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AbstractIntroductionRising rates of reported sexually transmitted infections (STIs) in the US and Europe are a public health priority and require a public health response. The diagnosis and treatment of STIs have been the cornerstone of STI control and prevention for many decades and, historically, publicly funded STI clinics have played a central role in the provision of STI care. Innovations in non‐invasive diagnostic techniques, especially nucleic acid amplification tests in the mid‐1990s, have facilitated the expansion of STI testing and treatment outside traditional STI clinics, including primary care, family planning, school‐based health, outreach, corrections, emergency departments and HIV prevention and care settings. As a result, the continued need for categorical STI clinics has been debated. In this Commentary, we discuss how practice can be improved at each level of STI care.DiscussionSTI practice improvement plans should be tailored to the strengths of each care setting. Thus, in primary care, the focus should be on improving STI screening rates, the provision of hepatitis B and human papillomavirus vaccines and, in jurisdictions where this is legal, expedited partner therapy for gonorrhoea and chlamydia. Extragenital (pharyngeal and rectal) testing for gonorrhoea and chlamydia should be available in settings serving populations more vulnerable to STI acquisition at these anatomical sites, including men who have sex with men. In family planning settings with a mostly female patient population, there are opportunities to serve male partners with both contraceptive and STI services. STI screening rates can also be improved in other settings serving populations at increased risk for STIs, including school‐based clinics, emergency departments, correctional health facilities and providers of HIV care and prevention. These improvements are predominantly logistical in nature and not dependent on extensive STI clinical expertise. While some providers in these settings may have the clinical knowledge and skills to evaluate symptomatic patients, many do not, and STI speciality clinics must be available for consultation and referral and evolve from "safety net" providers of last resort to STI centres of excellence.ConclusionsA tailored practice improvement plan can be envisioned to achieve an optimally functioning STI care continuum.

This study set out to investigate the influence of male circumcision and other factors on sexually transmitted infections in Botswana. A syndromic approach, which diagnoses a sexually transmitted infection based on the presence of urethral discharge or genital ulcers rather than on laboratory tests, was used. The data were from the 2001 Botswana AIDS Impact Survey where a nationally representative, randomly selected sample of men and women aged 10–64 years were interviewed in both urban and rural areas. The sample selected for this study consisted of 216,480 men aged 15–64 years who had ever had sexual intercourse. The logistic regression technique was executed to examine the association between male circumcision and self-reported urethral discharge or genital ulcers, while controlling for all other independent variables in the analysis. The main finding of this study was that among men who are circumcised, the odds for self-reported urethral discharge or genital ulcers are significantly lower than for those men who are not circumcised in both urban and rural Botswana. The analysis also showed that the odds in favour of self-reported urethral discharge or genital ulcers, for men who drink alcohol, are twice as large as those for men who do not drink alcohol, controlling for all other independent variables in the analysis. Religion and ethnicity also came through as factors exerting a protective influence against self-reported symptoms of sexually transmitted infections. The conclusion is that while male circumcision appears to be significantly associated with the risk for self-reported urethral discharge or genital ulcers, it is man's behaviour, irrespective of ethnicity or religious dictates, that continues to play a vital role in protection against self-reported symptoms of sexually transmitted infections in Botswana.

Epidemiological indicators in Georgia suggest that the number of STIs cases had been on the increase prior to 1998. Although there has been a recent decline from 1998 to 2000 in STIs cases due to the successful control and management of STIs in Georgia, the once extinct disease is now an epidemiologic concern. The problems and constraints facing the country are: • The concentration of STIs transmission along the Turkish border. • The lack of a specialized national STIs control service and need for preventive services to be upgraded to deal with the STIs situation. • Concentration of intense transmission of STIs with poor access to existing health services resulting in high and underreported morbidity. • Under-equipped, under-supplied and under-staffed health facilities and under-trained and under- paid public health personnel resulting in inadequate quality of disease management and prevention. • Poor capacities for early diagnosis and prompt treatment of STIs resulting in inadequate coverage of people being at risk of STIs. • Lack of surveillance particularly at the periphery resulting in untrue reflection of the extent of STIs problem in the country. • Lack of communities' knowledge and skills to prevent themselves from getting STIs resulting in a rather scanty use of personal protective measures. • Limited resources invested by the Government and external donors resulting in lack of proper funding to cope with the STIs problem. The authors suggest new strategies and research in the field of disease management.

Bacterial sexually transmitted infections (STIs) have been increasing over the past 2 decades in gay, bisexual, and other men who have sex with men. With the widespread use of early human immunodeficiency virus (HIV) treatment, which virtually eliminates transmission risk, and the availability of HIV pre-exposure prophylaxis, there have been attitudinal changes regarding HIV infection with resultant increases in sexual contact and declines in condom use. Doxycycline is used for primary prophylaxis in a number of infectious diseases. We conducted a state-of-the-art review to examine the current state of research, knowledge gaps, and challenges around the use of doxycycline prophylaxis to prevent syphilis and other STIs. International academic and government experts met in March 2019 to frame the initial inquiry, which was supplemented by focused literature searches. Two small short-term randomized controlled trials examining doxycycline prophylaxis found high efficacy. Five additional clinical studies are underway or in development. Studies differed in design, population, outcomes, and safety measures. Doxycycline prophylaxis for bacterial STIs shows promise. Better and more robust data are needed on efficacy; target population; community acceptability; behavioral risk compensation; doxycycline dose, regimen, and formulation; long-term safety; antimicrobial resistance; cost-effectiveness; and risk–benefit.

The goal of the point-of-care (POC) sexually transmitted infection (STI) Diagnostics meeting was to review the state-of-the-art research and develop recommendations for the use of POC STI diagnostics. Experts from academia, government, nonprofit, and industry discussed POC diagnostics for STIs such as Chlamydia trachomatis, human papillomavirus, Neisseria gonorrhoeae, Trichomonas vaginalis, and Treponema pallidum. Key objectives included a review of current and emerging technologies, clinical and public health benefits, POC STI diagnostics in developing countries, regulatory considerations, and future areas of development. Key points of the meeting are as follows: (i) although some rapid point-of-care tests are affordable, sensitive, specific, easy to perform, and deliverable to those who need them for select sexually transmitted infections, implementation barriers exist at the device, patient, provider, and health system levels; (ii) further investment in research and development of point-of-care tests for sexually transmitted infections is needed, and new technologies can be used to improve diagnostic testing, test uptake, and treatment; (iii) efficient deployment of self-testing in supervised (ie, pharmacies, clinics, and so on) and/or unsupervised (ie, home, offices, and so on) settings could facilitate more screening and diagnosis that will reduce the burden of sexually transmitted infections; (iv) development of novel diagnostic technologies has outpaced the generation of guidance tools and documents issued by regulatory agencies; and (v) questions regarding quality management are emerging including the mechanism by which poor-performing diagnostics are removed from the market and quality assurance of self-testing is ensured.

The goal of the Point-of-Care (POC) Sexually Transmitted Infection (STI) Diagnostics meeting was to review the state-of-the art research and develop recommendations for the use of POC STI diagnostics. Experts from academia, government, non-profit and industry discussed POC diagnostics for STIs such as Chlamydia trachomatis, Human Papillomavirus, Neisseria gonorrhoeae, Trichomonas vaginalis and Treponema pallidum. Key objectives included a review of current and emerging technologies, clinical and public health benefits, POC STI diagnostics in developing countries, regulatory considerations and future areas of development. Key points of the meeting are as follows: (i)while some rapid point-of-care tests are affordable, sensitive, specific, easy to perform, and deliverable to those who need them for select sexually transmitted infections, implementation barriers exist at the device, patient, provider and health system levels; (ii) further investment in research and development of point-of-care tests for sexually transmitted infections is needed and new technologies can be used to improve diagnostic testing, test uptake and treatment; (iii) efficient deployment of self-testing in supervised (i.e., pharmacies, clinics etc.) and/or unsupervised (i.e., home, offices etc.) settings could facilitate more screening and diagnosis that will reduce the burden of sexually transmitted infections; (iv) development of novel diagnostic technologies has outpaced the generation of guidance tools and documents issued by regulatory agencies and (v) questions regarding quality management are emerging including the mechanism by which poor performing diagnostics are removed from the market and quality assurance of self-testing is ensured.

The goal of the STAR Sexually Transmitted Infection Clinical Trial Group (STI CTG) Programmatic meeting on Sexually Transmitted Infections (STIs) in Pregnancy and Reproductive Health in April 2018 was to review the latest research and develop recommendations to improve prevention and management of STIs during pregnancy. Experts from academia, government, nonprofit, and industry discussed the burden of STIs during pregnancy; the impact of STIs on adverse pregnancy and birth outcomes; interventions that work to reduce STIs in pregnancy, and the evidence, policy, and technology needed to improve STI care during pregnancy. Key points of the meeting are as follows: (i) alternative treatments and therapies for use during pregnancy are needed; (ii) further research into the relationship between the vaginal microbiome and STIs during pregnancy should be supported; (iii) more research to determine whether STI tests function equally well in pregnant as nonpregnant women is needed; (iv) development of new lower cost, rapid point-of-care testing assays could allow for expanded STI screening globally; (v) policies should be implemented that create standard screening and treatment practices globally; (vi) federal funding should be increased for STI testing and treatment initiatives supported by the Centers for Disease Control and Prevention (CDC), the Centers of Excellence in STI Treatment, public STD clinics, and the President's Emergency Plan for AIDS Relief (PEPFAR).

The goal of the STAR Sexually Transmitted Infection Clinical Trial Group (STI CTG) Programmatic meeting on STIs in Pregnancy and Reproductive Health in April 2018 was to review the latest research and develop recommendations to improve prevention and management of STIs during pregnancy. Experts from academia, government, non-profit and industry discussed the burden of STIs during pregnancy, the impact of STIs on adverse pregnancy and birth outcomes, interventions that work to reduce STIs in pregnancy, and the evidence, policy, and technology needed to improve STI care during pregnancy. Key points of the meeting are as follows: (i) Alternative treatments and therapies for use during pregnancy are needed; (ii) Further research into the relationship between the vaginal microbiome and STIs during pregnancy should be supported; (iii) More research to determine whether STI tests function equally well in pregnant as non-pregnant women is needed; (iv) Development of new lower cost, rapid point-of-care testing assays could allow for expanded STI screening globally; (v) Policies should be implemented that create standard screening and treatment practices globally; (vi) Federal funding should be increased for STI testing and treatment initiatives supported by the Centers for Disease Control and Prevention (CDC), the Centers of Excellence in STI Treatment, public STD clinics, and the President's Emergency Plan for AIDS Relief (PEPFAR).

Sexual health education in the United States is inconsistent; information and methods vary from one location to another. Education plays a large role in developing safe sex practices, and despite the sexual education efforts, rates of sexually transmitted infections have risen for five consecutive years in the United States. A systematic literature review was conducted to determine the best methods for educating adolescents to promote behaviors to enhance sexual health. Multiple types of interventions have been studied including cognitive behavioral interventions, comprehensive sexual education, parent and teen dyad education, and abstinence only education. Sexual behavior is influenced by a variety of factors including individual environment, education, peer pressure, parental involvement, social situations, government and school policy, and many more. Abstinence education is a beneficial component of comprehensive sexual education, though it lacks the health information that an adolescent person needs. Comprehensive sexual education provides young people with the holistic knowledge, skills, attitudes, and values necessary to help them avoid negative consequences associated with sexuality. Adolescents have the right to medically accurate comprehensive sexual education beginning early in adolescence to build foundation for sexual health prior to the emergence of sexual intimacy. This education should be provided throughout the entirety of their education to solidify understanding and behavior to promote sexual health as adolescents prepare to enter adulthood.

Rates of sexually transmitted infections (STIs) in the U.S. military have historically been higher than those of civilians. One likely contributor to high military STI rates is the high prevalence of behaviors that correspond with transmission of STIs, including binge drinking, lack of condom use, and multiple sexual partnerships. Other potential contributors include the high prevalence of mental health conditions as well as unwanted sexual contact (i.e., sexual assault). In particular, women in the military tend to have higher rates of STIs than both their male colleagues in the military and their female peers in the general population. This dissertation aims to better understand the differences in sexual risk behaviors and risk for STIs between men and women in the military, and between women in the military and women in the general U.S. population. It also aims to describe the factors associated with unwanted sexual contact and mental health among service women in particular.This dissertation utilizes data from the 2008 Department of Defense Survey of Health Related Behaviors among Active Duty Personnel (HRBS) in order to estimate the prevalence of STIs and sexual risk behaviors among military personnel. Chapter 1 identifies and provides background information on women in the military as well as STI risk factors. Chapter 2 compares STI risk behaviors between men and women in the military and describes the factors that are associated with report of an STI and with report of multiple sexual partners, among both genders. Chapter 3 examines the relationships between unwanted sexual contact, sexual risk behaviors, mental health, and substance use among women in the military. Finally, Chapter 4 utilizes data from the 2007-2010 National Health and Nutrition Examination Survey (NHANES) in order to estimate the prevalence of STIs and sexual risk behaviors among women in the general population. These estimates are then compared to those of service women in the 2008 HRBS. Findings from this dissertation expand the current understanding of sexual risk behaviors among women in the military, and have implications for the development of interventions that promote sexual health among female service members in the United States.

Introduction: Data about the increase in human trafficking around the world are worrisome. Although there is legislation on the subject, its scope does not cover all forms and victims of trafficking. Thus, many women, children and men remain in a vulnerable situation. Objective: The purpose of this paper was to elucidate and understand, based on the literature, the relationship between human trafficking, health care systems and the increase in sexually transmitted diseases, and also to point out what is being done to combat the problem. Methods: A documentary research was conducted through an integrative review for the period from 2010 to 2020. The literature search was carried out on the basis of the CAPES journals portal using the keywords "human trafficking", "sexually transmitted diseases", "health care systems" and "education". Results: The results obtained indicated that the absence of access to information, health care and education are intrinsic to the process of illegal immigration and the destination of women and children for exploitation, whether sexual, for organ removal or forced labor, and that situations of violence, absence of health care or education and coercion, among others, are common both for the conditions of trafficking and for the conditions of the increase in sexually transmitted diseases. Conclusion: Given the information obtained, it is concluded that more research must be carried out together with the agencies that investigate and apply current laws to determine what are the most effective measures to combat human trafficking. Furthermore, we highlight the need for information on policies and projects that are able to reach vulnerable populations, with the promotion of education, health care and better living conditions.