To Screen or Not to Screen?

Today we will discuss if screening asymptomatic Men who have sex with Men, also referred to as MSM, who are receiving HIV pre-exposure anti-retroviral medication, called HIV PrEP, routinely for bacterial STIs, gonorrhoea and chlamydia through pharyngeal, urine and rectal PCR testing every three months- also referred to as 3x3 testing is indeed of benefit or may cause harm. This year, in Lancet HIV, the Gonoscreen trial, a randomised controlled trial, of 500 MSM on PrEP in each arm followed up for 12 months reported that 3x 3 testing does not reduce the incidence of gonorrhoea and chlamydia infections in this specific cohort. In Belgium, this trial has led to a change in clinic practice through the Belgium HIV PrEP guidelines where patients will be screened less frequently and intensely. Lancet ID on the other hand published an opinion piece by Raccagni et al where concerns about transmission and morbidity risk of untreated infection and implications of using poor quality screening tools are voiced. We will discuss today the merit of the Gonoscreen trial and other studies that support a decrease in screening & treating asymptomatic bacterial STIs and exercising stricter antimicrobial stewardship versus the risks associated with leaving asymptomatic infections untreated and risking morbidity and transmission. Relevant links: Effect of screening for Neisseria gonorrhoeae and Chlamydia trachomatis on incidence of these infections in men who have sex with men and transgender women taking HIV pre-exposure prophylaxis (the Gonoscreen study): results from a randomised, multicentre, controlled trial Primum non-nocere: Is it time to stop screening for Neisseria gonorrhoeae and Chlamydia trachomatis in men who have sex with men taking HIV pre-exposure prophylaxis? The arrested immunity hypothesis in an immunoepidemiological model of Chlamydia transmission Gonorrhoea and chlamydia screening for asymptomatic people with HIV and HIV PrEP users: open issues Host: Dr Fabiola Martin, Sexual Health Specialist and Associate Professor, Australian National University, Canberra, Australia Dr Thibaut Vanbaelen, physician and post-doctoral researcher at The Institute of Tropical Medicine in Antwerp, Belgium Dr Angelo Roberto Raccagni, physician at Vita-Salute San Raffaele University in Milan, Italy

Today we provide you with an update on the sexually transmitted infection: Trichomonas vaginalis, a protozoan which infects the vagina, urethra and paraurethral glands. It is an uncommon cause of vaginal discharge and penile urethritis and can persist for a long time if left untreated. Up to 50% of people with vaginal infections and especially people with urethral infections remain asymptomatic. Persistent trichomonas infection has been associated with facilitating the transmission of human immunodeficiency virus (HIV) and adverse poor reproductive health outcomes. Dr Christina Muzny, Professor in Infectious Diseases at University of Alabama, Birmingham, USA, will present on published clinical trial data on novel treatment against trichomoniasis. Relevant publications: Van Gerwen OT, Aaron KJ, Schroeder J, et al. Spontaneous resolution of Trichomonas vaginalis infection in men. Sexually Transmitted Infections. Published Online First: 27 June 2024. doi: 10.1136/sextrans-2024-056160. Muzny CA, Van Gerwen OT, Kaufman G, Chavoustie S. Efficacy of single-dose oral secnidazole for the treatment of trichomoniasis in women co-infected with trichomoniasis and bacterial vaginosis: a post hoc subgroup analysis of phase 3 clinical trial data. BMJ Open. 2023;13:e072071 Kissinger PJ, Gaydos CA, Seña AC, McClelland RS, Soper, Secor WE, Legendre D, Workowski KA, Muzny CA, Diagnosis and Management of Trichomonas vaginalis: Summary of Evidence Reviewed for the 2021 Centers for Disease Control and Prevention Sexually Transmitted Infections Treatment Guidelines, Clinical Infectious Diseases, Clinical Infectious Diseases, Volume 74, Issue Supplement_2, 15 April 2022 Howe K and Kissinger PJ. Single-dose compared with multidose metronidazole for the treatment of trichomoniasis in women: a meta-analysis. Sex Transm Dis 2017; 44: 29–34. Kissinger P, Muzny CA, Mena LA, et al. Single-dose versus 7- day-dose metronidazole for the treatment of trichomoniasis in women: an open-label, randomised controlled trial. Lancet Infect Dis 2018; 18: 1251–1259. Sherrard J, Pitt R, Hobbs KR, Maynard M, Cochrane E, Wilson J, Tipple C. British Association for Sexual Health and HIV (BASHH) United Kingdom national guideline on the management of Trichomonas vaginalis 2021. Int J STD AIDS. 2022 Jul;33(8):740-750. STI Guidelines Australia - Trichomoniasis Host: Dr Fabiola Martin, STI BMJ Podcast editor, a Sexual Health, HIV and HTLV Specialist, Canberra & University of Queensland, Brisbane, Australia Guest: Dr Christina Muzny, Professor in Infectious Diseases at University of Alabama, Birmingham, USA

You will recall a previous podcast about preventing Neisseria gonorrhoea through an effective vaccine. Neisseria gonorrhoeae is a ubiquitous sexually transmitted bacteria that can cause both localised and systemic disease if left untreated. It may be transmitted to neonates. We also reported on a rise of the gonorrhoea incidence, as well as increasing rates of antibiotic resistance. Today we will revisit the implementation of vaccinations against gonorrhoea in the UK. Here is an exciting up-date on the advice provided by UK's Joint Committee on Vaccination and Immunisation, JCVI, on using the vaccine 4CMebB OMV against Meningococcus used off-label for the prevention of gonorrhoea infection • in patients at significant risk of infection with bacterial STIs who • attend specialist sexual health services. Host: Dr. Fabiola Martin, Sexual Health HIV, HTLV Specialist, Canberra Sexual Health Services & University of Queensland, Australia Participants: Dr. Suneeta Soni, Consultant in Sexual Health and HIV, University Hospitals Sussex and Chair of the Bacterial special interest group for BASHH *British Association for Sexual health and HIV) Dr. Yen Bui, Consultant in Vaccination and Travel Health, Institut national de santé publique du Québec, Canada A/P. Dr. Kate Seib, NHMRC Leadership Fellow and Associate Director for Research, Institute for Glycomics, Griffith University, Australia

Today we will focus on the alternative treatments of early Syphilis. Worldwide many of us have experienced a shortage of gold standard treatment benzathine benzylpenicillin injections for syphilis. It is time we look for alternative antibiotic treatments and prevention strategies for syphilis. In conversation with Prof Jeffery Klausner, Professor of Medicine, Infectious Diseases and Public Health at the Keck School of Medicine of the University of Southern California, we will discuss a new study published in the Lancet in 2024. Mitja O. et al compared oral linezolid with benzathine penicillin G for treatment of early syphilis in adults (Trep-AB Study) in Spain, which is a prospective, open-label, non-inferiority, randomised controlled trial. Acknowledgement for his valuable contributions to the content of the podcast: Dr Oriol Mitjà, Skin Neglected Tropical Diseases and Sexually Transmitted Infections Section, Fundació Lluita Contra les Infeccions, Barcelona, Spain. Related link: https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(23)00683-7/fulltext 

In our final episode in honour of the World AIDS Day we have a conversation with Assistant Prof. Rajasuriar, who coordinates the translational research program in HIV immunology and Ageing at the Centre of Excellence for Research in AIDS (CERiA) in Kuala Lumpur, Malaysia. Today, thanks to effective HIV antiretroviral therapy, people living with HIV can live long and healthy lives. According to the latest data from the Centers for Disease Control and Prevention (CDC), in 2021, of the nearly 1.1 million people living with diagnosed HIV in the United States and dependent areas, over 53% were aged 50 or older. Hosted by: Dr Fabiola Martin, the BMJ STI Podcast editor and Sexual Health Specialist based in Australia and Senior Clinical Lecturer at School of Public Health at University of Queensland. Growing older with HIV in the Treat-All Era Reena Rajasuriar 1 , Heidi M Crane 2 , Aggrey S Semeere 3 PMID: 36176021 PMCID: PMC9522984 DOI: 10.1002/jia2.25997 https://onlinelibrary.wiley.com/doi/10.1002/jia2.25997  Integrated care for older people (‎ICOPE)‎: guidance for person-centred assessment and pathways in primary care https://www.who.int/publications-detail-redirect/WHO-FWC-ALC-19.1 

Today we are honouring the World AIDS Day on 1st December in 2023, by focusing on young people who live with HIV. Adolescents and young people represent a significant share of people living with HIV worldwide. In 2022 alone, 255,000-760,000 young people between the ages of 10 to 24 were newly infected with HIV, of whom 35,000-250,000 were adolescents between the ages of 10 and 19. In conversation with Prof Natella Rakhmanina, who is a Professor of Paediatrics at the George Washington University and the Director of the HIV Program at Children's National Hospital, we will discover the pro & cons of long-acting antiretrovirals to mange HIV infection in young people. Hosted by: Dr Fabiola Martin, the BMJ STI Podcast editor and Sexual Health Specialist based in Australia and lecturer at School of Public Health at University of Queensland.

Welcome to the 4th episode of the 2023 BMJ Sexually Transmitted Infections Podcast Series. This year the International AIDS Society Conference was held for the first time in Brisbane Australia in July 2023. It was wonderful to learn about many new research findings, community perspectives and to connect with old friends and make new ones. Today we will provide you with some of the many clinical, vaccine and policy research highlights of this conference and share our subjective perspectives. We were joined by: Dr Ming Lee, a sexual health & HIV physician and UK MRC Clinical Research Training Fellow at Imperial College London, London, UK, Prof Damian Purcell, Head of the Molecular Virology Laboratory in the Department of Microbiology and Immunology at the Peter Doherty Institute, University of Melbourne, Melbourne, Australia, Dr Meg Doherty, Director of Global HIV, Hepatitis and Sexually Transmitted Infection Programmes at World Health Organization, Heath Quarter. Hosted by: Dr Fabiola Martin, the BMJ STI Podcast editor and Sexual Health Specialist based in Australia and lecturer at School of Public Health at University of Queensland.

In honour of World Hepatitis Day, today we focus on the Hepatitis B virus (HBV), a virus that can be transmitted through contact with infected blood and from mother to child during labour. HBV can also be transmitted sexually. It infects liver cells and causes both acute and chronic infections, which can be severe. Since HBV was discovered in 1965, we have made great progress in reducing the burden of infections and disease through prevention and antiviral treatment, but much is left to do. The World Health Organization has called for enhanced efforts along four main pathways: i) increasing awareness of HBV infection, ii) promoting prevention strategies, iii) expanding access to testing and treatment; and iv) improving surveillance, data collection and research. Today we will discuss these topics with a focus on the European Region with our three guests: - Dr. Erika Duffell, Public Health Physician, the European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden - Prof. Anna Maria Geretti, Editor in Chief, STI journal; Professor & Consultant in Infectious Diseases & Virology, Fondazione PTV, University of Rome Tor Vergata, Rome, Italy; North Middlesex University Hospital and King’s College London, London, United Kingdom - Prof.  Simon de Lusignan, Senior Academic General Practitioner (GP) and Director of the Royal College of GPs Research & Surveillance Centre, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom Hosted by: Dr. Fabiola Martin, Sexual Health, HIV, HTLV specialist, BMJ STI Podcast Editor, Brisbane, Australia    Relevant papers: Hepatitis B virus infection in general practice across England: An analysis of the Royal College of General Practitioners Research and Surveillance Centre real-world database https://www.journalofinfection.com/article/S0163-4453(23)00130-5/ Impact of maternal HIV–HBV coinfection on pregnancy outcomes in an underdeveloped rural area of southwest China https://sti.bmj.com/content/96/7/509 Prevalence of hepatitis B immunity and infection in home self-sampling HIV service users https://sti.bmj.com/content/98/4/286 Hepatitis A and B vaccination in gbMSM in Ireland: findings from the European MSM Internet Survey 2017 (EMIS-2017) https://sti.bmj.com/content/99/5/337 Hepatitis A and B vaccine uptake and immunisation among men who have sex with men seeking PrEP: a substudy of the ANRS IPERGAY trial https://sti.bmj.com/content/99/2/140 Hepatitis A, hepatitis B and HPV vaccine needs and coverage in MSM initiating HIV PrEP in a sexual health clinic in Paris https://sti.bmj.com/content/99/5/361    

Neisseria gonorrhoeae, in short NG, is a ubiquitous sexually transmitted bacteria that can cause both localised and systemic disease if left untreated. NG may also be transmitted vertically from mother to baby. Over the last years, we have seen a rise in the number of people diagnosed with gonorrhoea, alongside growing rates of antibiotic resistance. New research makes us hopeful that a vaccine may soon become available to provide global, large scale benefits. In this podcast, we explore this possibility with three experts in the field: Prof Kate Seib (1), Dr Claire Dewsnap (2) and Dr Silvia Nozza (3).   Would you like to know more about the topic? Please read the paper we recently published in STI: "Prior Neisseria meningitidis (Nm) proctitis does not prevent Neisseria gonorrhoeae (Ng) proctitis among men who have sex with men (MSM)": https://sti.bmj.com/content/99/3/215   (1) NHMRC Leadership Fellow and Associate Director for Research, Institute for Glycomics, Griffith University, Gold Coast, Australia    (2) President of the British HIV Association for HIV & Sexual Health (BASHH) and Consultant in Genitourinary Medicine, Sheffield Teaching Hospital, Sheffield, UK   (3) Consultant in Infectious Diseases, Head of Prevention Unit, San Raffaele Hospital (IRCCS), Milan, Italy

Welcome back to the 2023 BMJ STI Podcasts. Today we will focus on the worsening Syphilis epidemic worldwide. Syphilis is a bacteria that infects humans, and is transmitted horizontally through close sexual contact and vertically to unborn babies and neonates. It can cause acute and severe illness in those affected, such as neurosyphilis, and have tragic consequences for mother and baby. With the discovery of penicillin, access to testing, and especially public health interventions such as regular testing of asymptomatic, sexually active people and routine antenatal testing, we thought we could start focusing on eradicating Syphilis one day. Alas, over the last decade we have seen what seems an unstoppable rise of syphilis incidence world-wide. In conversation with Prof Clare Nourse, Prof. James Ward and Dr Angelica Espinosa Miranda we explore the issue at hand focusing on Australia and South America.