ObjectiveSleep problems are common among people with HIV, but prospective data on sleep quality early after antiretroviral therapy (ART) initiation are limited. This pilot study evaluated changes in sleep quality during the first month after ART initiation.MethodsIn this pilot cohort study, sleep quality was prospectively assessed using the Pittsburgh Sleep Quality Index (PSQI) at ART initiation and 1 month later in an ART-initiation. A separate group receiving virologically suppressive ART for at least 1 year was assessed cross-sectionally. Continuous variables are presented as median [interquartile range (IQR)].ResultsNine participants were included in the ART-initiation group and 39 in the long-term suppressive ART group. In the ART-initiation group, median global PSQI scores were 4 [IQR 3-7] at baseline and 4 [IQR 4-6] at month 1, with no significant change (p = 0.915). Poor sleep quality (PSQI >5) was present in 33% at both assessments. In the long-term suppressive ART group, the median PSQI score was 6 [IQR 4-8], and 51% had poor sleep quality. Neither PSQI scores (p = 0.247) nor the prevalence of poor sleep quality (p = 0.466) differed significantly between baseline and the long-term suppressive ART group.ConclusionNo detectable change in sleep quality was observed during the first month after ART initiation. Approximately half of participants receiving long-term suppressive ART had poor sleep quality. These findings suggest that sleep quality may be a clinically relevant patient-reported outcome to consider during routine HIV care.

ObjectivesWorldwide, Mycoplasma genitalium infections are becoming more resistant to both macrolides and fluoroquinolones - termed multi-drug-resistant (MDR) infections. Combination therapy has shown promise in treating other MDR pathogens. We have previously reported the first five cases of MDR M. genitalium urethritis successfully treated with a novel combination therapy regimen consisting of minocycline, metronidazole, methenamine and pristinamycin ('M3P').MethodsWe describe a second case series of four individuals treated with M3P as salvage therapy for M. genitalium urethritis. Clinical data, laboratory findings, resistance profiles, and treatment outcomes were reviewed.ResultsAll four individuals had persistent M. genitalium urethritis and evidence of macrolide and fluoroquinolone resistance. Prior treatments included multiple courses of doxycycline, minocycline, azithromycin, fluoroquinolones, pristinamycin and other salvage regimens. Treatment with M3P for 14 days was associated with complete resolution of symptoms and negative post-treatment M. genitalium nucleic acid amplification tests in all four cases. No adverse effects were reported.ConclusionsM3P is a useful salvage therapy for MDR M. genitalium infections that do not respond to other regimens.

BackgroundBacterial vaginosis (BV) is a vaginal dysbiosis with a global prevalence range from 20 to 60%. The gold standard for diagnosis BV is the Nugent score, while clinical diagnosis uses Amsel criteria; both have limitations such as prolonged examination time, requiring a microscope, and trained healthcare personnel. Point-of-care lateral flow immunochromatographic assay (POCT-LFIA) is an alternative method for diagnosing BV.MethodsWe conducted a pilot diagnostic study among women with vaginal discharge at the Sexually Transmitted Infections (STI) Clinic at RSMH Palembang from February to April 2026. All study subjects suspected of having BV with vaginal discharge characteristics underwent POCT-LFIA, vaginal pH, whiff test, and Gram stain examinations to detect clue cells and calculate the Nugent score. A definitive diagnosis of BV was established based on a Nugent score of 7-10.ResultsAmong of 77 participants, 36 (47%) were diagnosed with BV based on Nugent score. POCT-LFIA was positive in 33 of 36 these cases, with three false-negative results, and three false-positive results occurred among the 41 participants without BV. Whereas Amsel criteria identified 32 cases. The POCT-LFIA had 92% sensitivity, 93% specificity, 92% positive predictive value, 93% negative predictive value, and 92% diagnostic accuracy. The corresponding values for the Amsel criteria were 89%, 90%, 91%, 90%, and 91%, respectively. The POCT-LFIA was comparable with Amsel criteria to diagnose BV.ConclusionsPOCT-LFIA demonstrated promising diagnostic performance for BV with results comparable to the Amsel criteria. Larger, multicentre studies are needed to validate these findings and determine its clinical applicability.

BackgroundCongenital syphilis remains a preventable cause of neonatal morbidity and mortality despite the availability of inexpensive diagnostics and effective treatment. We aimed to evaluate the burden of maternal and congenital syphilis at the Instituto Nacional Materno Perinatal, Peru's national referral center for maternal and perinatal care.MethodsWe conducted a cross-sectional study of aggregated, de-identified surveillance data from January 2023 to December 2025. We calculated the prevalence of maternal syphilis and incidence of congenital syphilis, and compared those estimates with World Health Organization (WHO) elimination benchmarks.ResultsAmong 59,598 pregnant people screened, maternal syphilis prevalence ranged between 1.0% and 1.2%. Across 36,094 live births, congenital syphilis incidence ranged between 383 and 526 per 100,000 live births, consistently exceeding the WHO target of 50 per 100,000 live births. Outside facilities identified over half of maternal infections before referral. Reported treatment coverage exceeded 90% among mothers and reached 100% among infants.ConclusionsCongenital syphilis incidence consistently exceeded elimination benchmarks despite relatively stable maternal syphilis prevalence, highlighting potential gaps in timely diagnosis and linkage between diagnosis and treatment.

BackgroundMen who have sex with men (MSM) face a high risk of HIV acquisition globally. Oral pre-exposure prophylaxis (PrEP) is effective but limited by adherence and stigma. Long-acting injectable PrEP (LAI-PrEP) offers a promising alternative, yet global acceptance among MSM remains unclear. This study aimed to estimate the pooled willingness to use LAI-PrEP among MSM and identify key determinants.MethodsPubMed, Embase, Web of Science, and CINAHL were searched up to March 26, 2026. The search strategy contained the keyword willingness and interest and the MeSH terms for MSM and PrEP. Data analysis was performed using R. The systematic review has been registered with PROSPERO (CRD420261432493).ResultsThirteen cross-sectional studies involving a total of 11,750 participants were included in the review. The pooled willingness rate was 69.9% (95% CI: 62.9%-76.9%). The test for subgroup differences showed no statistically significant difference among regions (χ[2] = 0.46, p = 0.686). Six variables were significantly associated with higher willingness to use LAI-PrEP (all p < 0.05): oral PrEP use experience (OR = 2.67), history of HIV testing (OR = 1.99), engagement in transactional sex (OR = 1.79), having two or more male sexual partners in the past 6 months (OR = 1.74), heard of PrEP (OR = 2.13), and awareness of post-exposure prophylaxis (PEP) (OR = 1.67).ConclusionsWillingness to use LAI-PrEP among MSM was high, but a substantial proportion expressed unwillingness. Therefore, we recommend integrated education campaigns, leveraging HIV testing as an entry point, and prioritizing high-risk subgroups for targeted LAI-PrEP promotion to optimize HIV prevention in this population.

BackgroundHuman Papilloma Virus (HPV)-related high-grade anal intraepithelial neoplasia (AIN) is the precursor of anal cancer. There are limited data identifying factors that influence AIN progression in adults eligible for HPV vaccines.MethodsA single-center cohort study including persons aged 18-45 years as of 2020 followed at the University of Pittsburgh Medical Center Anal Dysplasia Clinic (January 2020-December 2024), each with at least one anal cytology paired with histopathology or high-resolution anoscopy (reference standard). A subset with an initial non-HSIL result and ≥2 visits was followed longitudinally to assess progression to HSIL. Logistic regression identified factors associated with HSIL; Cox proportional hazards regression assessed progression to HSIL.ResultsWe included 238 individuals (191 with HIV and 47 without), with median age 37 years, 16% female sex at birth, and median age at HPV vaccination series initiation of 27 years, with 79 (82%) of vaccinated patients receiving all three doses. Among 507 paired cytology-reference results, anal cytology had low-moderate sensitivity (55%) and specificity (82%), but an acceptable negative predictive value of 96% for HSIL on the reference standard (ref-HSIL). In the full cohort, the risk factor for ref-HSIL was ASC-H (atypical squamous cells, cannot exclude HSIL) or HSIL on cytology (adjusted odds ratio [aOR] 5.95, p < 0.001). In PWH, lower nadir CD4 count was associated with higher risk of ref-HSIL. Seven individuals with initial non-ref-HSIL progressed to ref-HSIL, all PWH with nadir CD4 <300 cells/µl; higher nadir CD4 was protective against progression (adjusted hazard ratio 0.43 per 100 cells/µl, p = 0.002) while current smoking was a risk factor (aHR 5.09, p = 0.05).ConclusionsAnal cytology alone is not sensitive for HSIL detection in younger adults. Low nadir CD4 + count and current smoking identify patients needing closer surveillance.

BackgroundAs doxycycline post-exposure prophylaxis (doxyPEP) implementation for bacterial STI prevention expands among gay, bisexual and other men who have sex with men (GBMSM) and transgender women (TGW), this scoping review synthesised community knowledge, attitudes, barriers, facilitators and practices to inform guidelines and support uptake.MethodsThis scoping review followed JBI methodology and was reported per PRISMA-ScR. Three databases (Embase, Medline/PubMed, Web of Science) were searched for articles on community perspectives of doxyPEP among GBMSM and TGW published from 2013 to 2025. Included studies were screened, data extracted using inductive coding, and analysed thematically. Factors were mapped onto the Knowledge, Attitudes, and Practices (KAP) Model.Results24 studies (18,428 participants) met inclusion criteria, (North America (n = 12), Europe (n = 6), Asia (n = 3), Oceania (n = 3)). Most were quantitative (n = 20), with two qualitative and two mixed-methods studies, recruiting primarily via online/app-based surveys or from sexual health clinics. Five coding categories emerged: awareness and knowledge; previous use; willingness to try; barriers and concerns; and facilitators and predictors. Awareness and prior use were low and heterogenous (ranging from 17 to 67%), yet willingness was moderate to high (12% to 90%), particularly after brief education and when free of charge. Prior use remained limited (2.5-36%). Predictors of interest included prior STI diagnosis, HIV PrEP use, living with HIV, multiple sexual partners, condomless sex, and higher educational attainment. Side effects and antimicrobial resistance (AMR) were the primary concerns.ConclusionsClinicians and sexual health services should prioritise opportunistic doxyPEP offers to those with recent STIs, HIV PrEP use, or HIV, embedding education and low/no-cost access within routine care to close the awareness-uptake gap. Public health bodies should invest in robust AMR surveillance alongside implementation, and community-based education should directly address side-effect concerns. Extending research and delivery models to under-represented groups is also needed to ensure equitable, evidence-based uptake.

ObjectivesClinician-observed external genital lesions may be incorporated into syndromic STI management, yet their prevalence and morphology in antenatal populations are poorly characterized. We aimed to describe the prevalence and types of clinician-observed genital lesions among pregnant women in a high HIV/STI prevalence setting and examine their distribution by laboratory-confirmed HIV, syphilis, and Chlamydia trachomatis, Neisseria gonorrhoeae, or Trichomonas vaginalis (CT/NG/TV) status.MethodsWe analyzed clinical and laboratory data from the Philani Ndiphile antenatal STI screening study (2021-2025), conducted across four primary healthcare clinics in the Eastern Cape, South Africa (ClinicalTrials.gov identifier: NCT04446611). Among 2,247 pregnant women attending their first antenatal visit, trained clinicians documented the presence and morphology of external genital lesions during routine pelvic examination. Lesions were categorized as warts, inflammatory/dermatitis-like, ulcerative/erosive, boils/abscesses, scarring, cystic swelling, or other/unclassified. HIV and syphilis were diagnosed using rapid antibody testing and rapid treponemal tests; CT/NG/TV was detected by GeneXpert® molecular assay. Analyses used counts and proportions to characterize lesion prevalence overall and by infection status, with comparisons performed separately for HIV, syphilis, and CT/NG/TV.ResultsOverall, 61 participants (2.7%) had a clinician-observed genital lesion. Lesion prevalence was significantly higher among women living with HIV than among women without HIV (6.1% vs. 1.3%; p<0.001) and among women with, versus women without syphilis (11.9% vs. 2.4%; p < 0.001), but did not differ significantly between women with versus without CT/NG/TV (3.5% vs. 2.4%; p = 0.16). Warts were the most common lesion type overall and were disproportionately observed among women living with HIV. Among lesion-positive women within each infection group, ulcerative lesions were observed in 40% of those with syphilis, 12.5% of those living with HIV, and 19% of those with CT/NG/TV.ConclusionsClinician-observed genital lesions were uncommon in this antenatal cohort, and most laboratory-confirmed STIs were not accompanied by visible lesions. These findings highlight their limited overlap and support current guidelines emphasizing laboratory-based antenatal screening for HIV and syphilis, with expanded STI testing where diagnostic capacity permits.

BackgroundHuman T-cell lymphotropic virus type-1 (HTLV-1) is a retrovirus, mainly transmitted sexually, which causes adult T-cell leukaemia/lymphoma (ATLL) and HTLV-1 associated myelopathy (HAM). We aimed to update global HTLV-1 seroprevalence estimates, estimate the number of people living with HTLV-1 (PLHTLV) in England and Wales (E&W), and present E&W HTLV-1 surveillance data.MethodWe systematically reviewed countries with new HTLV-1 prevalence data since the 2015 European Centres for Disease Control report, including studies of adults in the general population, pregnant women and blood donors (Ovid MEDLINE, 01/09/2014-17/02/2023). Global seroprevalence and UK census data were used to estimate the number of PLHTLV in E&W for 1991 and 2021. Reference laboratory and hospital data were combined to describe patterns in new HTLV-1 diagnoses, and associated diseases, in 2013-2022, in E&W. Diagnoses in 2013-2022 were compared with 1993-1997 using Incidence Rate Ratios (IRR).ResultsNew seroprevalence data were found for Pakistan (0.19%, blood donors), Malawi (0.96%, healthy mothers), Jordan (0.00%, blood donors), Vietnam (0.00%, blood donors) and New Caledonia (0.60%, general population); 4/5 studies had a high risk of bias. Among 749 newly-diagnosed PLHTLV in E&W (2013-2022), most were women (58%, 434/749) and tested in London (64%, 480/749). Where recorded, Black Caribbean ethnicity predominated (61%, 228/373); 51% (396/619) were symptomatic, most commonly with ATLL (47%, 187/396). Comparing 1993-1997 with 2013-2022, the IRR was 1.26 (95%CI 1.09-1.46) overall, 1.60 (95%CI 1.17-2.23) for ATLL and 0.35 (95%CI 0.23-0.51) for HAM. Assuming all cases were due to migration from endemic countries, the estimated number of PLHTLV in E&W increased from 11,654 (range 3,804-19,504) in 1991 to 28,846 (range 10,365-47,328) in 2021.ConclusionsIn E&W, rising annual ATLL diagnoses are consistent with an increase in the estimate of the number of PLHTLV, necessitating enhanced public health interventions. The reduced IRR for HAM requires further investigation.

BackgroundLymphogranuloma venereum (LGV), caused by Chlamydia trachomatis L-genotypes, has re-emerged as a major anorectal infection in men who have sex with men (MSM), especially in people living with HIV. Distinguishing LGV from non-LGV C. trachomatis is essential because LGV requires 3 weeks of doxycycline. Long-term Latin American data are lacking.MethodsAnorectal swabs from patients with suspected anorectal sexually transmitted infections were studied in a cross-sectional study conducted at two Buenos Aires coloproctology referral centers (August 2017-November 2025). Anorectal swabs were tested for C. trachomatis by NAAT and positive samples were genotyped by PCR-RFLP targeting ompA. Monthly LGV positivity was analyzed using the modified Farrington algorithm to detect epidemic peaks and seasonality, with sensitivity analysis excluding months with <7 samples.ResultsOf 700 anorectal swabs, 285 (41%) were C. trachomatis positive. Among public-hospital samples with conclusive genotyping, 148/179 (83%) were LGV; in the private center, 78 additional LGV cases were confirmed, totaling 226 LGV cases. HIV coinfection was 78% in LGV versus 100% in non-LGV cases (p = 0.0016). Concurrent T. pallidum or N. gonorrhoeae infection occurred in 25% of cases and was associated with LGV. The endemic baseline was approximately 32% (range 28-36%), with no seasonal pattern or trend. Pandemic-era epidemic alarms disappeared after excluding low-volume months.ConclusionsAnorectal LGV is endemic in Buenos Aires, with no seasonality, and a ∼32% pre-test probability among symptomatic patients at specialized clinics. This supports considering empirical 3-week doxycycline for MSM with rectal symptoms and C. trachomatis infection when genotyping is unavailable, until further trials confirm the non-inferiority of proposed shortened regimens. Biovar-specific testing remains the goal for targeted therapy.

BackgroundAs India marks four decades since its first identified HIV case, national indicators tell a story of remarkable success: prevalence, incidence and HIV-related mortality have fallen since the peak of the epidemic. Yet this aggregate picture obscures a quieter and more troubling shift - the epidemic that the National AIDS Control Programme was built to fight is not the epidemic it now faces.Key concernsThe residual burden increasingly reveals populations, places and gaps in care that national figures can mask: pregnant and breastfeeding women who acquire HIV after an initial negative antenatal test, States recording rising mortality despite substantial national declines, and people reaching antiretroviral therapy centres only after advanced immunosuppression. Drawing on the Technical Report released by the Government of India (2024) on HIV estimation and recent peer-reviewed evidence, this opinion piece argues that India's HIV response risks mistaking a slowing epidemic for a defeated one.ConclusionFour decades after the first identified case, India's next HIV response must be built around the epidemic it faces today, not the one that shaped the architecture of the national HIV programme in 1992.

Background: Emergency department (ED)-based HIV linkage-to-care programs effectively connect newly diagnosed people living with HIV (PLWH) to care and can also facilitate re-engagement among patients disengaged from HIV care. The linkage-to-care needs of these populations may differ substantially. We sought to identify factors associated with engagement outcomes following ED-based re-linkage to inform service delivery. Methods: This cross-sectional analysis used programmatic data from an ED-based HIV linkage-to-care program that served PLWH identified by automated electronic health record alerts to program staff upon ED presentation from January 2023 to July 2024. Patients were classified as not engaged in HIV care if, within the preceding three months, they had missed at least one HIV care appointment without rescheduling and had not refilled their antiretroviral therapy (ART). These individuals were approached at the bedside and offered re-linkage-to-care services. Among patients who received re-linkage-to-care services, the primary outcome was attendance at the scheduled HIV care appointment. ART refill within three months of the scheduled appointment was assessed descriptively. Associations between sociodemographic and clinical characteristics and appointment nonattendance were evaluated using univariate and multivariable logistic regression models. Results: Among 892 PLWH presenting to the ED, 113 (13%) were classified as not engaged in HIV care, of whom 66 (58%) received re-linkage-to-care services. All 66 patients who received re-linkage-to-care services had an HIV care appointment scheduled, and 40 (61%) attended their scheduled appointment. In adjusted analyses, patients with a history of substance use disorder had greater odds of appointment non-attendance (aOR=4.50, 95% CI 1.57-14.88; p = 0.03). All patients who attended subsequently refilled ART. Conclusions: A history of substance use disorder was associated with greater odds of HIV care appointment nonattendance following ED-based re-linkage-to-care services, highlighting the need for tailored substance use disorder informed strategies that address social, behavioral, and structural barriers to sustained HIV care engagement.

BackgroundHerpes simplex virus (HSV) remains one of the most prevalent sexually transmitted infections worldwide, yet no established pharmacologic pre- or post-exposure prophylaxis strategy currently exists for primary HSV prevention. This study evaluated patient interest in HSV pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) to inform future clinical trial feasibility.MethodsAn anonymous cross-sectional online survey was conducted from August 2025 to April 2026 through outpatient clinics affiliated with an academic medical center, county hospital, and a community-based HIV/STI organization in Los Angeles, California. Participants were also encouraged to share a public survey link to facilitate broader dissemination. Participants were asked about demographics, sexual practices, STI prevention behaviors, and interest in hypothetical HSV PrEP and HSV PEP strategies.ResultsThere were 89 completed quality controlled surveys suitable for analysis. Participants had a median age of 30 years (range 21-76), and the majority identified as cisgender male (65%), white (65%), and HIV-negative (96%). Interest in HSV PEP (75%) exceeded HSV PrEP (54%) across all analyzed groups. Participants currently taking HIV PrEP demonstrated particularly high interest in both HSV PrEP (76%) and HSV PEP (82%). Common barriers included daily medication burden and concerns regarding side effects.ConclusionsInterest in HSV prophylaxis was observed, particularly among individuals already engaged in STI prevention strategies. These findings support the feasibility of future clinical trials evaluating HSV prophylaxis in high-risk populations.

AimTo describe the clinical, immunological, virological and safety outcomes observed during anti-IL-17 therapy in patients living with HIV who had cutaneous psoriasis.MethodFour patients living with HIV who had cutaneous psoriasis and were treated with anti-IL-17 agents were included in this case series. Psoriasis Area Severity Index (PASI) scores, CD4 cell counts, HIV RNA levels, treatment duration and adverse events were obtained from medical records.ResultsThree patients received secukinumab and one received ixekizumab. Psoriasis improved in all four patients. CD4 cell counts remained stable or increased, while HIV RNA levels remained suppressed or declined following antiretroviral therapy. No adverse events were observed during follow-up.ConclusionAnti-IL-17 therapy was associated with clinical improvement without observed deterioration in immunological or virological parameters in this small case series. Larger prospective studies are required before conclusions regarding safety can be drawn.

BackgroundFemale sex workers face high occupational exposure to human papillomavirus (HPV), but to our knowledge no molecular HPV genotyping data have been published for Papua, Indonesia, where cervical screening reaches few women. Non-16/18 genotypes account for a large share of HPV infection across Asia, relevant to vaccine policy. We aimed to measure high-risk HPV (HR-HPV) prevalence, describe the genotypes present, and identify factors associated with HR-HPV positivity among FSWs in Jayapura.MethodsIn this cross-sectional study, female sex workers attending a reproductive health centre in Jayapura, Papua, were recruited by consecutive sampling in August 2025. Cervical specimens were genotyped for HR-HPV with a real-time PCR assay distinguishing HPV16, HPV18 and a pooled channel covering 12 high-risk types. A structured questionnaire recorded age, duration of sex work, condom use, vaccination status, sexually transmitted infection history and sexual contact frequency. Candidate predictors were screened bivariately before multivariable logistic regression.ResultsOf 75 participants, 33 (44%; 95% CI 33-56) were HR-HPV positive. Of these, 30 (91%; 95% CI 76-98) carried at least one non-16/18 genotype, and only three were attributable to HPV16 or HPV18 alone. Three women (4%) reported prior HPV vaccination. After adjustment for sexual contact frequency, each additional year of age was associated with lower odds of HR-HPV positivity (adjusted odds ratio 0.928, 95% CI 0.871-0.990, p = 0.023). The association with sexual contact frequency was positive but not significant (1.322, 95% CI 0.986-1.773, p = 0.062). Condom use was associated bivariately but excluded from the final model owing to unstable estimates.ConclusionsHR-HPV infection is common among female sex workers in Papua and mostly involves non HPV16 and HPV18 genotypes, which the current quadrivalent national programme does not cover. These data support nonavalent vaccination and HPV-DNA screening for female sex workers, and make expanded screening in the general population a priority for provincial health authorities in Papua.