The study evaluated participants between July and September 2024, with most—84.8%—using a daily PrEP regimen. Among the 46 participants identified as cases, Ureaplasma urealyticum was the most frequently detected microorganism, accounting for 35 infections, or 76.1% of cases. Chlamydia trachomatis and Neisseria gonorrhoeae each accounted for 19.5% of cases.

These organism-specific percentages describe the distribution of detected infections among the 46 cases, whereas the 24.9% estimate applies to prevalence across all 185 enrolled patients. The researchers conducted univariate and multivariate analyses to identify variables associated with higher infection prevalence and calculated prevalence ratios with 95% confidence intervals. Two reported sexual practices were independently associated with a higher prevalence of infection.

Group sex had a multivariate prevalence ratio of 6.33, with a 95% confidence interval of 2.37 to 18.2 and a p value below 0.001. Fisting was also independently associated with infection, with a prevalence ratio of 2.18, a 95% confidence interval of 1.37 to 3.49 and a p value below 0.001. The confidence intervals for the group-sex estimate were especially broad, indicating substantial uncertainty in the magnitude of that association, although its direction was positive in the reported model.

Clinical management differed by the microorganism detected, according to the study. Participants with N. gonorrhoeae and C. trachomatis received treatment, while cases of U. urealyticum were treated only when symptoms were present. Because asymptomatic infections were the most common presentation in the cohort, symptom-based detection alone would have missed much of the observed prevalence.

The study’s central finding was that the population using PrEP had a substantial burden of infection with all three microorganisms tested, with group sex and fisting independently associated with higher prevalence. The findings should be interpreted as a snapshot from one center rather than a measure of incidence, long-term trends or prevalence across all PrEP users. It therefore cannot establish whether PrEP use itself influenced infection prevalence or whether the observed patterns differ from those in other populations.

The sample size, single-center setting and three-month recruitment period also limit how broadly the results can be generalized. The authors’ conclusion was that regular STI screening and tailored prevention strategies are important in this population, making the study’s high prevalence and frequent asymptomatic infection central concerns for services already reaching people through PrEP programs.

Subject of Research: Cross-sectional assessment of genital STI prevalence and associated factors among 185 PrEP users at one Bogotá center

Article Title: Prevalence and factors associated with genital Chlamydia trachomatis, Neisseria gonorrhoeae and Ureaplasma urealyticum infections among patients in a preexposure prophylaxis (PrEP) program at a single center in Bogotá, Colombia

Article References: Florez, Y. F. M., Bolivar, Z. R., Brochero, C. R. D., Rubio, A. P. G., Rojas, L. T., Coronado, S. O., Dallos, V. V., Guerra, S. A., Diaz, J. S. M., & Beltran, S. L. V. (2026). Prevalence and factors associated with genital Chlamydia trachomatis, Neisseria gonorrhoeae and Ureaplasma urealyticum infections among patients in a preexposure prophylaxis (PrEP) program at a single center in Bogotá, Colombia. BMC Infectious Diseases. https://doi.org/10.1186/s12879-026-13404-5

Image Credits: AI Generated

DOI: 10.1186/s12879-026-13404-5

Keywords: PrEP, sexually transmitted infections, Chlamydia trachomatis, Neisseria gonorrhoeae, Ureaplasma urealyticum, Bogotá, asymptomatic infection, prevalence, group sex, fisting, factors, associated

The interviews were audio-recorded, transcribed and coded using NVivo, with the researchers then identifying emergent themes. The participants supported diagnostic screening during pregnancy for Chlamydia trachomatis and Neisseria gonorrhoeae . One expressed the view that “if there are new technologies, let’s move forward.” Their responses indicate that the proposed screening was viewed as a potentially acceptable way to identify infections that might otherwise be missed, but acceptance was conditional on the health system having the resources needed to deliver it reliably.

One provider said the system “sometimes it collapses—the supplies run off,” while another referred to times when even treatment was unavailable. These accounts suggest that adding diagnostic screening would occur within a service already managing shortages of essential supplies, rather than in an otherwise fully resourced system. Participants said they were already overwhelmed by their workloads, raising questions about whether existing personnel could absorb additional screening responsibilities.

Others described equipment that stopped working after it had been installed, indicating that maintenance was not consistently available. The providers also identified staff training, health education for patients and faster tests as factors that could facilitate implementation. Overall, the findings show strong professional support for antenatal diagnostic STI screening in Botswana, alongside clear warnings that electricity, physical space, stock levels, staffing and equipment maintenance would shape whether the approach could be delivered.

Because the research was limited to interviews with 15 providers in one city, it does not establish the feasibility of screening across Botswana or demonstrate effects on treatment uptake, maternal health or infant health. It instead offers a qualitative assessment of potential implementers’ views ahead of roll-out, identifying the health-system conditions that those providers considered essential.

Subject of Research: Healthcare providers’ perspectives on implementing antenatal diagnostic STI screening in Botswana

Article Title: “Provided power is there, it will be a good initiative”: healthcare provider perspectives on diagnostic screening for curable STIs during pregnancy in Botswana

Article References: Mussa, A., Russell, J. C., Hansman, E., Babalola, C. M., Bame, B., Ndlovu, N., Tamuthiba, L., Klausner, J. D., Morroni, C., & Wynn, A. (2026). “Provided power is there, it will be a good initiative”: healthcare provider perspectives on diagnostic screening for curable STIs during pregnancy in Botswana. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15608-6

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15608-6

Keywords: Botswana, antenatal care, chlamydia, gonorrhoea, diagnostic screening, sexually transmitted infections, healthcare providers, health systems, qualitative research, Provided, power, there

The research team, led by Thanaset Hiranbandit and Wutthichai Jariya, conducted their investigation across three correctional facilities in a province of Thailand. Rather than enrolling every incoming prisoner, the investigators used a case–control design, a method particularly well suited to studying relatively uncommon outcomes such as syphilis infection. Cases were newly admitted prisoners who tested positive for syphilis during routine screening at prison entry, while controls were newly admitted prisoners who tested negative. Both groups were randomly selected from individuals who had undergone syphilis screening between April 1, 2025, and September 30, 2025, a six-month window that captured a representative cross-section of the incoming prison population.

Data collection relied on validated instruments, including case record forms and structured questionnaires, ensuring that the information gathered was consistent and comparable across participants. The researchers then applied multivariable logistic regression, a statistical technique that allows investigators to estimate the independent effect of each risk factor while controlling for the influence of all the others. This approach is essential in observational studies of this kind, because many risk behaviors cluster together; without statistical adjustment, it would be impossible to determine whether an association reflects a genuine independent effect or merely the overlap of correlated exposures. Statistical significance was set at a p-value below 0.05, the conventional threshold in epidemiological research.

The final analysis included 51 cases and 204 controls, a four-to-one ratio that maximizes statistical power in case–control designs. The results were striking. Five factors emerged as independently and significantly associated with syphilis infection among newly admitted prisoners. Homosexual or bisexual orientation carried an adjusted odds ratio of 9.59, meaning that individuals with this orientation had nearly ten times the odds of syphilis infection compared with heterosexual participants after controlling for other variables. A history of sexually transmitted infections proved even more predictive, with an adjusted odds ratio of 38.03, indicating that prior STI diagnosis was one of the strongest markers of current syphilis infection in this population.

Behavioral factors related to sexual practice also weighed heavily in the analysis. Anal intercourse was associated with an adjusted odds ratio of 4.47, while sexual intercourse without condom use showed an adjusted odds ratio of 13.82. These findings align with well-established understanding of syphilis transmission, which occurs through direct contact with syphilitic lesions during vaginal, anal, or oral sex. Condoms, when used consistently and correctly, substantially reduce but do not eliminate transmission risk, and anal intercourse carries particular anatomical vulnerability because the rectal mucosa is more susceptible to microabrasions through which the bacterium can enter the bloodstream.

Perhaps the most dramatic association in the study involved injection drug use, which carried an adjusted odds ratio of 45.60, with a confidence interval ranging from 2.88 to 722.12. While the wide confidence interval reflects the relatively small number of participants reporting this behavior, the magnitude of the association underscores the profound overlap between substance use and infectious disease risk in carceral settings. Injection drug use is a recognized driver of bloodborne and sexually transmitted infections worldwide, both through direct needle sharing and through the social and economic circumstances that often accompany dependence, including transactional sex and inconsistent condom use.

The biological logic behind these associations is worth unpacking. Syphilis progresses in distinct stages, beginning with a painless ulcer known as a chancre at the site of infection, which may go unnoticed, particularly in rectal or vaginal locations. Untreated, the infection can progress to secondary and latent stages and, in a minority of cases, to devastating tertiary disease affecting the heart, brain, and nervous system. Because early syphilis can be asymptomatic, individuals may harbor the infection unknowingly for months or years, making screening the only reliable way to detect and treat it in populations with elevated prevalence. A prior history of any sexually transmitted infection serves as a powerful proxy for sustained exposure to the conditions that facilitate syphilis transmission, which explains why it dominated the statistical analysis.

The study’s conclusions carry direct operational significance for correctional health systems. The researchers argue that prison entry represents a critical opportunity for syphilis screening, a moment when a captive and accessible population can be systematically evaluated and treated. Rather than screening every incoming prisoner uniformly, the authors advocate for risk-based screening strategies that prioritize individuals with high-risk sexual behaviors and substance use. Such targeted approaches could concentrate resources where they are most needed, reducing syphilis transmission both within correctional facilities and, by extension, in the communities to which prisoners eventually return. This is particularly important given that most prisoners serve finite sentences, and untreated infections acquired before or during incarceration can seed further transmission after release.

From a broader public health perspective, the Thai findings resonate with global concerns about syphilis resurgence. Many countries have witnessed rising syphilis rates in recent years, particularly among men who have sex with men and among populations with limited healthcare access. Prisons concentrate many of the structural drivers of infectious disease, including overcrowding, interrupted continuity of care, and the social marginalization that shapes risk behavior long before admission. Treating correctional entry screening as a strategic public health intervention, rather than a routine administrative procedure, could yield substantial returns in infection control. The study’s identification of injection drug use and prior STI history as the two strongest predictors offers correctional systems a practical triage framework: incoming prisoners reporting these factors warrant immediate and thorough evaluation, while those reporting condomless sex or anal intercourse should also be flagged for enhanced screening and preventive counseling.

As syphilis continues to circulate globally, studies like this one demonstrate how rigorous epidemiological methods can translate into actionable prevention strategies for vulnerable populations. The Thai case–control study provides correctional facilities with clear, quantified evidence of which factors matter most, and it reinforces a growing consensus that prisons must be integrated into national infectious disease control efforts rather than treated as separate from them. With targeted screening at admission, prompt treatment of detected infections, and linkage to care upon release, correctional health systems have a genuine opportunity to interrupt syphilis transmission chains that extend far beyond prison walls.

Subject of Research: Syphilis risk factors among newly admitted prisoners in Thailand

Article Title: Risk factors for syphilis among newly admitted prisoners: A case–control study

Article References: Hiranbandit, T., & Jariya, W. (2026). Risk factors for syphilis among newly admitted prisoners: A case–control study. PLOS One, 21(10), e0360956. https://doi.org/10.1371/journal.pone.0360956

Image Credits: AI Generated

DOI: 10.1371/journal.pone.0360956

Keywords: syphilis, prisoners, case-control study, Thailand, sexually transmitted infections, injection drug use, prison health, public health, epidemiology, infectious disease, Risk, factors

Cervical cancer remains a leading gynecological malignancy worldwide, and persistent infection with high-risk HPV is its principal cause. Yet the progression from HPV infection to cancer is not a simple one-way street. Chronic inflammation, disruption of the cervical epithelial barrier, and immune modulation caused by other genital pathogens are thought to facilitate the persistence of high-risk HPV and the development of lesions. The Shaanxi study set out to quantify how frequently HPV co-occurs with Chlamydia trachomatis (CT), Ureaplasma urealyticum (UU), Neisseria gonorrhoeae (NG), Mycoplasma hominis (MH), and Mycoplasma genitalium (MG), and to describe how these patterns vary across age groups.

The methodology was straightforward but large in scale. Vaginal swabs were obtained for nucleic acid testing of CT, UU, NG, MH, and MG DNA, while cervical exfoliated cells were subjected to HPV genotyping. Because the analysis was retrospective and descriptive, using anonymized clinical data, the ethics committee waived the requirement for individual informed consent. Detection rates were then calculated for each pathogen, for mixed infections, and for the co-occurrence of HPV genotypes with bacterial and mycoplasmal pathogens across different age strata.

The headline number is striking: the overall HPV infection rate in this population was 21.46 percent, meaning 6,862 of the 31,975 women tested positive for at least one HPV genotype. Genotype distribution followed a pattern that has important implications for vaccine strategy. HPV16 was the most prevalent genotype, followed by HPV58, HPV53, HPV52, and HPV61. This ranking is notable because HPV58 and HPV52, which are covered by the nonavalent vaccine, appear prominently in this Chinese cohort, while HPV53, a partially covered type, also ranks high. Regional differences in genotype prevalence are a key argument for tailoring vaccination and screening programs to local epidemiology rather than relying solely on data from other populations.

The bacterial and mycoplasmal pathogens showed distinctly different age profiles. Infection rates of Neisseria gonorrhoeae and Chlamydia trachomatis were highest in women aged 20 years or younger and declined steadily with age, a pattern consistent with the epidemiology of these classic sexually transmitted bacteria in younger, sexually active populations. Ureaplasma urealyticum infection peaked in the 21 to 30-year age group, the demographic window that typically encompasses peak sexual activity and childbearing. In contrast, Mycoplasma hominis prevalence increased with age and was highest in women over 50, suggesting that MH may behave less like a classic sexually acquired infection and more like an opportunistic colonizer whose detection rises as the vaginal microbiome and hormonal milieu change with age.

Mixed infections accounted for a minority of STI-positive cases, but their composition was informative. The combination of Ureaplasma urealyticum and Mycoplasma hominis was the most common mixed infection, with a detection rate of 2.24 percent, reflecting the high individual prevalence of these genital mycoplasmas. At the other extreme, triple infection with Chlamydia trachomatis, Ureaplasma urealyticum, and Mycoplasma hominis was rare, occurring at a rate of just 0.10 percent. The rarity of triple co-infection suggests that while dual colonization with mycoplasmas is common, the accumulation of multiple distinct pathogens in one patient is constrained, possibly by competitive interactions within the genital tract microbiome or by differences in transmission routes.

The association between HPV and the other pathogens emerged clearly in the genotype-level analysis. The authors report that in Shaanxi Province, women with positive samples for genital tract pathogens CT, UU, MH, MG, or NG had a higher likelihood of carrying HPV16, HPV52, HPV58, or HPV53. This co-occurrence pattern aligns with the cofactor hypothesis: bacterial and mycoplasmal infections may damage the cervical epithelium, provoke inflammatory responses, or alter local immunity in ways that favor the acquisition, persistence, or reactivation of high-risk HPV. Chlamydia trachomatis in particular has been repeatedly implicated in cervical cancer risk in prior literature because it can establish intracellular infections that trigger chronic inflammation without provoking strong protective immunity.

The technical basis of the study deserves attention because it illustrates how modern molecular diagnostics enable this kind of population-level mapping. HPV genotyping from cervical exfoliated cells identifies not just the presence of the virus but its specific genotype, allowing researchers to distinguish between the roughly dozen high-risk types and the many low-risk types that circulate in the population. Nucleic acid amplification testing of vaginal swabs for CT, NG, UU, MH, and MG DNA provides sensitive detection of organisms that are difficult or impossible to culture, particularly Mycoplasma genitalium, which has emerged in recent years as an important cause of pelvic inflammatory disease and is increasingly recognized as a cofactor in HPV persistence. The combination of these two testing platforms on paired specimens from the same patients is what makes co-infection analysis possible at this scale.

The clinical implications of the findings are layered. For screening programs, the high overall HPV prevalence of 21.46 percent in gynecologic outpatients reinforces the value of HPV-based cervical cancer screening, and the prominence of HPV16, 58, 53, and 52 in this population provides a benchmark for evaluating which genotyping panels and vaccines offer the best local coverage. For prevention, the association between bacterial STIs and high-risk HPV genotypes suggests that treating or preventing CT, NG, and genital mycoplasma infections could form part of a broader cervical cancer prevention strategy, not merely a strategy for controlling the STIs themselves. For clinicians, the age-specific patterns offer practical guidance: younger women warrant vigilance for gonorrhea and chlamydia, while older women may harbor Mycoplasma hominis more frequently than classic STI models would predict.

The study also has limitations inherent to its design. As a retrospective, single-center, descriptive analysis of gynecologic outpatients, it captures a clinical population rather than a random community sample, so the prevalence figures may not generalize to all women in Shaanxi or to asymptomatic populations. The cross-sectional nature means that temporal relationships cannot be established; the data show that HPV and other pathogens co-occur more often than expected, but they cannot demonstrate whether bacterial infections precede and promote HPV persistence, whether HPV infection increases susceptibility to bacterial pathogens, or whether both are driven by shared behavioral risk factors. Nevertheless, the sheer sample size of nearly 32,000 women, the systematic genotyping, and the multi-pathogen testing make this one of the most comprehensive regional datasets on HPV and STI co-infection in China, and the authors suggest that these findings can help in developing more effective intervention, prevention, and treatment strategies for sexually transmitted infections in the region.

Subject of Research: Prevalence of HPV and its co-occurrence with common sexually transmitted infections among women in Shaanxi, China

Article Title: Prevalence of HPV and its association with common sexually transmitted infections among women in Shaanxi, China: a cross-sectional study

Article References: Zheng, Y., Bai, J., Li, J., Liu, S., Chen, L., & Wang, G. (2026). Prevalence of HPV and its association with common sexually transmitted infections among women in Shaanxi, China: a cross-sectional study. BMC Infectious Diseases. https://doi.org/10.1186/s12879-026-14362-8

Image Credits: AI Generated

DOI: 10.1186/s12879-026-14362-8

Keywords: HPV, cervical cancer, sexually transmitted infections, Chlamydia trachomatis, Mycoplasma hominis, Ureaplasma urealyticum, Neisseria gonorrhoeae, HPV16, genotype distribution, co-infection, Shaanxi China, cross-sectional study

HIV self-testing has become a cornerstone strategy for reaching people who face barriers to conventional clinic-based services. In Cameroon, both same-sex practices and sex work are criminalised, and the resulting stigma and fear of disclosure deter many men who have sex with men and female sex workers from visiting health facilities for testing. Self-testing sidesteps that obstacle: participants collect a small blood sample themselves, apply it to a rapid diagnostic strip, and read the result privately. Crucially, the test functions as a triage tool rather than a definitive diagnosis, meaning any reactive result must be confirmed through standard laboratory algorithms before treatment can begin.

The study enrolled 789 participants through 17 community-based organisations, ten serving men who have sex with men and seven serving female sex workers, in the two largest cities. All participants were aged 21 or older and were recruited through voluntary sampling. After counselling, each person performed an unassisted self-test and completed a structured questionnaire covering demographic characteristics, sexual behaviour, and medical history. The researchers then used modified Poisson regression, a statistical approach suited to common outcomes in cross-sectional data, to calculate adjusted prevalence ratios that quantify how each factor relates to the probability of a reactive test while controlling for other variables.

The headline finding is sobering: 23.3 percent of all participants had a reactive self-test, with a 95 percent confidence interval of 20.5 to 26.4 percent. The proportions were nearly identical across the two populations, at 23.2 percent among female sex workers and 23.4 percent among men who have sex with men, suggesting that both groups carry a comparably heavy and previously underappreciated burden of presumed infection. Because reactive self-tests require confirmatory testing, these figures represent an upper signal of infection prevalence rather than confirmed diagnoses, but the sheer scale of reactivity underscores how much undiagnosed infection may be circulating within networks that clinics rarely reach.

Perhaps the most dramatic signal in the data is geographic. Reactivity was more than three times higher in Yaoundé, the capital, than in Douala, the country’s economic hub, at 38.3 percent versus 12.2 percent. After statistical adjustment, living in Douala was associated with a 78 percent lower probability of reactivity among female sex workers and a 69 percent lower probability among men who have sex with men. This concentration in a single city is epidemiologically significant because it implies that tailored interventions, from intensified testing campaigns to partner services and pre-exposure prophylaxis roll-out, could achieve disproportionate impact if prioritised in Yaoundé rather than spread evenly across both metropolises.

Education emerged as a powerful and consistent protective correlate, particularly among women. Relative to female sex workers with no formal schooling, those with primary education had a 72 percent lower adjusted probability of a reactive test, those with secondary education a 66 percent lower probability, and those with higher education a 56 percent lower probability. A similar gradient appeared among men who have sex with men, where secondary education was associated with a 63 percent reduction. The pattern likely reflects the ways literacy and schooling shape access to health information, negotiating power in commercial sex, economic alternatives, and familiarity with preventive technologies, though the cross-sectional design cannot disentangle the underlying mechanisms.

Behavioural and clinical history markers also carried important signals. Among female sex workers, a history of symptoms suggestive of sexually transmitted infections nearly tripled the adjusted probability of reactivity, tripling the odds relative to women without such a history. This finding aligns with well-established virology: genital ulceration and inflammation amplify both acquisition and transmission of HIV by recruiting activated CD4-bearing target cells to mucosal surfaces and disrupting epithelial barriers. It also suggests that syndromic STI screening, when integrated with self-testing programmes, could serve as an efficient triage layer identifying women at highest risk.

Among men who have sex with men, each additional sexual partner over the preceding six months was associated with a modest but statistically reliable 3 percent increase in the probability of reactivity, a dose-response relationship consistent with cumulative exposure risk. Interestingly, alcohol consumption was associated with a 35 percent lower adjusted probability of reactivity in this group. The authors caution that such counterintuitive associations in cross-sectional data may reflect residual confounding or complex social patterns rather than any protective biological effect of alcohol itself.

The methodological strength of the study lies in its scale, its reliance on trained community-based organisations to recruit criminalised populations that formal health systems typically miss, and its use of regression techniques appropriate for high-prevalence outcomes. The ethical scaffolding was equally careful: the protocol received approval from Cameroon’s National Ethics Committee for Human Health Research and administrative authorisation from the Ministry of Health, and every participant provided written informed consent, with data handled confidentially given the acute legal risks these populations face.

The implications for public health strategy are direct. The authors conclude that reactive self-tests were frequent among both populations, with a marked concentration in Yaoundé and among unschooled female sex workers, and they argue that geographically prioritised, differentiated prevention, combined with STI screening and robust linkage to confirmatory testing, would meaningfully reduce this burden. As Cameroon and its regional neighbours work toward UNAIDS testing and treatment targets, the study demonstrates that self-testing is not merely a convenience but a surveillance instrument, capable of mapping where infection concentrates and guiding resources to the people and places that need them most.

Subject of Research: Factors associated with reactive HIV self-test results among female sex workers and men who have sex with men in Cameroon

Article Title: Factors associated with a reactive HIV blood self-test result among female sex workers and men who have sex with men in Yaoundé and Douala, Cameroon: a cross-sectional study

Article References: Ndié, J., Noah, J.-P. Y. A., Ndongo, F. A., Dongmo, R. K., Yongwa, O., Tchikangni, G., Palisson, T. A. N., Ketchaji, A., Yepndo, C. D., Ndindjock, C. B., IV, Tabala, F. N., Bonyohe, M., Moulioum, F., Nzaddi, A. R. D., Monteh, C. T., Mboussam, P. H., Nguemkam, G., Seukam, B., Anaba, E. D. M., … Bissek, A. C. Z.-K. (2026). Factors associated with a reactive HIV blood self-test result among female sex workers and men who have sex with men in Yaoundé and Douala, Cameroon: a cross-sectional study. BMC Infectious Diseases. https://doi.org/10.1186/s12879-026-14598-4

Image Credits: AI Generated

DOI: 10.1186/s12879-026-14598-4

Keywords: HIV self-testing, HIV, Cameroon, men who have sex with men, female sex workers, key populations, prevalence, Yaoundé, Douala, sexually transmitted infections, public health, cross-sectional study

The research team, led by investigators at the Dermatology Hospital of Southern Medical University in Guangzhou, recruited 984 participants with the help of community-based organizations in Shenzhen, Foshan, Jiangmen and Yunfu. Each respondent answered questions covering sociodemographic characteristics, sexual behavior, and their attitudes toward a hypothetical online self-sampling service in which they would collect their own specimens and receive results remotely. The headline figure was stark: just 30.1 percent said they would be willing to use such a service for gonorrhea and chlamydia screening. In a population that bears a disproportionate share of the global STI burden, and where stigma and clinic access often suppress testing rates, that level of hesitancy represents a substantial missed opportunity.

The technical logic behind self-sampling is straightforward. Gonorrhea and chlamydia are caused by bacteria, Neisseria gonorrhoeae and Chlamydia trachomatis, that infect mucosal surfaces and are frequently asymptomatic, meaning that people who feel well can still transmit the infections unknowingly. Diagnosis depends on nucleic acid amplification tests, which are highly sensitive and can be run on urine specimens or swabs collected from the throat, rectum or urethra. Because these specimens can be collected without a clinician, self-sampling decouples testing from the clinic visit itself. A user orders a kit online, collects the sample at home, mails it to a laboratory, and receives results through a phone or web portal. In theory, this removes the two biggest deterrents to screening: the time and cost of travel, and the fear of being seen in a sexual health clinic.

That theory has performed reasonably well in countries such as the United Kingdom, the United States and Australia, where internet-based testing services have grown steadily and studies have repeatedly shown high acceptability among men who have sex with men. China presents a different landscape. Sexual health services are concentrated in dermatology and venereology hospitals, confidentiality concerns weigh heavily given persistent stigma toward homosexuality, and there is no established national infrastructure for mailing diagnostic specimens. The Guangdong study is among the first to quantify how these conditions shape willingness to adopt self-sampling, and the answer, at 30 percent, is considerably lower than the figures of 60 to 90 percent often reported from Western settings.

Why did so many respondents decline? The researchers asked directly, and the answers clustered around three concerns. Among those unwilling to use online self-sampling, 70.5 percent cited doubts about the accuracy and reliability of the test, 63.8 percent worried about the privacy of their data, and 60.5 percent pointed to cost. Each of these concerns is technically addressable, which is precisely what makes the findings useful. Accuracy worries can be countered with transparent information about the performance of nucleic acid amplification testing on self-collected specimens, which in clinical validation studies performs comparably to clinician-collected samples. Privacy concerns can be met with encrypted result delivery, discreet packaging and clear data governance policies. Cost can be subsidized or folded into public health programs, since treating an asymptomatic infection is far cheaper than managing its complications.

The statistical analysis added a second layer of insight by identifying who was more and less willing to embrace the technology. Using multivariable logistic regression, the team found that men who had previously used HIV pre-exposure prophylaxis, or PrEP, were markedly more open to self-sampling, with an adjusted odds ratio of 3.46, meaning their odds of willingness were roughly three and a half times those of men without PrEP experience. This makes intuitive sense. PrEP users are already engaged with a sexual health service, accustomed to regular screening, and familiar with the idea of preventive medicine delivered proactively rather than reactively. Their experience appears to build a kind of health system literacy that transfers to new testing modalities.

At the opposite end of the spectrum, two behavioral factors predicted lower acceptability. Men who reported more frequent sexual activity were less willing to use online self-sampling, as were men who reported engaging in commercial sex. This pattern is the most concerning finding in the study, because it inverts the public health ideal. The people at highest risk of acquiring and transmitting gonorrhea and chlamydia, and who therefore have the greatest need for frequent screening, are precisely the ones most reluctant to use a tool designed to make screening easier. The authors suggest several possible explanations: highly sexually active men may prefer the immediacy and reassurance of in-person clinical care, may already have established testing routines they trust, or may doubt that a mailed kit can keep pace with their testing needs. Whatever the mechanism, the implication is that a self-sampling program rolled out without attention to this group could widen rather than narrow existing screening gaps.

The cross-sectional design of the study imposes some limits on interpretation. Attitudes were measured at a single point in time, willingness was hypothetical rather than observed, and the sample was recruited through community-based organizations in one province, which may not represent men who are less connected to community networks. The authors are careful to frame their conclusions accordingly. Still, the consistency of the three dominant concerns, accuracy, privacy and cost, across a sample of nearly a thousand respondents gives the findings considerable weight, and the association with PrEP use provides a concrete lever for intervention.

That lever points toward a broader lesson about digital health adoption. Self-sampling is often described as a technology problem, as if mailing kits were the hard part. The Guangdong data suggest otherwise: the hard part is trust. A diagnostic service that asks people to handle their own specimens, share sensitive information online, and wait for results without a clinician in the room asks for a level of confidence in an unfamiliar system that cannot be assumed. The authors argue that improving health awareness, strengthening engagement with existing sexual health services, and enhancing user confidence in online platforms are the keys to raising acceptability. In practice, this could mean introducing self-sampling to PrEP cohorts first, where trust is already established, and using peer educators from community-based organizations to vouch for the service’s accuracy and discretion.

The stakes extend well beyond Guangdong. Gonorrhea and chlamydia continue to climb globally, drug-resistant gonorrhea is an escalating threat, and the World Health Organization has emphasized expanding testing as a cornerstone of control. If self-sampling is to fulfill its promise as a scalable screening strategy, it will need to work not only in London and San Francisco but in the large cities of Asia and Africa where stigma is intense and clinical capacity is stretched thin. The Chinese study is a reminder that the same kit can be a welcome convenience in one context and a source of suspicion in another. Closing that gap will require the unglamorous work of validation studies, transparent communication and community partnership, done before the technology is scaled, so that the people with the most to gain from discreet, accurate home testing are not the last to trust it.

Subject of Research: Acceptability of online self-sampling for gonorrhea and chlamydia testing among men who have sex with men in Southern China

Article Title: Acceptability of online self-sampling for gonorrhea and chlamydia among men who have sex with men in Southern China: a cross-sectional study

Article References: Zhang, J., Liang, P., Zhao, P., Huang, S., & Wang, C. (2026). Acceptability of online self-sampling for gonorrhea and chlamydia among men who have sex with men in Southern China: a cross-sectional study. BMC Public Health. https://doi.org/10.1186/s12889-026-29791-y

Image Credits: AI Generated

DOI: 10.1186/s12889-026-29791-y

Keywords: gonorrhea, chlamydia, online self-sampling, men who have sex with men, sexually transmitted infections, STI screening, China, public health, PrEP, cross-sectional study, test acceptability, Guangdong

The study, led by Masoumeh Beig and co-first author Sara Hajilari, with Khalil Azizian and Ebrahim Kouhsari as equally contributing corresponding authors, followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and included studies published up to 8 February 2026. The team used R software to compute pooled prevalence estimates with 95 percent confidence intervals, quantifying heterogeneity with Cochran’s Q and tau-squared statistics. Their focus was the minimum inhibitory concentration, or MIC, the lowest concentration of an antibiotic that prevents visible bacterial growth. When MICs rise above established breakpoints, an isolate is classified as non-susceptible, signaling that standard dosing may fail at the site of infection.

Macrolides work by binding to the 50S subunit of the bacterial ribosome, blocking the exit tunnel through which newly synthesized proteins must pass. Erythromycin, the prototype 14-membered macrolide, azithromycin, a 15-membered derivative prized for its tissue penetration, and clarithromycin and roxithromycin, both 14-membered agents, all share this target. Josamycin, a 16-membered macrolide, binds somewhat differently and has retained activity where its smaller relatives have faltered. Resistance in mycoplasmas typically arises through point mutations in the 23S ribosomal RNA gene, particularly in domain V, which alter the drug-binding pocket. Because these organisms lack a cell wall, beta-lactam antibiotics such as penicillins are useless against them, leaving macrolides, tetracyclines, and fluoroquinolones as the principal therapeutic options.

The numbers assembled by the Iranian team paint a genus-specific picture. For Ureaplasma species, pooled non-susceptibility was 13.3 percent for erythromycin, 15.3 percent for roxithromycin, 9.9 percent for clarithromycin, 6.4 percent for azithromycin, and just 2.6 percent for josamycin. For Mycoplasma species, the corresponding estimates were dramatically higher: 63.4 percent for roxithromycin, 84.5 percent for clarithromycin, 78.8 percent for azithromycin, and 7.7 percent for josamycin. Erythromycin non-susceptibility in Mycoplasma reached 75.7 percent. The authors caution, however, that Mycoplasma hominis is intrinsically resistant to 14- and 15-membered macrolides, meaning pooled estimates for erythromycin, azithromycin, clarithromycin, and roxithromycin in that species reflect biology as much as acquired resistance. For M. hominis, the clinically meaningful figure is josamycin, where pooled non-susceptibility was only 6.1 percent.

Geography emerged as a significant modifier for four of the five drugs examined. The meta-analysis detected significant geographic variation in non-susceptibility for erythromycin, clarithromycin, azithromycin, and josamycin, all with P values below 0.05, while roxithromycin showed no significant regional difference, with a P value of 0.283. This pattern suggests that local prescribing habits, population structure, and transmission dynamics shape resistance profiles unevenly across the globe. In regions where azithromycin has been deployed widely, including mass drug administration campaigns and routine sexually transmitted infection management, elevated MICs appear more frequently, whereas areas with lighter macrolide pressure retain comparatively vulnerable bacterial populations.

Perhaps the most reassuring finding is what the analysis did not show. Across the entire dataset, no significant temporal trends were observed for any of the evaluated macrolides: the P value was 0.994 for erythromycin, 0.165 for roxithromycin, 0.615 for clarithromycin, 0.326 for azithromycin, and 0.467 for josamycin. In other words, resistance levels appear to have remained roughly stable over the period covered by the included studies rather than climbing year over year. The authors interpret this cautiously, noting that stability is not the same as safety. A plateau at 75 percent erythromycin non-susceptibility in Mycoplasma offers little therapeutic comfort, and the absence of a trend may simply reflect the coarse resolution of pooled cross-sectional data.

The clinical implications are direct. Urogenital mycoplasmas and ureaplasmas are associated with urethritis, cervicitis, pelvic inflammatory disease, adverse pregnancy outcomes, and complications in neonates, and they are among the most difficult sexually associated bacteria to culture, often requiring nucleic acid amplification tests for detection and specialized broth-based systems for susceptibility testing. When macrolides fail, clinicians typically turn to tetracyclines such as doxycycline or to fluoroquinolones, but resistance to those classes has also been documented in these organisms, narrowing the armamentarium further. The new pooled estimates give guideline committees a quantitative baseline for deciding when macrolide therapy remains defensible and when an alternative should be the default.

Josamycin stands out as the quiet winner of the analysis. With pooled non-susceptibility of 2.6 percent in Ureaplasma and 7.7 percent in Mycoplasma overall, and 6.1 percent in M. hominis specifically, the 16-membered macrolide demonstrated consistently low MICs across the included studies. The authors suggest it may represent a promising alternative, particularly where 14- and 15-membered agents have lost efficacy. Josamycin is not licensed in every country, and its availability varies widely, but the data provide an evidence-based argument for reconsidering its place in treatment algorithms for urogenital infections, especially in regions where azithromycin MICs have drifted upward.

For erythromycin and azithromycin, the message is restraint. The combination of high erythromycin resistance and moderate elevation of azithromycin MICs, the authors conclude, warrants cautious use of these agents, reserving them for cases where susceptibility has been confirmed or where no better option exists. Empirical macrolide monotherapy for suspected Mycoplasma-driven disease, once a reflexive choice, now carries a substantial probability of failure in many settings. The researchers emphasize that ongoing global surveillance remains essential to support evidence-based treatment guidelines, since resistance in organisms with rapid replication and frequent horizontal gene exchange can shift within years, and the fragmented geographic data they aggregated highlight how little standardized susceptibility testing exists in much of the world.

The study, published open access on 8 October 2026 and citable under DOI 10.1186/s12879-026-14585-9, was approved by the Ethics Committee of Golestan University of Medical Sciences and conducted in accordance with the Declaration of Helsinki. The authors declared no competing interests and no external funding, and they state that a language-model tool was used solely to polish the manuscript’s prose, not to collect or analyze data. As antimicrobial resistance continues to erode the utility of first-line antibiotics across the infectious disease spectrum, this meta-analysis offers both a warning and a waypoint: the macrolide era for urogenital Mycoplasma is largely over in much of the world, but for Ureaplasma, and for josamycin across both genera, carefully stewarded options remain.

Subject of Research: Global macrolide antibiotic resistance in urogenital Ureaplasma and Mycoplasma species

Article Title: Global macrolide non-susceptibility in urogenital Ureaplasma and Mycoplasma: a systematic review and meta-analysis

Article References: Beig, M., Azizian, K., Hajilari, S., Shakourzadeh, M. Z., & Kouhsari, E. (2026). Global macrolide non-susceptibility in urogenital Ureaplasma and Mycoplasma: a systematic review and meta-analysis. BMC Infectious Diseases. https://doi.org/10.1186/s12879-026-14585-9

Image Credits: AI Generated

DOI: 10.1186/s12879-026-14585-9

Keywords: antimicrobial resistance, macrolides, Ureaplasma, Mycoplasma, erythromycin, azithromycin, josamycin, minimum inhibitory concentration, systematic review, meta-analysis, sexually transmitted infections, BMC Infectious Diseases

The research team, led by Ines Heinen and Nina Matthes, who contributed equally to the work, brought together experts from two departments that rarely share a classroom: dermatology and venereology on one side, and medical psychology on the other. Their workshop for medical students combined the hard clinical science of syphilis with the soft skills of stigma-sensitive communication. Thirty-three students participated in the session, and thirty-one of them completed the voluntary surveys that formed the basis of the analysis. The design was a pre-post evaluation, meaning each student rated their own knowledge and confidence immediately before and immediately after the workshop using standardized questionnaires, allowing the researchers to measure change at the level of the individual learner.

On the dermatological side, the curriculum covered the epidemiology of syphilis, its clinical presentation across its stages, diagnostic procedures, and current treatment standards. This technical grounding matters because syphilis is famously called the great imitator: its symptoms can mimic everything from a harmless rash to neurological disease, and a clinician who does not think to ask the right questions may never order the right test. The students also practiced a practical procedural skill that is easy to overlook in lecture-based teaching, namely the administration of an intramuscular injection, which they rehearsed using a model. Because benzathine penicillin, the mainstay of syphilis therapy, is delivered intramuscularly, this hands-on component connected the pharmacology of treatment directly to a skill students will need at the bedside.

The psychological half of the workshop addressed what many educators consider the true bottleneck in STI care: stigma. Students explored how stigmatization affects patients with sexually transmitted infections, engaged in structured self-reflection about their own attitudes and discomforts, and learned the concrete content of a professional sexual history. The centerpiece of this component was a series of role-playing exercises based on fictional patient cases, in which students practiced taking a medical history in a simulated clinical encounter. This format deliberately forced learners to confront the awkwardness of asking intimate questions in a safe environment, where mistakes carry no consequences for real patients but generate immediate feedback and reflection.

The results were striking in their breadth. After the workshop, students reported a significant increase in their self-assessed knowledge of syphilis epidemiology, clinical symptoms, diagnostic procedures, and treatment. Their confidence in administering an intramuscular injection also rose significantly. Just as importantly, the measures targeting communication shifted in the right direction: students reported greater knowledge of what a sexual history should contain, more confidence while actually taking one, and a better understanding of the relevance of stigmatization. These gains were recorded on standardized self-assessment scales, the workhorse of medical education research, which capture a learner’s subjective sense of preparedness, a known predictor of whether a skill will actually be used in practice.

Equally telling were the scores that fell. Students’ self-reported embarrassment while taking a sexual history decreased significantly after the workshop, and so did their concerns that patients might feel stigmatized during such conversations. This dual movement, confidence up and anxiety down, is precisely the pattern educators hope to see, because embarrassment is one of the most commonly cited barriers that keeps young doctors from asking about sexual behavior at all. When a clinician hesitates to ask, the question often goes unasked, the risk factor goes unrecorded, and the infection goes undiagnosed. Reducing that hesitation at the training stage could therefore ripple forward into better case-finding years later.

The study did not rely solely on self-report. After the workshop, students also completed an objective test covering the treatment of syphilis and sexual history taking, providing a check on whether the subjective confidence gains were anchored in actual knowledge. The authors present this combination of subjective and objective measures as a methodological strength, since self-assessed competence can inflate independently of real ability. While the pre-post design without a control group means the researchers cannot rule out effects of simply spending a day in focused study, the consistency of the improvements across knowledge, communication, and attitudinal domains lends credibility to the intervention itself.

Perhaps the most persuasive endorsement came from the participants themselves. Most students stated that the workshop should be integrated into the standard medical curriculum, a notable verdict in a crowded course of study where every additional hour competes with anatomy, pathology, and clinical rotations. The enthusiasm suggests that students perceive the gap the workshop fills, and that they experience the combination of clinical content and communication training as directly relevant to the doctors they are becoming. In an era when curricula are increasingly packed with technical content, a format that students actively want more of is a valuable currency for curriculum reformers.

The broader implications reach beyond syphilis. Sexually transmitted infections remain among the most common infectious diseases worldwide, and public health agencies have documented rising case numbers for years, including congenital syphilis, which can cause severe harm to newborns. Every missed diagnosis begins with a conversation that never happened, and every conversation that never happened often traces back to a clinician who was never trained to have it. The Hamburg team argues that teaching dermatological and psychological content together may prepare students for patient-centered sexual healthcare better than traditional discipline-specific education, in which the biology of infection and the human dynamics of disclosure are taught in separate silos, if the latter is taught at all.

The study, conducted with ethics approval from the local Psychological Ethics Committee at University Medical Center Hamburg-Eppendorf and published open access, is a small one, and the authors are careful about what it can and cannot show. Thirty-one students, one workshop, and self-assessed outcomes do not settle the question of long-term behavior change in clinical practice. But the findings offer a concrete, replicable template: pair the venereology with the psychology, add role-play and procedural practice, and measure what happens. If subsequent studies with larger cohorts and follow-up assessments confirm these results, medical schools may gain a proven answer to a question that has lingered for decades, namely how to turn students who dread asking about sex into clinicians who can do it competently, confidently, and without judgment.

Subject of Research: Medical education interventions for sexually transmitted infection training

Article Title: Enhancing medical students’ self-assessed competence in sexually transmitted infections: outcomes of an interdisciplinary workshop on syphilis, stigmatization and sexual history-taking

Article References: Heinen, I., Matthes, N., Booken, N., Härter, M., Schneider, S. W., & Abeck, F. (2026). Enhancing medical students’ self-assessed competence in sexually transmitted infections: outcomes of an interdisciplinary workshop on syphilis, stigmatization and sexual history-taking. BMC Medical Education. https://doi.org/10.1186/s12909-026-10507-0

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10507-0

Keywords: syphilis, sexually transmitted infections, medical education, medical students, sexual history-taking, stigmatization, dermatology, medical psychology, workshop, communication skills, Hamburg-Eppendorf, curriculum

The research team, led by Mary Aku Ogum and including Thomas Hormenu and Edward Wilson Ansah, set out to quantify both the prevalence of risky sexual behaviours and the social and demographic factors that predict them among unmarried, regular undergraduate students. Their motivation was straightforward: university students in Ghana, as in many countries, represent a large, mobile, and socially transitional population. They are typically living away from parental oversight for the first time, navigating new peer environments, and encountering the freedoms and pressures of early adulthood. Studies from universities in multiple countries have shown that this group is more likely to be sexually active and to engage in behaviours with negative consequences for health and academic achievement, making them a priority population for prevention efforts.

Methodologically, the study was ambitious in scale. The researchers conducted a quantitative cross-sectional survey using a multistage sampling procedure to recruit 10,896 undergraduate students, split evenly between 5,448 males and 5,448 females. Data were collected with an adapted questionnaire drawn from the Core Expanded Questions of the Global School-based Student Health Survey, a standardized instrument designed to allow comparison across settings and countries. The team then analyzed responses using frequencies, percentages, and binary logistic regression, a statistical technique that estimates how strongly each candidate factor predicts a binary outcome, in this case whether a student engaged in risky sexual behaviour. The study received ethical approval from the Institutional Review Board of the University of Cape Coast, and every participating student signed an informed consent form before taking part.

The headline numbers are sobering. Of the 10,896 students surveyed, 38.3 percent, or 4,176 individuals, reported being sexually active. Within that sexually active group, the researchers documented a cluster of behaviours that epidemiologists consider high-risk. The most common was condom non-use: 63.7 percent of sexually active students, amounting to 2,661 individuals, reported not using condoms. Nearly half, 45.7 percent or 1,654 students, reported having multiple sexual partners, a pattern that multiplies the number of potential transmission pathways for HIV and other sexually transmitted infections. A substantial 37.2 percent, or 1,552 students, reported using alcohol or drugs in connection with sex, a behaviour known to impair judgment, reduce condom negotiation, and increase the likelihood of unprotected encounters.

Two further findings rounded out the risk profile. Some 16.3 percent of sexually active students, or 682 individuals, reported engaging in anal sex, a practice associated with a heightened biological risk of HIV transmission compared with vaginal intercourse because of the fragility of rectal mucosal tissue. Meanwhile, 12.4 percent, or 520 students, reported an early onset of sexual activity, defined in the study context as first intercourse at a young age. Taken together, these behaviours produced an overall magnitude of risky sexual behaviour of 78.8 percent among sexually active students, meaning 3,291 of the 4,176 sexually experienced respondents reported at least one behaviour placing them at elevated risk. The authors frame this figure as a clear signal that the burden of sexual risk in this population is not confined to a small minority but is a mainstream campus health issue.

Beyond the raw prevalence figures, the study’s regression analysis identified which characteristics predicted risky behaviour. Chronological age emerged as a significant factor, with risk profiles shifting as students moved through their undergraduate years. Religious affiliation also played a measurable role, consistent with a body of literature suggesting that religious identity can shape sexual norms, expectations, and disclosure behaviour among young adults in Ghana. Perhaps most tellingly, the age at first sexual intercourse and the circumstances influencing that first experience predicted later risk-taking, suggesting that early sexual trajectories cast a long shadow over subsequent behaviour during university years.

Living arrangements and family communication completed the predictive picture. The researchers found that who students lived with during their studies influenced their likelihood of engaging in risky behaviour, an intuitive but important result given that residence type shapes supervision, privacy, and peer exposure. Equally significant was the difficulty students reported in discussing sexual issues with their parents. Where parent-child communication about sexuality was strained or absent, students were more likely to engage in risky practices. This finding resonates with a broader public health consensus that open, accurate family communication about sexuality acts as a protective factor, delaying sexual debut and increasing protective behaviours such as condom use when sexual activity does begin.

The implications for intervention are spelled out clearly in the study’s conclusion. The authors argue that public health programmes should incorporate campus-based counselling and peer education, with a particular focus on students who are already sexually experienced. Peer education, in which trained students deliver health information and norm-change messages within their own social networks, has a long track record in HIV prevention because it leverages trust and shared language in ways that top-down messaging often cannot. Counselling services, meanwhile, can address the individual-level drivers of risk, including alcohol use, relationship pressures, and gaps in knowledge about transmission and contraception. The finding that parental communication difficulties predict risk suggests that interventions may also need to reach beyond the campus gates, supporting families in sustaining conversations about sexual health into late adolescence and early adulthood.

The study also situates itself within global health frameworks. The rising prevalence of HIV/AIDS and unintended pregnancies is widely attributed to exactly the behaviours this survey measured: non-use of condoms, alcohol intake before sex, multiple sexual partnerships, early sexual debut, and survival sex. Because university students represent an educated cohort whose health behaviours today shape the health of families and communities tomorrow, the authors argue that securing their well-being is crucial for the overall health and development of society, in line with the United Nations Sustainable Development Goals. In Ghana, where young people constitute a large share of the population, the stakes of translating these findings into policy are considerable.

Caveats are worth noting, as with any cross-sectional survey. The design captures behaviour at a single point in time and cannot establish cause and effect; it shows that age, religious affiliation, early sexual debut, living situation, and parental communication are associated with risky behaviour, not that one directly produces the other. Self-reported data on sexual behaviour are also vulnerable to social desirability bias, particularly on sensitive topics, although the large sample size and use of a validated international instrument strengthen confidence in the overall patterns. The study was conducted at a single public university, so generalization to other institutions or countries should be made cautiously. The authors received no specific funding for the research and declare no competing interests. Even with these limitations, the sheer scale of the survey, nearly eleven thousand respondents balanced by sex, makes it one of the most detailed portraits to date of sexual risk among Ghanaian undergraduates, and its central message is hard to ignore: condom use, partner reduction, and substance-related risk remain stubbornly high on campus, and the levers of change run through families, faith communities, and student peer networks as much as through clinics and lecture halls.

Subject of Research: Prevalence and predictors of risky sexual behaviours among undergraduate university students in Ghana

Article Title: Prevalence and factors influencing risky sexual behaviours among university students in Ghana

Article References: Ogum, M. A., Mintah, J. K., Ogum, P. N., Hormenu, T., & Ansah, E. W. (2026). Prevalence and factors influencing risky sexual behaviours among university students in Ghana. BMC Public Health. https://doi.org/10.1186/s12889-026-29715-w

Image Credits: AI Generated

DOI: 10.1186/s12889-026-29715-w

Keywords: risky sexual behaviour, university students, Ghana, HIV/AIDS, condom non-use, multiple sexual partners, sexually transmitted infections, unintended pregnancy, cross-sectional survey, peer education, parental communication, public health

The methodological core of the study is what statisticians call multilevel latent class analysis, or MLCA. Traditional variable-centered approaches ask how single factors, such as partner age or substance use, relate to outcomes like condomless sex. Person-centered mixture models instead search for hidden subgroups within a population, defined by co-occurring patterns across many indicator variables simultaneously. The multilevel extension is crucial for sexual network data, because each participant, or ego, nominated multiple partners, or alters, creating a nested structure in which partnerships are clustered within individuals. Ignoring this nesting can distort estimates and obscure the fact that a single man may move fluidly between very different kinds of sexual encounters. The researchers modeled both levels at once: lower-level classes describing types of individual partnerships, and upper-level groups describing the overall composition of each man’s sexual network.

Data collection relied on an egocentric social network approach implemented through the Network Canvas platform, with participants recruited through a modified respondent-driven sampling strategy led by a community-based sexual health clinic. Each participant named the people with whom he had anal or vaginal sex in the past six months and reported detailed characteristics of each relationship: whether the partner was a main or casual partner, whether condoms were always used, which sexual positions involved condomless contact, whether the partner disclosed an HIV status, and how emotionally close the respondent felt to that person. Covariates included alcohol and other substance use when the dyad met to have sex, the respondent’s current PrEP use, country of nativity, and total sexual network size. Participants averaged 34.5 years of age, 88 percent were born outside the United States, and 57 percent reported currently using PrEP.

The analysis converged on a three-class, two-group solution. At the partnership level, three distinct sexual partner typologies emerged. The first, accounting for 37 percent of partnership contexts, was an elevated-risk context with a main sexual partner: seroconcordant dyads in which both partners disclosed being HIV-negative, marked by high emotional closeness, main partnership status, and a high probability of versatile condomless sex. The second class, 35 percent of contexts, was labeled selective and close casual partnerships, in which men reported condomless sex in only one position, such as insertive or receptive anal sex exclusively, alongside moderate emotional closeness. The third class, 27 percent, comprised low-exposure casual partnerships with little condomless sex, variable closeness, and a high probability that the partner’s HIV status was simply unknown. At the network level, two groups emerged: one dominated by casual partnerships, accounting for 54 percent of sexual partnerships, and one centered on a main sexual partner, accounting for 46 percent.

Perhaps the most striking finding concerns what these typologies reveal about trust. Consistent with the dyadic framework for HIV prevention developed by Karney and colleagues, the study found that risk behaviors clustered within emotionally close relationships rather than anonymous encounters. Condomless sex was most prevalent in main partnerships, where intimacy and trust may paradoxically substitute for barrier protection, and lowest in casual partnerships where serostatus was undisclosed. Partners in the low-exposure casual class frequently had unknown HIV seroconcordance, which may itself have prompted greater caution. Meanwhile, classes with higher perceived closeness involved partners who disclosed being HIV-negative, more versatile condomless practices, and more substance use when the dyad met for sex. This inversion of the intuitive risk hierarchy, in which the most trusted relationships carry the most condomless exposure, has been documented in prior research among Latino men and now receives a rigorous person-centered confirmation.

The multinomial logistic regression results sharpened the picture of who occupies which network context. Respondents currently using PrEP had 1.60 times greater odds of belonging to the group whose networks were composed primarily of main partnerships with elevated risk contexts, relative to the casual-network group. Latino men born outside the United States had 43 percent lower odds of having elevated-risk main-partner contexts compared to those born in the country. Network size mattered as well: every additional partner reduced the odds of belonging to the main-partnership group by 29 percent. Substance use when the dyad met to have sex was independently associated with roughly threefold higher odds of condomless sex in a random intercept model, and within the multilevel model, substance use sharply reduced the odds of membership in low-exposure casual classes relative to elevated-risk main-partner contexts.

These associations carry important caveats that the authors themselves emphasize. The data are cross-sectional, so the temporal direction of the PrEP finding remains unresolved: men may adopt PrEP because they are in higher-exposure partnerships, or their partnerships may take a particular shape because PrEP has reduced their perceived need for condoms. PrEP, when taken as directed, is extremely effective against HIV acquisition but does not prevent other sexually transmitted infections, and systematic reviews have documented elevated STI diagnosis rates among PrEP users, potentially reflecting both reduced condom use and increased testing frequency. The study also captured only the daily-pill form of PrEP, predating wider availability of long-acting injectable options, and the reporting window overlapped with the COVID-19 pandemic, when social distancing measures may have altered sexual network patterns in ways that differ from pre- and post-pandemic behavior.

Cultural and structural context adds further layers of complexity. Miami-Dade is a distinctive setting in which 69 percent of residents identify as Latino, more than half were born outside the United States, and 68 percent of adults speak Spanish. Approximately one-third of foreign-born participants had lived in the country for a year or less, a period that may be insufficient to establish close, serious partnerships and during which navigating new social and sexual environments can shape partner selection, communication, and trust. Prior research suggests that cultural values such as collectivism and familismo can support condom use, while acculturative processes, language barriers between partners, and hypermasculine norms may complicate safer-sex negotiation. The authors argue that future work should move beyond a simple US-born versus foreign-born dichotomy and apply syndemic theory or intersectional perspectives to capture how immigration experiences, stigma, substance use, and cultural values interact to shape vulnerability.

The practical implications point toward interventions designed at the level of the dyad and the network rather than the isolated individual. Couples-based programs can facilitate conversations about relationship agreements, the increasing openness of sexual partnerships, and the role of substances in sexual decision-making, while network interventions that engage opinion leaders can diffuse prevention messaging through the social structures the study has now characterized in detail. The researchers also propose expanding clinic screening tools to include brief egocentric sexual network modules, allowing providers to tailor recommendations, whether PrEP, doxycycline post-exposure prophylaxis, routine testing, or negotiated safety agreements, to the specific partnership typologies a patient actually experiences. By replacing blunt risk categories with empirically derived partnership profiles, the study offers a template for precision HIV and STI prevention that respects the fluid, context-dependent reality of Latino men’s sexual lives in one of America’s hardest-hit communities.

Subject of Research: Sexual partnership typologies and HIV/STI risk contexts among Latino men in Miami analyzed with multilevel latent class analysis of egocentric sexual network data

Article Title: Sexual Partner Typologies Among Latino Men Living in Miami, Florida: A Multilevel Latent Class Analysis

Article References: Despres, L., Rodriguez, E., Johnson, A. L., Bravo, A., Vilchez, L., Doblecki-Lewis, S., Fallon, S., & Kanamori, M. (2026). Sexual Partner Typologies Among Latino Men Living in Miami, Florida: A Multilevel Latent Class Analysis. Archives of Sexual Behavior. https://doi.org/10.1007/s10508-026-03441-1

Image Credits: AI Generated

DOI: 10.1007/s10508-026-03441-1

Keywords: HIV, sexually transmitted infections, Latino men, Miami-Dade County, multilevel latent class analysis, sexual networks, PrEP, condomless sex, substance use, dyadic prevention, immigration and acculturation, syndemic theory