Routine high-frequency screening for asymptomatic Chlamydia trachomatis and Neisseria gonorrhoeae among cisgender gay, bisexual and other men who have sex with men (gbMSM) is established despite limited evidence that it reduces population-level incidence or harm. Recent studies support reconsideration but do not settle the balance of benefits and harms. Reducing screening could delay diagnosis and affect transmission or partner notification; continuing screening may increase antimicrobial exposure, possible overdiagnosis, anxiety and stigma. The demonstrated benefits and unresolved long-term stewardship implications of doxycycline post-exposure prophylaxis (DoxyPEP) illustrate why antimicrobial use should be differentiated. We argue for cautious, co-produced, evaluated and reversible de-implementation while maintaining symptomatic, contact-based and otherwise clinically indicated testing, HIV and syphilis screening and HIV pre-exposure prophylaxis (PrEP) care. With transparent communication and community partnership, less screening need not mean less care.

This guideline provides details on the pathology and clinical features of Chlamydia trachomatis infection and makes recommendations for diagnostic tests, treatment regimens and the health promotion principles needed for the effective management of chlamydia, in people aged 16 years or older attending sexual health services. The guideline is primarily aimed at level 3 sexual health services in the UK, although it could also serve as a reference guide for sexually transmitted infection services at other levels. This guideline is an update of the previous one published in 2015.

ObjectivesTo describe the clinical characteristics, aetiologies, severity, and short-term outcomes of acute kidney injury (AKI) among hospitalized people living with HIV in a European tertiary HIV referral center.MethodsThis cross sectional analysis included adults living with HIV who developed AKI during hospitalization at Saint-Pierre University Hospital, Brussels, between 2007 and 2016. AKI was defined according to Kidney Disease: Improving Global Outcomes (KDIGO) serum creatinine criteria. Aetiologies, clinical characteristics, and outcomes were recorded, including intensive care unit admission, renal replacement therapy, renal recovery, chronic kidney disease (CKD) progression, in-hospital mortality, and one-year rehospitalization.ResultsAmong 206 patients with AKI, 64% had KDIGO stage 1, 21% stage 2, and 15% stage 3 AKI. Pre-renal AKI was the most frequent aetiology (45%), followed by intrinsic (25%) and mixed AKI (16%). Intensive care unit admission occurred in 36% of patients and renal repolacement therapy was required in 12%. In-hospital mortality was 16%. Among survivors, 77% achieved renal recovery, 5% progressed to chronic kidney disease, and 38% were rehospitalized within 1 year.ConclusionsAKI remains a clinically important complication among hospitalized people living with HIV, with substantial short-term morbidity and mortality. Early recognition and management of reversible causes and avoidance of nephrotoxic exposures remain important.

BackgroundDisengagement from HIV care may impair immune reconstitution and increase the risk of advanced disease and transmission. We evaluated the association between HIV care status and CD4 count among patients identified through a universal emergency department-based HIV screening program.MethodsWe conducted a cross-sectional study of electronic health records from six emergency departments within a single healthcare system in South Broward County, Florida, from July 2018 through February 2024. Adults were offered free HIV combination assay testing. Patients with reactive screening tests were referred for CD4 count and viral load testing. HIV care status was categorized as out of care/refused, in care, linked to care, re-engaged in care, or deceased. Multivariable linear regression examined the association between CD4 count and care status, adjusting for HIV status, demographics, insurance, viral load, and transmission risk.ResultsAmong 828 positive HIV screening tests (positivity rate, 0.6%), 459 patients (55%) met inclusion criteria. The remaining 369 patients (45%) were excluded, primarily because of missing CD4 count data. After adjustment, patients engaged in HIV care had significantly higher CD4 counts than those out of care/refusing care (median CD4, 628 vs 176 cells/mm[3]; β = 244.6; 95% CI, 48.7-440.6; p = 0.014). Detectable and unknown viral loads were independently associated with lower CD4 counts compared with undetectable viral loads (β = -223.1 and -227.8, respectively; both p < 0.001). Although newly diagnosed patients had lower unadjusted CD4 counts, adjusted analyses demonstrated higher CD4 counts than patients with previously known HIV (β = 149.0; 95% CI, 56.6-241.4; p = 0.002), indicating confounding by care engagement. Excluded patients were similar to included patients except for more frequent unknown HIV transmission risk.ConclusionPatients disengaged from HIV care had substantially lower CD4 counts, suggesting more advanced disease. These findings support universal emergency department-based HIV screening as an opportunity to identify people living with HIV who are out of care and prioritize linkage and retention interventions to improve immune outcomes and reduce onward transmission.

BackgroundHIV drug resistance testing plays an important role in optimizing antiretroviral therapy, yet routine testing remains limited in China. This study applied a discrete choice experiment to evaluate patient preferences and willingness-to-pay for HIV drug resistance testing; to inform patient-centered implementation strategies for HIV drug resistance testing.MethodsBetween April and June 2025, people living with HIV were recruited from community healthcare centers in China. Mixed logit models and latent class analysis were used to quantify attribute trade-offs, identify preference heterogeneity, and estimate willingness-to-pay across clinical and demographic subgroups.ResultsAmong 204 participants, out-of-pocket cost was the dominant barrier to uptake, accounting for 62.3% of overall decision importance. Testing after treatment failure (β = 0.862), and doctor recommendation (β = 0.519) were primary determinants of choice (all p < 0.001). Combined testing (p = 0.037), shorter waiting time (3 days: p = 0.008), and high accuracy (p = 0.031) also significantly increased testing preference. Latent class analysis identified two distinct subgroups. Class 1 (failure-driven) prioritized testing after treatment failure (β = 3.547) but showed a negative preference for combined testing and high accuracy (all p < 0.05). Class 2 (service-oriented) strongly valued doctor recommendation and high accuracy (all p < 0.01). Older participants (≥50 years old) had a higher willingness-to-pay for doctor recommendation than the younger (240.2 vs 115.7 CNY), while younger showed higher WTP for combined testing and high accuracy.ConclusionsReducing financial barriers, strengthening provider recommendations, and tailoring testing services to different patient preference patterns may improve HIV drug resistance testing uptake. These findings support patient-centered implementation strategies to promote earlier and more routine HIV drug resistance testing in China.

BackgroundDrug-use in sexual settings among men who have sex with men (MSM) is increasing across Europe and is a key driver of sexually transmitted infections (STIs). Chemsex is evolving with increasing use of new psychoactive substances and diversification of context, shifting from private homes to diverse settings. Our aim was to assess changes in drug-use for sex among MSM who attended our STI/HIV reference center in two different periods over the last 8 years.MethodsWe compared two cross-sectional surveys conducted at the STI/HIV center of the San Gallicano Dermatological Institute (Rome, Italy) in 2018 (using paper-based, self-administered questionnaires) and 2024-2025 (using online self-administered questionnaires). The main outcome was the self-reported sexualized drug-use and chemsex (i.e., use of any of the three classic "chems": crystal methamphetamine, mephedrone, and GHB/GBL) in the previous year. Proportions were compared using Fisher's exact test or chi-square test, as appropriate.ResultsThe surveys included 354 MSM in 2018 and 331 MSM in 2024-2025. Overall, chemsex significantly increased from 5.1% in 2018 to 19.0% in 2024-2025 (p < 0.0001), both among MSM living with HIV (p < 0.0001) and MSM not living with HIV (p = 0.0005). A significant increase was observed in the use of crystal meth (2.3% vs 8.2%, p = 0.0005), mephedrone (4.0% vs 9.4%, p = 0.005), and GHB/GBL (3.4% vs 16.9%, p < 0.0001). Synthetic cathinones (from 0 to 2.7%, p = 0.001) and cannabinoids (from 0 to 0.9%, p = 0.112) emerged as new substances reported only in the most recent survey.ConclusionsIn our setting, drug-use for sex increased over time among MSM, with expansion of chemsex and diversification of substances. This behavioral change may increase STI/HIV transmission. Public health & STI/HIV services should update screening, counselling and harm reduction strategies to address these evolving patterns.

BackgroundThe balance of benefits and harms associated with frequent asymptomatic testing for Chlamydia trachomatis and Neisseria gonorrhoeae in gay, bisexual and other men who have sex with men (GBMSM) remains uncertain. While many guidelines recommend three-monthly testing for those perceived to be at higher risk, the evidence supporting this frequency is unclear. We reviewed existing evidence on testing frequency for C. trachomatis and N. gonorrhoeae in asymptomatic GBMSM and synthesised what is known about its impact on infection incidence and prevalence, symptomatic disease, and antimicrobial consumption.MethodsWe conducted a review of studies published between 2005 and 2025 across EMBASE, MEDLINE, CINAHL, Web of Science and Scopus. Quantitative, qualitative and mixed-methods studies evaluating outcomes associated with repeated asymptomatic screening in GBMSM were included.ResultsFifteen studies met eligibility criteria. More frequent screening increases detection of asymptomatic infections with limited evidence of reducing incidence, symptomatic presentations, or population-level prevalence. More frequent screening was associated with higher antimicrobial consumption. A single randomised controlled trial found modest reductions in C. trachomatisincidence with three-monthly screening but no clear benefit for N. gonorrhoeae. Frequent screening is closely tied to GBMSM's sense of responsibility, reassurance and community norms, and both GBMSM and clinicians express discomfort with reduced screening despite limited awareness of the natural clearance of C. trachomatis or N. gonorrhoeae or implications for antimicrobial resistance.ConclusionsThe current evidence base provides limited support for three-monthly asymptomatic C. trachomatis and N. gonorrhoeaescreening among GBMSM, and highlights the potential harms of increased antimicrobial use. A move to less frequent screening may offer a more balanced public health approach, but change will require careful engagement, transparent communication and attention to social and behavioural dimensions. More rigorous trials, especially in the context of emerging prevention strategies such as doxyPEP are needed to inform optimal screening intervals.

BackgroundHIV-related stigma remains a barrier to HIV care cascade engagement among key populations globally. In Jamaica, men who have sex with men (MSM) and female sex workers (FSW) living with HIV experience intersecting stigma that complicates disclosure decision-making and HIV care engagement. Guided by the Disclosure Processes Model, this study examined how approach and avoidance-focused goals shaped disclosure-related outcome aims, affective responses, and coping strategies related to HIV care engagement among MSM and FSW living with HIV in Jamaica.MethodsThis community-based qualitative study was conducted with an AIDS Service organization across Kingston, St Ann, and Montego Bay, Jamaica (2020-2022). We conducted six focus groups with MSM and FSW living with HIV (n = 46), followed by comic-guided in-depth individual interviews (n = 31). We conducted codebook thematic analysis informed by the antecedent goals component of the Disclosure Processes Model. Analyses explored how approach and avoidance-focused goals shaped outcome aims, affect, and coping strategies related to HIV disclosure and care engagement.ResultsParticipants (n = 28 FSW, n = 49 MSM) described disclosure decision-making was shaped by competing aims to achieve positive outcomes and avoid stigma-related harms. Approach-focused goals related to disclosure focused on pursuing positive outcomes (preserving health; sustaining family responsibilities; building a meaningful future), positive affect (peace of mind; hopefulness), and coping (accessing social support; self-acceptance). Avoidance-focused disclosure related goals centered prevention of negative outcomes (confidentiality breaches; social rejection), negative affect (fear; worry; isolation), and avoidance coping (concealment; social withdrawal). Participants described healthcare settings, pharmacies, workplaces, and family environments as spaces of potential disclosure risk.ConclusionHIV disclosure decision-making among MSM and FSW participants was a complex process shaped by stigma, distress, and institutional mistrust, and also access to social support. Findings underscore the need for trauma-informed and stigma reducing HIV services that support safe disclosure and HIV care engagement with key populations in Jamaica.

BackgroundRecent increases in syphilis diagnoses among heterosexual individuals are a growing public health concern. The NEXUS study aimed to qualitatively assess the contexts surrounding syphilis transmission among heterosexually-identifying individuals in England.MethodsWe conducted semi-structured interviews with heterosexually-identifying individuals diagnosed with primary, secondary, or early latent syphilis in the previous year, and with healthcare professionals (HCPs) involved in syphilis management. Participants were recruited from sexual health services across three regions in England between December 2023 and September 2024. A qualitative descriptive and interpretive approach was used. Transcripts were analysed using framework analysis, incorporating deductive and inductive coding. Service user and HCP data were triangulated to compare perspectives and enhance credibility.ResultsNineteen service users (53% male, 74% White British) and seven HCPs were interviewed. Syphilis was reported to occur in the context of condomless vaginal or oral sex. Many heterosexual individuals perceived low STI risk due to few partners, presumed exclusivity, or isolated changes in behaviour. Syphilis knowledge was limited and the infection was often viewed as rare or historical. Symptom recognition was poor, particularly for non-genital symptoms, and some service users initially sought care in non-sexual health settings, contributing to delayed diagnosis. HCPs highlighted similar gaps in awareness among non-sexual health clinicians. Following diagnosis, awareness of STI risk increased and most service users described intentions to reduce risk, although understanding of infectiousness and follow-up remained variable.ConclusionsFindings highlight gaps in awareness, risk perception, and clinical recognition of syphilis among heterosexual populations and non-sexual health HCPs. Public health strategies should emphasise syphilis as relevant to all sexually active people, raise awareness, and support earlier diagnosis by non-sexual health HCPs.

These guidelines are an update to the 2008 UK guidelines for the management of sexual and reproductive health of people living with HIV. The writing group has followed updated British Association for Sexual Health and HIV (BASHH) guideline methodology, notably using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system for assessing evidence and making recommendations. We have made significant changes to the recommendations which are summarised below.

Lymphogranuloma venereum (LGV) caused by Chlamydia trachomatis (CT) serovars L1-L3 has re-emerged among men who have sex with men (MSM), predominantly manifesting as anorectal disease. Oropharyngeal LGV remains poorly characterized, with only sporadic case reports in Western countries. Although CT genovariant L2b has been detected in an oropharyngeal specimen through surveillance in Taiwan, the clinical features of oropharyngeal LGV have not been described in Asia. We report two MSM living with HIV in Taiwan with oropharyngeal LGV. Case 1 was a 32-year-old asymptomatic patient and CT was identified through routine multi-site screening prompted by a rising rapid plasma reagin (RPR) titer. LGV was detected only at the oropharyngeal site, with a negative rectal specimen. Case 2, a 51-year-old man, presented with small oral ulcers resembling aphthous stomatitis, along with anorectal symptoms and amoebic liver abscess. Genovariant L2b was confirmed in both oropharyngeal and rectal specimens by ompA sequencing. In both cases, Treponema pallidum PCR on oropharyngeal specimens was negative despite elevated RPR titers. Case 1 received doxycycline 100 mg twice daily for 7 days for asymptomatic LGV carriage, while Case 2 received a 21-days course for symptomatic infection. Case 1 achieved microbiological cure confirmed by follow-up PCR testing. Case 2 demonstrated resolution of oral and anorectal symptoms, with microbiological cure confirmed at follow-up. These cases illustrate that oropharyngeal LGV may be asymptomatic or mimic common oral conditions. Multi-site CT testing and ompA genotyping should be considered in MSM with suspected STI, even in the absence of typical anorectal symptoms.

BackgroundLung cancer is the leading cause of cancer-related death among persons with HIV (PWH) in the United States. Annual screening with low-dose chest computed tomography may reduce mortality, but uptake remains unclear. We sought to characterize lung cancer screening eligibility and uptake among PWH engaged in HIV care at a Southeastern tertiary care center.MethodsA cross-sectional analysis with 6 time points corresponding to each calendar year from 2018 through 2023 among PWH receiving care. Data were collected from electronic health records, clinical event adjudications, and patient-reported outcomes. Prevalence differences and 95% CIs were estimated across demographic and clinical characteristics.ResultsAmong 2798 PWH in care, 74% were men, 57% identified as non-Hispanic Black and the median age was 48 years (IQR: 35-57). Among all PWH, 62% had a history of smoking with a median pack-year history of 40 (IQR: 27-50) and 51% of these were current smokers. The proportion of PWH meeting United States Preventative Services Task Force screening criteria increased from 6% in 2018 to 15% by 2023 (p < 0.05). Overall, 13% of PWH were eligible for screening, among whom less than one-third (27%) received screening at least once during follow-up. Annual screening was 11% and 24% in 2018 and 2023, respectively, (p = 0.10).ConclusionsLung cancer screening utilization remains low, even among a high-risk population in the Southeastern United States. Understanding barriers to screening is needed to improve lung cancer outcomes among PWH.