We conducted a cross-sectional study to estimate the prevalence of urogenital and extragenital sexually transmitted infections (STIs) among men who have sex with men (MSM) with and without urethral discharge syndrome, to assess infections missed by syndromic management, and to describe phenotypic antimicrobial susceptibility patterns of Neisseria gonorrhoeae. The study included 189 MSM attending the Engage Men's Health Clinic in Johannesburg, South Africa, in 2024. Urethral, rectal and oropharyngeal swabs were tested by multiplex PCR for Neisseria gonorrhoeae (NG), Chlamydia trachomatis (CT), Mycoplasma genitalium (MG) and Trichomonas vaginalis (TV). Genital ulcer swabs were tested for HSV-1/2, lymphogranuloma venereum (LGV), Haemophilus ducreyi (HD) and Treponema pallidum (TP). Serological diagnostic testing for HIV, hepatitis B virus (HBV) and syphilis was performed. NG isolates underwent culture and antimicrobial susceptibility testing. Among MSM with urethritis, NG was most prevalent (urethra: 80.3%, rectum: 41.7%), followed by CT (urethra: 14.8%, rectum: 11.7%). Pharyngeal NG was more common among MSM with urethritis than those without (18.0% vs 3.1%, p = 0.001). Among MSM without urethritis, rectal NG and CT prevalence were 13.5% and 9.5%; rectal LGV was detected in three cases. Among 22 participants with genital ulcers, an aetiology was identified in eight: HSV-2 (n = 3), TP (n = 4) and LGV (n = 1). All NG isolates were susceptible to ceftriaxone, cefixime, and azithromycin, and had low MICs of gentamicin. HIV, HBsAg and treponemal antibody seroprevalence were 31.4%, 3.2% and 50.8%. Active syphilis (RPR titres ≥1:32) was more frequent among MSM without urethral symptoms. Among MSM with urethritis, CT infection was less likely in those reporting recent insertive oro-anal sex and HIV pre-exposure prophylaxis (PrEP) use. Among MSM without urethritis, any discharge STI was associated with homosexual orientation, HIV positivity and lack of circumcision, NG with HIV positivity and being uncircumcised and CT with HIV positivity. Extragenital and asymptomatic STIs remain common among MSM in Johannesburg, stressing the need for routine multi-site molecular screening and inclusion of rapid serological syphilis testing in national STI guidelines for key populations.

This study compared the efficacies of single-dose ceftriaxone therapy at doses of 250 mg, 500 mg, and 1 g for gonococcal paraurethral duct infection in men. Forty-eight men with gonococcal paraurethral duct infection were assigned to Groups A, B, and C based on their order of arrival in the clinic; each group comprised 16 patients. Groups A, B, and C received single intramuscular doses of ceftriaxone at 250 mg, 500 mg, and 1 g, respectively. The mean times to resolution of purulent discharge from the paraurethral duct were 1.87 ± 0.81 days in Group A, 1.06 ± 0.25 days in Group B, and 1.13 ± 0.34 days in Group C. The mean times to resolution of erythematous swelling at skin lesions were 4.75 ± 1.69 days in Group A, 3.44 ± 0.89 days in Group B, and 3.31 ± 1.25 days in Group C. The mean times to resolution of tenderness at skin lesions were 5.25 ± 1.00 days in Group A, 3.06 ± 0.10 days in Group B, and 2.38 ± 1.03 days in Group C. The mean times to closure of the paraurethral duct orifice were 9.88 ± 2.92 days in Group A, 6.88 ± 1.71 days in Group B, and 6.38 ± 1.86 days in Group C. The resolution times significantly differed between Group A and Groups B and C (all p < .05); however, there were no significant differences between Groups B and C (all p > .05). The study shows that all three ceftriaxone single-dose regimens effectively cured gonococcal paraurethral duct infection in men. A single 500 mg dose may represent a more suitable treatment option.

A retrospective cross-sectional description was conducted to investigate co-infection rates of Neisseria gonorrhoeae (Gonorrhea) and Chlamydia trachomatis (Chlamydia) in patients from Northern Vietnam who visited the Central Dermatology Hospital during 2016-2019 and the factors including gender, age, location, and season that may relate to the co-infection rates. Data of hospital routine diagnostics using rapid tests for chlamydia and Gram staining for gonorrhea for patients with vaginal or urethral discharge syndrome were analysed. Real-time PCR was used to confirm the positive samples. During the 4 year study period, 5937 (0.74%) cases of either mono- or co-infections of gonorrhea and chlamydia were detected among 795,599 visiting patients. Of these cases, 2427 (41.36%) were diagnosed with gonorrhea, 3474 (57.99%) with chlamydia, and 36 (0.65%) with co-infections of gonorrhea and chlamydia. The co-infection rate in women was 4.8-fold higher than that in men (p < 0.0001), and in Hanoi capital, it was 2.3-fold higher than in all other regions in Northern Vietnam (p = 0.018). In terms of seasonality, the highest and lowest co-infection rates were observed in summer (33.33%) and winter (19.41%), respectively. In conclusion, the prevalence of gonorrhea and chlamydia co-infections was comparatively low, with a predominance in women as compared to men, in Hanoi capital than in the remaining areas of Northern Vietnam. Additionally, a higher frequency was observed during the summer season. The data obtained is important in controlling the rate of gonorrhea and chlamydia in Vietnam and contributes valuable insights to the global and Asian epidemic mapping of these infections.

Sexually transmitted infections (STIs) present significant public health challenges in resource-limited settings where syndromic management, which often leads to misdiagnosis and over-treatment, remains standard care. We retrospectively evaluated hypothetical STI risk assessment-only (Triage-only) and sequential risk assessment plus STI diagnostic testing (Triage&Test) approaches as potential enhancements to syndromic management in a high-burden setting. A retrospective analysis was conducted using historic data from a cross-sectional study of adults (≥ 18 years) accessing six outpatient care sites in Eswatini between July 2022 and April 2023. Clinical records included STI risk factor assessments, outcomes of syndromic assessment for vaginal discharge syndrome (VDS) and male urethritis syndrome (MUS), leukocyte esterase (LE) and HIV testing, and molecular-based testing for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and Trichomonas vaginalis (TV). Sex-specific predictive risk scores (PRS) tools for CT/NG/TV infections were developed using LASSO penalized logistic regression. Subsequently, the diagnostic performance of various hypothetical Triage-only and Triage&Test approaches was compared to molecular-based testing for CT/NG/TV infections. The aim was to identify strategies meeting programmatic benchmarks of ≥ 90% sensitivity and < 60% testing efficiency. Of 1396 participant records analysed, 65.4% (n = 913) were women and the median age was 29 years (IQR 23-36). Triage-only approaches underperformed, resulting in high proportions of false-positive and false-negative cases. Specifically, VDS showed a sensitivity of only 32.9% (95% CI 27.5-38.6) and a specificity of 75.1% (95% CI 71.5-78.5), while MUS had a sensitivity of 65.0% (95% CI 57.0-72.4) and specificity of 88.0% (95% CI 84.0-91.4). All PRS tools configurations in simulated Triage&Test approaches outperformed Triage-only methods by reducing false-negative and eliminating false-positive cases, thus achieving 100% specificity and positive-predictive value. Despite these improvements, no Triage&Test approach fully met established benchmarks. The highest sensitivity, observed in men, was 91.1% (95% CI 85.5-95) with an efficiency of 86.0%. In women, the best sensitivity was 79.0% (95% CI 73.8-83.6) at an efficiency of 60.1%. While PRS tools integrated within Triage&Test approaches may improve STI diagnosis in high-burden settings, challenges in balancing accuracy and resource demands persist. Access to affordable and well-targeted point-of-care rapid diagnostic tests appears essential to improve STI care quality in resource-limited environments.

Bladder exstrophy (BE) is a rare, complex, congenital malformation predominantly observed in men. We report a case of a female infant with BE who underwent complete primary repair of BE (CPRE). After 5 weeks of appropriate medical care and nursing, the infant was discharged successfully without urinary retention, hematuria, fever, or abdominal distention. After discharge, the child was followed up via telephone. At 1.5 months post-op, the child showed no signs of urinary incontinence, hydronephrosis, or reflux. However, ultrasonography revealed an unfilled bladder. By the third month, the child voided volitionally through the urethra every 3 h. At 6 months of age, renal ultrasonography revealed an unfilled bladder. Children may undergo augmentation cystoplasty at 2 or 3 years of age. During telephone follow-ups, the parents expressed concerns regarding their child's sexual function and fertility in adulthood. Patient follow-up will be continued to determine long-term health outcomes.

Mycoplasma genitalium can cause urinary tract infections and nonchlamydial, nongonococcal urethritis. Recent studies have suggested that M. genitalium is associated with sexually transmitted diseases, particularly among men who have sex with men. Herein, we report a case of M. genitalium infection where treatment related changes in the endoscopic image of the rectum were documented. A 21-year-old male presented to our hospital with bloody stools and fever. Lower gastrointestinal endoscopy revealed multiple rectal erosions and ulcers, and the patient was diagnosed with proctitis. Blood and tissue tests showed no findings suggestive of syphilis or cytomegalovirus infection, and polymerase chain reaction testing confirmed a diagnosis of M. genitalium-induced proctitis. Sitafloxacin (200mg/day) was administered for 2 weeks, after which the bloody stools and fever resolved. Lower gastrointestinal endoscopy confirmed improvement in the rectal lesions, and the patient was discharged from the hospital. To date, no reports have described endoscopic images of M. genitalium-induced proctitis. This was a valuable case in which we followed the treatment progression of M. genitalium-induced proctitis endoscopically.

The global spread of antimicrobial resistance (AMR) in Neisseria gonorrhoeae threatens empiric single-dose gonorrhoea treatment. Enhanced global AMR surveillance is imperative. We report i) gonococcal antimicrobial susceptibility and resistance data from 2023 in the World Health Organization Enhanced Gonococcal Antimicrobial Surveillance Programme (WHO EGASP) in the WHO Western Pacific Region (Cambodia, the Philippines, Viet Nam), Southeast Asian Region (Indonesia, Thailand), and African Region (Malawi, South Africa, Uganda, Zimbabwe), and ii) metadata of the gonorrhoea patients.