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.
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.
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.
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.
BackgroundNeurosyphilis remains a challenging diagnosis, and the British Association for Sexual Health and HIV (BASHH) guideline recommends lumbar puncture in patients with clinically suspected neurological syphilis. However, the extent to which this guidance is implemented in routine practice across England is uncertain. This study aimed to characterise current approaches to the diagnosis and management of neurosyphilis in England.MethodsWe conducted an opportunistic cross-sectional, web-based survey of clinicians managing neurosyphilis in England in March 2025. Eligible services had treated at least one case of neurosyphilis within the preceding 12 months. Data were collected on service characteristics, access to and indications for lumbar puncture, laboratory investigations, treatment regimens, and follow-up practices.ResultsForty-two responses representing 66 services across England were included. The majority (93%) were level 3 sexual health services, primarily community-based. Neurosyphilis was infrequently encountered (<10 cases/year in 67% of services). Lumbar puncture practice varied widely: 26% routinely performed lumbar puncture in suspected cases, 21% never performed lumbar puncture, and others reserved lumbar puncture for diagnostic uncertainty or suspected treatment failure. Logistical barriers and perceptions that cerebrospinal fluid (CSF) results would not alter management were common reasons for not performing lumbar puncture. The majority of services (65%) initiated treatment without awaiting CSF results. While 70% used first-line penicillin-based regimens, 23% used ceftriaxone first line, and ceftriaxone was often used in penicillin allergy (18% of services). Follow-up was predominantly serological and clinical; repeat CSF testing was uncommon.ConclusionsThere is substantial variation in neurosyphilis diagnosis and management across England, with frequent divergence from national guidance. Logistical barriers and diagnostic uncertainty contribute to pragmatic, empiric treatment approaches.
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.
BackgroundMen who have sex with men (MSM) in Nigeria experience a disproportionate burden of HIV, shaped by stigma, criminalization, and limited access to care. This study examined the multi-level social and structural factors influencing the lived experiences of MSM living with HIV in Nigeria.MethodsParticipants were recruited from a non-governmental organization in Lagos, Nigeria, for virtual interviews. The analysis was restricted to MSM (age: 21-33) living with HIV. Guided by the Social Ecological Model, interviews explored intrapersonal, interpersonal, community, and structural influences on HIV-related experiences. Interviews were audio-recorded, transcribed, and analyzed using thematic analysis.ResultsTwenty-four MSM (median age = 25) were interviewed. Three primary themes emerged. At the interpersonal level, family functioned as both a source of support and a site of stigma, influencing disclosure, housing stability, and engagement in care. At the community level, religious institutions reinforced stigma through homophobic messaging and promotion of faith-based healing, contributing to concealment and reduced healthcare utilization. At the societal level, cultural norms and criminalizing policies, including the Same Sex Marriage Prohibition Act, created an environment of fear, violence, and social exclusion. These intersecting factors contributed to delayed testing, limited disclosure, and challenges in sustained HIV care engagement.ConclusionHIV-related experiences among MSM in Nigeria are shaped by interconnected social and structural forces across multiple levels. Effective interventions must extend beyond individual behavior change to address family dynamics, religious influences, and structural barriers, including criminalization, to improve HIV outcomes and quality of life among MSM.
Lenacapavir is now approved for highly treatment experienced persons living with HIV (PLWH) and for HIV pre-exposure prophylaxis (PrEP). Limited lenacapavir clinical data exist with real-world drug-drug interactions. We report two possible drug-drug interactions with ambulatory lenacapavir subcutaneous injections in two PLWH prescribed long-acting injection therapy. Case 1 describes a PLWH prescribed clopidogrel after an acute cerebrovascular event receiving an antiretroviral (ARV) regimen including subcutaneous lenacapavir and ibalizumab biweekly infusions. The clopidogrel was discontinued with no harm noted. Case 2 is a highly treatment experienced PLWH prescribed an ARV regimen including subcutaneous lenacapavir and intramuscular cabotegravir/rilpivirine injections on concomitant inhaled and nasal fluticasone. Symptoms consistent with adrenal insufficiency were reported with immediate fluticasone discontinuation and transition to beclomethasone. The patient's baseline cortisol concentration was low with improvement after fluticasone discontinuation. The electronic medical record alerts were customized to note these possible lenacapavir drug-drug interactions, similar to protease inhibitors/pharmacokinetic boosters (ritonavir and cobicistat) to prevent future events. This case series highlights possible lenacapavir drug-drug interactions and is a precautionary tale to other institutions to consider customizing electronic medical alerts for this novel long-acting injection.
IntroductionLong-acting injectable cabotegravir/rilpivirine (CAB/RPV LA) represents a novel antiretroviral strategy that bypasses gastrointestinal absorption, potentially advantageous in pregnant individuals unable to tolerate oral therapy. However, its use in pregnancy remains off-label due to limited pharmacokinetic (PK), safety and clinical outcome data.Case presentationWe report the case of a 26-year-old woman from Ghana living with HIV-1 (subtype CRF02_AG), with a longstanding history of social vulnerability, poor adherence and multiple treatment interruptions. She presented at gestational week (GW) 20 with an ongoing oral regimen of bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF), initiated weeks earlier. Despite an initial viral load decline, virological rebound to 57,950 copies/mL was documented at GW 28, attributed to severe hyperemesis gravidarum (HEG) impairing drug intake and absorption. No resistance-associated mutations were detected. Given the inability to tolerate oral therapy, CAB/RPV LA (600/900 mg) was initiated intramuscularly at GW 29, with a second injection 4 weeks later. Virological suppression (<20 copies/mL) was achieved within 4 weeks of the first injection. At GW 36, an elective caesarean section was performed with intravenous zidovudine prophylaxis and neonatal zidovudine syrup, resulting in the delivery of a neonate who has tested HIV-negative on all assessments to date. No adverse maternal or neonatal outcomes were observed.DiscussionThis case highlights HEG as an underrecognised cause of antiretroviral treatment failure mediated by impaired absorption rather than virological resistance, and supports CAB/RPV LA as a viable rescue strategy in this setting.ConclusionIt also underscores the urgent need for prospective pharmacokinetic and safety data in pregnancy.
BackgroundTestosterone-associated vulvovaginitis is an under-recognised cause of genital symptoms in transmasculine patients receiving testosterone as gender-affirming hormone therapy, with 5-years prevalence 64-78%. BASHH's Gender and Sexual Minorities Special Interest Group convened sexual health, gender, gynaecological and primary care experts and patient representatives to formulate a first-in-world best practice statement.MethodWe searched Medline, Embase, CINAHL, UpToDate, Trip Medical Database and Cochrane, to April 2025, regarding testosterone's impact on transmasculine people's vaginal histology and microbiomes, symptoms, and management. Papers on cis- or transgender women, editorials, and study protocols were excluded. Included studies were assessed using the Critical Appraisal Skills Programme tool. Recommendations for best practice were graded using GRADE methodology where possible, and supplemented by expert group consensus where evidence was limited.Results14 papers were included, of which 11 were descriptive/non-management focused. Testosterone is associated with vaginal Lactobacilli depletion, increased speciation, pH changes, atrophy, inflammation, and epithelial cell differentiation shift. The diagnosis of testosterone-associated vulvovaginitis is clinical; symptom severity does not reliably correlate with any of the above, nor other markers such as hormone levels. Two small case series and one cohort study (total n = 12) discussed treatment; topical estrogen reduced vaginal symptoms and increased Lactobacilli, with some refractory inflammatory cases requiring topical clindamycin +/- topical steroids. Presumed efficacy and safety are extrapolated from topical estrogen use in cisgender menopausal women.ConclusionSpecific evidence for testosterone-associated vulvovaginitis management is lacking; we suggest a culturally competent approach, considering it as a differential in any transmasculine people on testosterone with genitourinary symptoms. Offer examination (if possible) to exclude infection or dermatoses; offer first-line treatment with topical vaginal estrogens. Adjunctive/alternative measures include emollients and lubricants; topical clindamycin +/- topical steroids for refractory cases or aerobic/desquamative vaginitis. Long-term maintenance therapy and review is advised. Robust trans-specific clinical trials are needed to strengthen the evidence and optimise long-term outcomes.
BackgroundHuman papillomavirus (HPV) associated cervical cancer remains the leading cause of cancer mortality among women in resource-limited settings. The WHO recommends HPV screening with a high-performance screening test for women by age 35 and 45 years. We compared the Cepheid Xpert HPV test to the hybriSpot laboratory-based assay among women living with Human Immunodeficiency Virus (WLHIV) starting antiretroviral treatment (ART).MethodsIn this cross-sectional analysis we performed a rapid Xpert HPV test on an endocervical liquid-based cytology (LBC) sample, which detects 14 high-risk HPV (hr-HPV) subtypes (HPV16, HPV18/45, P3: HPV31, 33, 35, 52, 58; P4: HPV51, 59; P5: HPV39, 56, 66, 68). The LBC samples were also tested on the hybriSpot platform (Vitro S.A., Master Diagnostica, Sevilla, Spain), which distinguishes between the same hr-HPV subtypes and an additional 21 high- and low-risk HPV subtypes.ResultsAmong 47 WLHIV included, the median age was 32 [Interquartile Range 28-39] years, and mean CD4 count 338 cells/µl. Overall, 32 (68%) WLHIV were positive for hr-HPV on the Xpert assay and 35 (74.5%) WLHIV were positive on the hybriSpot platform. Agreement between the Xpert and hybriSpot tests was good (kappa co-efficient ≥0.75) for the detection of HPV16, HPV18/45 and other hr-HPV subtypes, except for hr-HPV subtypes 51, 59 (kappa co-efficient 0.56). High sensitivity (>90%) was observed only for the P3 (HPV 31, 33, 35, 52, 58) and P4 (HPV39, 56, 66, 68) channels, while specificity exceeded 90% for all channels except P4. Among P3 HPV subtypes, particularly HPV52, prevalence was high in this subset as detected by the hybriSpot assay.ConclusionsThe Xpert HPV test demonstrated high agreement when compared to a laboratory PCR-based reverse dot-blot hybridisation assay among WLHIV at ART initiation. Near point-of-care HPV testing may be beneficial where HPV screen-and-treat models can be integrated into routine HIV care.
BackgroundGenital mpox has been scarcely described in Central and West Africa where the disease is endemic. This study aimed to describe the clinical manifestations of genital mpox acquired through sexual contact in heterosexual African couples.MethodsThis was a case series of patients presenting with genital lesions associated or without febrile pustular or vesicular eruptions and confirmed with a positive PCR. Medical records of patients were scrutinized between March 2022 and December 2025 in three dermatology centres located either in Cameroon or Benin. Sociodemographic characteristics, clinical features, laboratory results, treatment, and outcomes were systematically documented.ResultsIn total, nine cases of genital mpox from six heterosexual couples were documented. Patients' median age was 35 years (IQR 31-42 years; range: 28-45 years). Two heterosexual partners were living with HIV with undetectable plasma viral loads. Sexual contact preceding genital lesions' onset was reported in seven of 9 cases (78%). The incubation period ranged from 3 to 10 days. Clinical manifestations included vesicles, pustules, erosions, ulcerations, genital edema, umbilicated necrotic papules, and inguinal lymphadenopathy. The morphology of lesions varied from rounded/oval to arcuate and linear patterns. The recovery time ranged from 2 to 8 weeks, though longer for ulcerations. People living with HIV experienced severe presentations and prolonged recovery.ConclusionGenital manifestations of mpox on black skin are polymorphic and can present with atypical features. Mpox should be considered as a differential diagnosis of genital lesions following condomless sexual intercourse, particularly in endemic areas.
