The 20th European AIDS Conference (EACS) was held in Paris, France, over 4 days in October 2025. The event was co-chaired by Milosz Parczewski (Poland), Karine Lacombe, Bruno Spire and Jean-Michel Molina (France). This meeting provided up-to-date information on HIV prevention, treatment and cure research, as well as comorbidities.

BACKGROUND:Clade Ib monkeypox virus (MPXV) emerged in the Democratic Republic of Congo in 2023 with sustained sexual transmission and has since spread internationally, including to Europe. This review synthesises evidence on MVA-BN vaccine effectiveness, safety and durability to guide Belgian clinical practice. METHODS:Narrative review of MVA-BN effectiveness studies, meta-analyses, immunogenicity data and safety surveillance from the 2022-2025 clade IIb outbreak response. RESULTS:Two-dose MVA-BN effectiveness against symptomatic mpox is approximately 82% (95% CI 72-92%), although these 2022 observational estimates may be inflated by concurrent behavioural risk reduction. Pooled single-dose effectiveness is 76%, but is lower in people living with HIV (34.9%) than in HIV-negative individuals (84.1%), underlining the importance of two-dose completion in immunocompromised populations. Neutralising antibodies wane within 5 to 7 months, yet clinical protection persists through memory B-cell and T-cell responses. MVA-BN is safe in HIV infection and atopic dermatitis, with myocarditis risk below 1 per 100,000 doses; pregnancy data are limited and must be weighed against maternal and fetal risk. No direct clade I effectiveness data exist, but cross-protection is expected from epitope conservation, animal data and human evidence of protection after previous smallpox vaccination. CONCLUSIONS:Sexual health services should offer prompt vaccination to men who have sex with men with multiple partners, PrEP users, sex workers and people living with HIV, emphasising two-dose completion in immunocompromised individuals. Despite antibody waning, memory responses support durable protection against hospitalisation. Post-exposure prophylaxis is ideally given within four days, though administration up to 14 days may attenuate severity.

Background. The global mpox outbreak that started in May 2022 was caused by a novel clade IIb variant of the mpox virus (Orthopoxvirus monkeypox, MPXV). It differed from the traditional Western and Central Africa disease in transmission patterns and clinical presentation. Methods. To address the need for detailed clinical and virologic data, we conducted an observational cohort study (MOSAIC) during May 2022-July 2023 in individuals with confirmed MPXV infection enrolled in 6 European countries. Case management decisions were left to the attending physician. Participants were monitored for up to 6 months for clinical signs/symptoms and clinical and virologic outcomes through hospital visits, phone interviews, and self-administered questionnaires. Outcomes included time to lesion resolution, clinical status, and virus clearance. Results. The 518 participants not receiving any specific treatment ("untreated") were diagnosed a median 5 days from symptom onset; 90% were managed as outpatients. Lesions were mostly cutaneous (88%) and perigenital (74%). By day 14 from the first polymerase chain reaction (PCR)-positive sample, 39% had resolved lesions. Time to 95% unculturable virus was longest in cutaneous lesions (52 days). A putative systemic antiviral was available for 57 participants, 44% as inpatients; 34% and 58% had resolved lesions by day 14 from the first PCR-positive sample and from treatment start, respectively. Time to 95% unculturable virus was 60 days in skin and oropharynx. No death or recrudescence occurred by day 180. Conclusions. MOSAIC provides comprehensive insights into the clinical and virologic characteristics of mpox caused by the clade IIb variant. The study forms the basis of clinical characterization for ongoing mpox outbreaks.

Objective:The recombinant herpes zoster vaccine is recommended for aging populations to prevent herpes zoster. We aimed to assess awareness of herpes zoster and acceptance of the herpes zoster vaccine acceptance among people living with HIV (PLWH). Methods:We conducted a written survey among PLWH attending an HIV outpatient clinic in Brussels from March 2022 to April 2023. Participation was voluntary. We collected epidemiological data, assessed knowledge of herpes zoster and opinion about herpes zoster vaccine and vaccination in general. We described the surveyed cohort and reported their attitudes toward vaccination. Herpes zoster vaccine acceptance and general vaccine acceptance were defined as two binary outcome variables. We performed binary logistic regression to identify factors associated with vaccine acceptance. Results:A total of 327 patients completed the questionnaire. While 64 % reported being aware of herpes zoster, only one third reported a link between herpes zoster and varicella infection. The majority (77.1 %) declared being in favour of overall vaccination. Willingness to be vaccinated (regardless of vaccine type) was the factor associated with herpes zoster vaccine acceptance. General vaccine acceptance was associated with the belief that vaccination is useful for preventing infectious diseases. Conclusions:Knowledge and awareness about herpes zoster were low among PLWH surveyed. Herpes zoster vaccine acceptance was more related to general attitudes toward vaccination rather than specific knowledge about herpes zoster.

Background: Sexual assault victims involving penetration are at risk of contracting human immunodeficiency virus (HIV). Post-exposure prophylaxis (PEP) can effectively prevent HIV infection if initiated promptly within 72 h following exposure and adhered to for 28 days. Nonetheless, therapeutic adherence amongst sexual assault victims is low. Victim-centered care, provided by specially trained forensic nurses and midwives, may increase adherence. Methods: We conducted a retrospective case–control study to evaluate the impact of sexual assault center (SAC)—centered care on adherence to PEP compared to care received in the emergency department (ED). Data from January 2011 to February 2022 were reviewed. Multivariable logistic regression analysis was employed to determine the association between centralized specific care for sexual assault victims and completion of the 28-day PEP regimen. The secondary outcome assessed was provision of psychological support within 5 days following the assault. Results: We analyzed 856 patients of whom 403 (47.1%) received care at a specialized center for sexual assault victims. Attendance at the SAC, relative to the ED, was not associated with greater probability of PEP completion both in the unadjusted (52% vs. 50.6%; odds ratio [OR]: 1.06, 95% CI: 0.81 to 1.39; p = 0.666) and adjusted (OR: 0.81, 95%CI 0.58–1.11; p = 0.193) analysis. The care provided at the SAC was associated with improved early (42.7% vs. 21.5%; p < 0.001) and delayed (67.3% vs. 33.7%; p < 0.001) psychological support. Conclusions: SAC-centered care is not associated with an increase in PEP completion rates in sexual assault victims beyond the increase associated with improved access to early and delayed psychological support. Other measures to improve PEP completion rates should be developed. What is already known on this topic—Completion rates for HIV post-exposure prophylaxis (PEP) among victims of sexual assault are low. Specialized sexual assault centers, which provide comprehensive care and are distinct from emergency departments, have been suggested as a potential means of improving treatment adherence and completion rates. However, their actual impact on treatment completion remains unclear. What this study adds—This study found that HIV PEP completion rates in sexual assault victims were not significantly improved by centralized care in a specialized sexual assault center when compared to care initiated in the emergency department and continued within a sexually transmitted infection clinic. However, linkage to urgent psychological and psychiatric care was better in the specialized sexual assault center. How this study might affect research, practice or policy—Healthcare providers in sexual assault centers should be more aware of their critical role in promoting PEP adherence and improving completion rates. Policymakers should ensure that measures aimed at improving HIV PEP outcomes are implemented at all points of patient contact in these centers. Further research is needed to assess the cost-effectiveness of specialized sexual assault centers.

Klebsiella aerogenes has recently been reported as a causative agent of folliculitis in men who have sex with men (MSM). We present four cases of folliculitis in MSM diagnosed in Brussels, Belgium. Patients were aged between 25 and 50 years, and all were infected by a single multilocus sequence type (ST117) strain. This strain carried the yersiniabactin siderophore genes. Following a preliminary treatment by sulfamethoxazole−trimethoprim for 7−14 days, all patients experienced a recurrence of symptoms, necessitating an extended therapeutic regimen.

INTRODUCTION:In Belgium, oral HIV pre-exposure prophylaxis (PrEP) is primarily provided in specialized clinical settings. Optimal implementation of PrEP services can help to substantially reduce HIV transmission. However, insights into implementation processes, and their complex interactions with local context, are limited. This study examined factors that influence providers' adaptive responses in the implementation of PrEP services in Belgian HIV clinics. METHODS:We conducted a qualitative multiple case study on PrEP care implementation in eight HIV clinics. Thirty-six semi-structured interviews were conducted between January 2021 and May 2022 with a purposive sample of PrEP care providers (e.g. physicians, nurses, psychologists), supplemented by 50 hours of observations of healthcare settings and clinical interactions. Field notes from observations and verbatim interview transcripts were thematically analysed guided by a refined iteration of extended Normalisation Process Theory. RESULTS:Implementing PrEP care in a centralized service delivery system required considerable adaptive capacity of providers to balance the increasing workload with an adequate response to PrEP users' individual care needs. As a result, clinic structures were re-organized to allow for more efficient PrEP care processes, compatible with other clinic-level priorities. Providers adapted clinical and policy norms on PrEP care (e.g. related to PrEP prescribing practices and which providers can deliver PrEP services), to flexibly tailor care to individual clients' situations. Interprofessional relationships were reconfigured in line with organizational and clinical adaptations; these included task-shifting from physicians to nurses, leading them to become increasingly trained and specialized in PrEP care. As nurse involvement grew, they adopted a crucial role in responding to PrEP users' non-medical needs (e.g. providing psychosocial support). Moreover, clinicians' growing collaboration with sexologists and psychologists, and interactions with PrEP users' family physician, became crucial in addressing complex psychosocial needs of PrEP clients, while also alleviating the burden of care on busy HIV clinics. CONCLUSIONS:Our study in Belgian HIV clinics reveals that the implementation of PrEP care presents a complex-multifaceted-undertaking that requires substantial adaptive work to ensure seamless integration within existing health services. To optimize integration in different settings, policies and guidelines governing PrEP care implementation should allow for sufficient flexibility and tailoring according to respective local health systems.

To assess the prevalence of Neisseria meningitidis (Nm) carriage among men who have sex with men (MSM) and examine potential risk factors associated with colonization. This was an observational, cross-sectional, monocentric study. Inclusion criteria were asymptomatic adult MSM. Recruitment took place at an outpatient sexual health clinic in Brussels, Belgium from October 2019 to March 2020. The primary outcome of this study was to determine the prevalence of meningococcal oropharyngeal carriage. Secondary outcomes included characterization of the participants colonized with Nm and serogroup identification of encapsulated strains. Ordinal logistic regression analysis was performed to evaluate for associations with Nm colonization. A total of 143 participants were included, of which 36 (25.2

OBJECTIVES:We aimed to develop a guidance on the use of pre-exposure prophylaxis (PrEP) for HIV tailored to the Belgian context.METHODS:Different aspects of PrEP care were judged by an expert group of nine Belgian clinicians, seeking consensus for areas of controversies.RESULTS:PrEP should be considered in HIV negative patients at high risk of acquiring HIV. Currently, only oral tenofovir/emtricitabine is available in Belgium for PrEP, which can be used daily, or also event-driven in cisgender men and trans women who are not taking exogenous estradiol-based hormones. Personal counselling directed at medication adherence and sexual health should have a central role in PrEP care. At the initial assessment clinicians should give attention to symptoms of an acute HIV infection, the patients' immunization status and renal function. A regular follow-up must be set up to diagnose HIV seroconversion, treat sexually transmitted infections, and manage side effects of PrEP.CONCLUSION:The Belgian guidance on the use of PrEP provides a point of reference for standard PrEP care in Belgium and will be periodically updated.

BACKGROUND:Guidelines recommend screening for Neisseria gonorrhoeae and Chlamydia trachomatis at three anatomical sites (urethra, anus, and pharynx) every 3 months (3 × 3) in men who have sex with men (MSM) and transgender women taking HIV pre-exposure prophylaxis (PrEP). We present the first randomised controlled trial to compare the effect of screening versus non-screening for N gonorrhoeae and C trachomatis on the incidence of these infections in MSM and transgender women taking PrEP. METHODS:A multicentre, randomised, controlled trial of 3 × 3 screening for N gonorrhoeae and C trachomatis versus non-screening was done among MSM and transgender women taking PrEP in five HIV reference centers in Belgium. Participants attended the PrEP clinics quarterly for 12 months. N gonorrhoeae and C trachomatis was tested at each visit in both arms, but results were not provided to the non-screening arm, if asymptomatic. The primary outcome was incidence rate of N gonorrhoeae and C trachomatis infections in each arm, assessed in the per-protocol population. Non-inferiority of the non-screening arm was proven if the upper limit of the 95% CI of the incidence rate ratio (IRR) was lower than 1·25. This trial is registered with ClinicalTrials.gov, NCT04269434, and is completed. FINDINGS:Between Sept 21, 2020, and June 4, 2021, 506 participants were randomly assigned to the 3 × 3 screening arm and 508 to the non-screening arm. The overall incidence rate of N gonorrhoeae and C trachomatis was 0·155 cases per 100 person-days (95% CI 0·128-0·186) in the 3 × 3 screening arm and 0·205 (95% CI 0·171-0·246) in the non-screening arm. The incidence rate was significantly higher in the non-screening arm (IRR 1·318, 95% CI 1·068-1·627). Participants in the non-screening arm had a higher incidence of C trachomatis infections and symptomatic C trachomatis infections. There were no significant differences in N gonorrhoeae infections. Participants in the non-screening arm consumed significantly fewer antimicrobial drugs. No serious adverse events were reported. INTERPRETATION:We failed to show that non-screening for N gonorrhoeae and C trachomatis is non-inferior to 3 × 3 screening in MSM and transgender women taking PrEP in Belgium. However, screening was associated with higher antibiotic consumption and had no effect on the incidence of N gonorrhoeae. Further research is needed to assess the benefits and harms of N gonorrhoeae and C trachomatis screening in this population. FUNDING:Belgian Health Care Knowledge Centre.

1 INTRODUCTION 7 -- BACKGROUND 7 -- REMIT OF THE GUIDELINE 9 -- 1.2.1 Objectives of the guideline 9 -- 1.2.2 Patient-centered care 9 -- 2 METHODOLOGY 10 -- THE GUIDELINE DEVELOPMENT GROUP 10 -- CLINICAL RESEARCH QUESTIONS 10 -- GENERAL APPROACH 11 -- QUALITY ASSESSMENT OF STUDIES 11 -- FORMULATION OF RECOMMENDATIONS 12 -- EXTERNAL REVIEW 12 -- FINAL VALIDATION 12 -- 3 CLINICAL RECOMMENDATIONS FOR MANAGEMENT OF GONORRHOEA 14 -- GONORRHOEA DIAGNOSIS 14 -- 3.1.1 Recommendations: Who to test for gonorrhoea 14 -- 3.1.2 Recommendations: Diagnostic tests for gonorrhoea 16 -- 3.1.3 Diagnosis of gonorrhoea: Good practice statements 18 -- GONORRHOEA TREATMENT 19 -- 3.2.1 Recommendations regarding information and advice for the patient 19 -- 3.2.2 Recommendations regarding testing and surveillance for resistance 20 -- 3.2.3 Recommendation regarding initiation of therapy 20 -- 3.2.4 Referral to the second line for gonorrhoea: Good practice statements 21 -- 3.2.5 Recommendation for treatment of gonorrhoea in women and men including young people 21 -- 3.2.6 Treatment of gonorrhoea: Good practice statements 22 -- 3.2.7 Recommendation for treatment of gonorrhoea in pregnant women 22 -- 3.2.8 Treatment of gonorrhoea in pregnant women: Good practice statements 23 -- 3.2.9 Treatment of gonorrhoea in people with an allergy to cephalosporin: Good practice statement 23 -- 3.2.10 Recommendations for treatment of chlamydia and gonorrhoea co-infection 24 -- GONORRHOEA TEST OF CURE AND FREQUENCY OF TESTING 25 -- 3.3.1 Recommendations regarding a test of cure for gonorrhoea 25 -- 3.3.2 Recommendations regarding testing frequency for gonorrhoea 26 -- MANDATORY NOTIFICATION OF GONORRHOEA 26 -- 4 CLINICAL RECOMMENDATIONS FOR MANAGEMENT OF SYPHILIS 27 -- SYPHILIS DIAGNOSIS 27 -- 4.1.1 Recommendations: Who to test for syphilis 27 -- 4.1.2 Recommendations: Which sample to take for syphilis 28 -- 4.1.3 Recommendation: Which tests to use for syphilis 29 -- 4.1.4 Choice of tests for syphilis diagnosis: Good practice statements 30 -- SYPHILIS TREATMENT 30 -- 4.2.1 Recommendations regarding syphilis information and advice for the patient 30 -- 4.2.2 Recommendation regarding initiation of syphilis therapy 31 -- 4.2.3 Recognising syphilis clinical symptoms: Good practice statements 31 -- 4.2.4 When to refer to the second line for syphilis: Good practice statements 32 -- 4.2.5 Recommendations for treatment of syphilis in women and men including young people (excluding pregnant women) 32 -- 4.2.6 Treatment of syphilis: Good practice statements 33 -- SYPHILIS FOLLOW-UP AND FREQUENCY OF TESTING 34 -- 4.3.1 Recommendations regarding follow-up of a treated patient 34 -- 4.3.2 Testing frequency for syphilis: Good practice statements 35 -- MANDATORY NOTIFICATION OF SYPHILIS 35 -- 5 IMPLEMENTATION OF THIS GUIDELINE 36 -- POLICY AND OTHER IMPLEMENTATION OF THIS GUIDELINE 36 -- 5.1.1 Barriers and facilitators 36 -- 5.1.2 Actors of dissemination and publication on Ebpractice net 36 -- TRANSLATING THE GUIDELINE INTO A PRIMARY CARE SEXUAL HEALTH CONSULTATION STI TESTING INSTRUMENT 37 -- 5.2.1 Clinical guidance 37 -- 5.2.2 Structure of the STI consultation instrument 37 -- 6 GUIDELINE UPDATE 39 -- RECOMMENDATIONS 40 -- REFERENCES 42

Het Federaal Kenniscentrum voor de Gezondheidszorg (KCE) stelde in 2019 een richtlijn op voor de diagnose en aanpak van gonorroe en syfilis. De richtlijn was toe aan een update, wegens de toenemende gonorroe resistentie tegen azithromycine, het antibioticum dat gecombineerd met ceftriaxon, voor de behandeling werd aanbevolen. De overheidsinstelling Sciensano in ons land stelde vast dat 18,6% van de gonokokken in 2021 resistent was tegen azithromycine. In 2022 was deze resistentie gestegen naar 33,6%. Om die reden beveelt het KCE het gebruik van azithromycine voor de behandeling van gonorroe niet meer aan, enkel nog het antibioticum ceftriaxon. Het KCE ontwikkelde ook een gratis online tool (www.soa.kce.be) voor het opsporen, behandelen en opvolgen van gonorroe, syfilis, chlamydia, HIV en hepatitis A, B en C. Dit gebeurde samen met mensen van het terrein. De tool is bedoeld voor zorg- en hulpverleners om te gebruiken tijdens de consultatie. Deze tool werd eveneens aangepast.

Background An international outbreak of the monkeypox (MPX) virus is ongoing with a different clinical presentation than previously reported. Objective A monocentric retrospective study was designed to investigate clinical predictors of confirmed MPX cases among a group of patients referred for MPX screening. Furthermore, the additional value of performing a real-time polymerase chain reaction (RT-PCR) on multiple anatomical sites was analyzed. Methods Between 28/05/2022 and 22/07/2022, the medical records of patients referred for MPX screening were investigated. Patients with positive RT-PCR were defined as cases, while the ones with negative RT-PCR as controls. Multivariable regression analysis was performed to estimate predictors of MPX diagnosis. Results Among the 141 included patients, 85 (60%) had at least one positive RT-PCR for MPX. Carrying out RT-PCR only on the swab obtained by skin lesion sampling, 7 patients (7/85: 8%) would have been misdiagnosed. Multivariable regression analysis showed significant differences in the independent variables: “being men who have sex with men (MSM)”, “living with HIV”, “having multiple sexual partners in the last 3 weeks”, and “having skin lesions in the anogenital area” for prediction of MPX diagnosis. These four discriminants were used to create a score to improve diagnosis in patients screened for MPX. Conclusion MPX diagnosis was associated with being MSM, living with HIV, having multiple sexual partners, and presenting with anogenital skin lesions. In this study, the derived score had good sensitivity and specificity to predict MPX diagnosis. Finally, performing multi-site swabs for MPX RT-PCR might lower false negative rates.

Summary Background Guidelines recommend three-site (urine, anal, pharynx) three-monthly (3X3 screening) screening for Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) in men who have sex with men (MSM) taking HIV pre-exposure prophylaxis (PrEP). We present the first randomized controlled trial to compare the effect of screening versus non-screening for NG/CT on the incidence of these infections in MSM taking PrEP. Methods A multicenter, randomized, controlled trial of 3X3 screening for NG/CT versus non-screening was conducted among MSM taking PrEP in five HIV reference centers in Belgium. Participants attended the PrEP clinics quarterly for 12 months. NG/CT was tested at each visit in both arms, but results were not provided to the non-screening arm. The primary outcome was the incidence rate (IR) of NG/CT infections in each arm, assessed in the per-protocol population. Non-inferiority of the non-screening arm was proven if the upper limit of the 95% confidence interval of the IR ratio (IRR) was lower than 1.25. The trial protocol was registered at clinicaltrials.gov ( NCT04269434 ). Findings Between September 2020 and June 2021, 508 subjects were randomized to the 3X3 screening arm and 506 to the non-screening arm. The overall IR of NG/CT was 0.155 cases/100 person-days (95%CI 0.128-0.186) in the 3×3 screening arm and 0.205 (95%CI 0.171-0.246) in the non-screening arm. The IR was significantly higher in the non-screening arm (IRR 1.318, 95%CI 1.068-1.627). Participants in the non-screening arm had a higher incidence of CT infections and symptomatic CT infections. There were no significant differences in NG infections. Participants in the non-screening arm consumed significantly less antimicrobials. No serious adverse events were reported. Interpretation We failed to show that non-screening for NG/CT is non-inferior to 3-site 3-monthly screening in MSM taking PrEP in Belgium. However, screening was associated with higher antibiotic consumption and had no effect on the incidence of NG. Therefore, our findings do not provide strong support for screening for NG/CT in this population. Funding Belgian Healthcare Knowledge Center (KCE - INV18-1133)

En 2019, le Centre Fédéral d’Expertise des Soins de Santé (KCE) publiait des recommandations pour le diagnostic et le traitement de la gonorrhée et de la syphilis. Face à la résistance croissante du gonocoque à l’azithromycine, l’antibiotique préconisé à l’époque pour la prise en charge de cette infection en combinaison avec la ceftriaxone, une mise à jour était toutefois devenue nécessaire. Dans notre pays, l’institut de santé publique Sciensano a en effet constaté que, de 18,6 % en 2021, le taux de résistance des gonocoques à azithromycine était passé à 33,6 % en 2022. Le KCE ne recommande donc plus le recours à l’azithromycine pour le traitement de la gonorrhée, qui repose désormais uniquement sur un autre antibiotique, la ceftriaxone. Profitons-en pour rappeler que le KCE a développé en collaboration avec des acteurs de terrain un outil en ligne gratuit (www.ist.kce.be) pour le dépistage, le traitement et le suivi de la gonorrhée, de la syphilis, des infections à Chlamydia, du VIH et des hépatites A, B et C. Il est destiné à être utilisé par les prestataires de soins au cours de la consultation, et a également été adapté.

OBJECTIVE:Review the evidence on the incidence and impact of herpes zoster among people living with HIV and the potential impact of recombinant zoster vaccine for people aging with HIV. METHODS:Narrative review. RESULTS:Although antiretroviral therapy has substantially reduced the risk of herpes zoster among people living with HIV, they remain at an increased risk compared with the general population. Among people aging with HIV, aging per se is now the main risk factor for herpes zoster. Beyond pain, herpes zoster is also associated with a risk of sight-threatening complications in case of trigeminal involvement, disseminated diseases and stroke. Post-herpetic neuralgia is also a potential threat to the quality of life of people aging with HIV. The recombinant zoster vaccine has demonstrated high and sustained efficacy in the prevention of herpes zoster, post-herpetic neuralgia, and other herpes zoster complications in the general population. Immunogenicity data among people living with HIV with high CD4+ T-cell count and controlled viral load are comparable to those among the general population. Real-life effectiveness data indicate high vaccine efficacy among immunocompromised patients other than people living with HIV. High vaccine price, vaccine hesitancy, and limited disease and vaccine awareness represent potential hurdles for high vaccine uptake among people aging with HIV in Europe. CONCLUSIONS:Herpes zoster, and its complications, is a vaccine-preventable disease of aging people. Given its impact on quality of life, herpes zoster prevention using recombinant zoster vaccine is a safe strategy to be considered in every person aging with HIV.