusions Our data demonstrate the importance of universal adolescent HPV vaccination to ensure MSM receive the same benefits as MSW. [ABSTRACT FROM AUTHOR]

Background: Web-based, testing for sexually transmitted infections (STI) is becoming increasingly available. However, treatment pathways from web-based services are often not well-coordinated, contributing to treatment delays and access gaps. This study investigated clinician perspectives on building service linkages with a new, web-based, STI testing service in Victoria, Australia. Methods: We interviewed 16 clinicians from regional/outer metropolitan areas who are part of government-funded, primary care programs to strengthen sexual health services in Victoria. Interviews enquired about: clinician attitudes, considerations for managing referrals, compatibility with clinic systems, and broader policy/healthcare system factors. Results: Clinicians were enthusiastic, perceived web-based services as complementary (not competition), and believed local treatment pathways were important for patient choice/access. They felt that administrative aspects of handling referrals from an online service could be managed without problems. To inform treatment, clinicians recommended that referral letters from the web-based service list all tests ordered, dates, and complete results. Tensions were raised regarding the utility and appropriateness of including treatment guidelines and pre-prepared prescriptions in referral letters. Respondents reported that most clinics did not stock injectable antibiotics, raising concerns by clinicians about potential treatment delays and privacy challenges related to patient-led procurement at pharmacies. Conclusions: Our study suggests that clinicians are receptive to local treatment pathways being designed as part of web-based STI testing services, and strengthened service linkages could improve client access, particularly outside urban areas. Capacity-building and additional resourcing of local partner clinics may be needed to support decentralised, patient-centred treatment pathways. For individuals who test positive using web-based, sexually transmitted infection testing services, getting treatment can be challenging. Our study found that primary care providers in outer metro and regional Victoria were willing to treat individuals who used web-based services, but raised concerns about administering online prescriptions and lack of injectable antibiotics available on-site at clinics for free, same-day treatment. Capacity-building and additional resourcing of local, partner clinics may be needed to enable effective, client-centered referrals from online to in-person sexual health services. [ABSTRACT FROM AUTHOR]

Background: Chlamydia is one of the most common sexually transmissible infections globally and can lead to reproductive complications, including pelvic inflammatory disease and infertility. Interventions to reduce disease burden, including retesting for reinfection, partner management, and early detection of complications, are the focus of the Management of Chlamydia Cases in Australia (MoCCA) study, an implementation and feasibility trial aiming to strengthen chlamydia management in Australian general practice. This study aimed to identify factors influencing participation in and adoption of a multifaceted chlamydia management intervention within the general practice setting. Methods: We conducted semi-structured interviews with general practice staff (n = 13) from clinics (n = 9) participating in the MoCCA study. Data were analysed using inductive content analysis to identify facilitators and barriers to study participation and intervention adoption. Results: Participants felt that practice champions, motivated staff and interventions that improved workflow efficiency, integrated with existing processes and improved patient interactions, facilitated participation in, and adoption of, study interventions. A perceived lack of staff engagement related to time constraints, competing priorities, staff retention issues and interventions that were less convenient to use or had reduced patient uptake were identified as barriers to participation. Conclusions: Identifying perceived facilitators and barriers to successful implementation of a multifaceted chlamydia intervention enables public health practitioners to better support general practice in the ongoing uptake and use of evidence-based chlamydia management strategies, ultimately aiming to reduce the burden of chlamydia and its complications in Australia. Chlamydia is a common sexually transmissible infection in Australia, and can lead to permanent reproductive complications. Management of Chlamydia Cases in Australia (MoCCA) involves a multifaceted intervention aiming to strengthen the management of chlamydia in general practice. Our findings show that practice champions, motivated staff and useful resources facilitated adoption of interventions, whereas competing priorities, difficulties retaining staff, and a lack of staff and patient engagement hindered adoption. Findings can support general practitioners and reduce burden of disease. [ABSTRACT FROM AUTHOR]

Anal high‐risk human papillomavirus (HRHPV) testing‐based anal cancer screening gay and bisexual men (GBM) is associated with high sensitivity, but low specificity. We report the potential role of triage use of anal cytology with HRHPV testing in detecting 12‐month persistent anal high‐grade squamous epithelial lesions (HSIL) in a cohort of GBM in Sydney, Australia. Participants were GBM from the Study of the Prevention of Anal Cancer (SPANC) who underwent annual anal HPV testing, cytology, and high‐resolution anoscopy (HRA)‐guided histology. The sensitivity and specificity of five screening algorithms based on HRHPV test results with triage use of anal cytology (atypical squamous cells of undetermined significance (ASCUS) and atypical squamous cells, cannot exclude HSIL (ASC‐H) used as referral thresholds) were compared to these of HRHPV testing and anal cytology alone. A total of 475 men who had valid HRHPV, cytological, and histological results at both baseline and first annual follow‐up visits were included, median age 49 years (inter‐quartile range: 43–56) and 173 (36.4%) GBM with human immunodeficiency virus. Of all triage algorithms assessed, two had comparable sensitivity with HRHPV testing alone in detecting persistent anal HSIL, but ~20% higher specificity and 20% lower HRA referral rates. These two algorithms involved the immediate referral of those with HPV16 and for those with non‐16 HRHPV either immediate or delayed (for 12 months) referral, depending on cytology result at baseline. Triage use of anal cytology in GBM testing positive for anal HRHPV increases specificity and reduces referral rates while maintaining high sensitivity in detection of HSIL. [ABSTRACT FROM AUTHOR]

Background: Early diagnosis of syphilis is vital for its effective control. This study aimed to develop an Artificial Intelligence (AI) diagnostic model based on radiomics technology to distinguish early syphilis from other clinical skin lesions. Methods: The study collected 260 images of skin lesions caused by various skin infections, including 115 syphilis and 145 other infection types. 80% of the dataset was used for model development with 5-fold cross-validation, and the remaining 20% was used as a hold-out test set. The exact lesion region was manually segmented as Region of Interest (ROI) in each image with the help of two experts. 102 radiomics features were extracted from each ROI and fed into 11 different classifiers after deleting the redundant features using the Pearson correlation coefficient. Different image filters like Wavelet were investigated to improve the model performance. The area under the ROC curve (AUC) was used for evaluation, and Shapley Additive exPlanations (SHAP) for model interpretation. Results: Among the 11 classifiers, the Gradient Boosted Decision Trees (GBDT) with the wavelet filter applied on the images demonstrated the best performance, offering the stratified 5-fold cross-validation AUC of 0.832 ± 0.042 and accuracy of 0.735 ± 0.043. On the hold-out test dataset, the model shows an AUC and accuracy of 0.792 and 0.750, respectively. The SHAP analysis shows that the shape 2D sphericity was the most predictive radiomics feature for distinguishing early syphilis from other skin infections. Conclusion: The proposed AI diagnostic model, built based on radiomics features and machine learning classifiers, achieved an accuracy of 75.0%, and demonstrated potential in distinguishing early syphilis from other skin lesions. Highlights: Radiomics is highly effective for detecting sexually transmitted infection lesions. Integrating the radiomics model with machine learning achieves high AUC for early syphilis detection. Important radiomics features extracted from models reveal lesion shape details crucial for early syphilis detection. [ABSTRACT FROM AUTHOR]

Background: Bacterial vaginosis affects one third of reproductive-aged women, and recurrence is common. Evidence of sexual exchange of bacterial vaginosis-associated organisms between partners suggests that male-partner treatment may increase the likelihood of cure., Methods: This open-label, randomized, controlled trial involved couples in which a woman had bacterial vaginosis and was in a monogamous relationship with a male partner. In the partner-treatment group, the woman received first-line recommended antimicrobial agents and the male partner received oral and topical antimicrobial treatment (metronidazole 400-mg tablets and 2% clindamycin cream applied to penile skin, both twice daily for 7 days). In the control group, the woman received first-line treatment and the male partner received no treatment (standard care). The primary outcome was recurrence of bacterial vaginosis within 12 weeks., Results: A total of 81 couples were assigned to the partner-treatment group, and 83 couples were assigned to the control group. The trial was stopped by the data and safety monitoring board after 150 couples had completed the 12-week follow-up period because treatment of the woman only was inferior to treatment of both the woman and her male partner. In the modified intention-to-treat population, recurrence occurred in 24 of 69 women (35%) in the partner-treatment group (recurrence rate, 1.6 per person-year; 95% confidence interval [CI], 1.1 to 2.4) and in 43 of 68 women (63%) in the control group (recurrence rate, 4.2 per person-year; 95% CI, 3.2 to 5.7), which corresponded to an absolute risk difference of -2.6 recurrences per person-year (95% CI, -4.0 to -1.2; P<0.001). Adverse events in treated men included nausea, headache, and metallic taste., Conclusions: The addition of combined oral and topical antimicrobial therapy for male partners to treatment of women for bacterial vaginosis resulted in a lower rate of recurrence of bacterial vaginosis within 12 weeks than standard care. (Funded by the National Health and Medical Research Council of Australia; StepUp Australian New Zealand Clinical Trials Registry number, ACTRN12619000196145.)., (Copyright © 2025 Massachusetts Medical Society.)

Background: Many international guidelines recommend routine treatment for individuals reporting sexual contact with sexual partners with chlamydia. In October-2019, the Melbourne Sexual Health Centre changed routine treatment of all chlamydia contacts to selective treatment, reserving same-day treatment for those testing positive, unless patients presented with symptoms or with specific reasons., Methods: We conducted a before-and-after study among chlamydia contacts at MSHC by comparing 12 months before the 'routine treatment period' (December-2018 to October-2019) and after the 'selective treatment period' (November-2019 to December-2020)., Results: Of the 2843 chlamydia contacts included in the analysis, chlamydia positivity was 31.9% (907/2843). The proportion of contacts who received treatment before test results decreased from 91% (1380/1515) to 56% (739/1328) (p<0.0001). We reviewed 232 of the 739 chlamydia contacts in the selective period to determine reasons for treatment, 41.4% (96/232) were treated due to the presence of symptoms. The proportion of those who received treatment and later tested positive did not change between the two periods (35% [482/1380] vs. 34% [253/739], p=0.750). However, the proportion of contacts who received unnecessary treatment (treated but tested negative) did not change between the two periods (65% [898/1380] vs. 66% [486/739], p=0.750). Of the 60 who did not receive treatment but tested positive subsequently, seven (11.7%) did not return for treatment, and it did not differ between the two periods (p=0.370)., Conclusions: The selective treatment approach has reduced antibiotic consumption and likely decreased the overall workload of clinic staff by minimising the need to treat all contacts., (© The Author(s) 2025. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)

Infection with Neisseria gonorrhoeae, the causative agent of gonorrhoea, causes significant morbidity worldwide and can have long-term impacts on reproductive health. The greatest global burden of gonorrhoea occurs in low- and middle-income settings. Global public health significance is increasing due to rising antimicrobial resistance (AMR), which threatens future gonorrhoea management. The oropharynx is an important asymptomatic reservoir for gonorrhoea transmission and a high-risk site for development of AMR and treatment failure. Controlled human infection model (CHIM) studies using N. gonorrhoeae may provide a means to accelerate the development of urgently needed therapeutics, vaccines and other biomedical prevention strategies. A gonorrhoea urethritis CHIM has been used since the 1980s with no reported serious adverse events. Here, we describe the rationale for an oropharyngeal gonorrhoea CHIM, including analysis of potential ethical issues that should inform the development of this novel study design., (© The Author(s) 2025. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)