2f:I[703058,["/_next/static/immutable/chunks/3bhq_5eh1d760.js","/_next/static/immutable/chunks/1855-ogyi8eh4.js","/_next/static/immutable/chunks/2pfsjpn6k6zlg.js","/_next/static/immutable/chunks/26c7v3_3uwnwu.js","/_next/static/immutable/chunks/25a3ozcrvi1ff.js","/_next/static/immutable/chunks/2r4wx50nvjh_4.js","/_next/static/immutable/chunks/23fsw06hsi5b1.js","/_next/static/immutable/chunks/06_yt270h41rg.js","/_next/static/immutable/chunks/3ezsiz-7shkna.js","/_next/static/immutable/chunks/20x2y96ldu5wx.js","/_next/static/immutable/chunks/2lxntcm3pd1_h.js","/_next/static/immutable/chunks/00dgco8irq3jw.js","/_next/static/immutable/chunks/00nwe-kq0rboc.js","/_next/static/immutable/chunks/2051ffx3xzio9.js"],"PaperListPageClient"] 30:T52a,The Neisseria gonorrhoeae pilE gene encodes the PilE protein, the major subunit of the Type IV pilus and a primary colonization and virulence factor. The pilE gene undergoes high-frequency diversification mainly through gene conversion from one of many pilS copies. These unique molecular processes contribute to gonococcal population diversity, facilitating immune evasion. While the process of pilin variation is understood, the diversity of pilE and pilS genes from clinical isolates is understudied. We analyzed 15 186 N. gonorrhoeae genomes, including finished (n = 65) and draft (n = 15 121) genomes, in the PubMLST database to characterize pilE and pilS gene diversity. The finished genomes had one to nine pilS loci at conserved chromosomal locations. Only 52.13% of sequences contained a pilE gene, despite all genomes having other Type IV pilus genes. When the pilE was present, most defined conserved sequences were preserved. However, most predicted PilE protein sequences contained premature stop codons, which were found in several silent copies. All N. gonorrhoeae strains possess the genes necessary for pilin AV; however, most genomic sequences were derived from nonpiliated variants that emerged during in vitro culture through reversible pilus phase variation and irreversible deletion of the pilE gene.31:T7a7,Abstract Background The Neisseria gonorrhoeae pilE gene encodes the PilE protein, the major subunit of the Type IV pilus and a primary colonization and virulence factor. The pilE gene undergoes high-frequency diversification mainly through gene conversion from one of many pilS copies. These unique molecular processes contribute to gonococcal population diversity, facilitating immune evasion. While the process of pilin variation is understood, the diversity of pilE and pilS genes from clinical isolates is understudied. Methods We analyzed 15 186 N. gonorrhoeae genomes, including finished (n = 65) and draft (n = 15 121) genomes, in the PubMLST database to characterize pilE and pilS gene diversity. Results The finished genomes had one to nine pilS loci at conserved chromosomal locations. Only 52.13% of sequences contained a pilE gene, despite all genomes having other Type IV pilus genes. When the pilE was present, most defined conserved sequences were preserved. However, most predicted PilE protein sequences contained premature stop codons, which were found in several silent copies. Conclusions All N. gonorrhoeae strains possess the genes necessary for pilin AV; however, most genomic sequences were derived from nonpiliated variants that emerged during in vitro culture through reversible pilus phase variation and irreversible deletion of the pilE gene. 25:[[["$","script","0",{"type":"application/ld+json","dangerouslySetInnerHTML":{"__html":"{\"@context\":\"https://schema.org\",\"@type\":\"CollectionPage\",\"name\":\"Gonorrhea: condition Research & Clinical Takeaways\",\"description\":\"Explore peer-reviewed papers on Gonorrhea (condition). Clinician-written summaries and actionable practice insights. Updated daily.\",\"url\":\"https://www.reachrx.ai/hub/tag/condition/Gonorrhea\",\"breadcrumb\":{\"@type\":\"BreadcrumbList\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https://www.reachrx.ai\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Research Hub\",\"item\":\"https://www.reachrx.ai/hub\"},{\"@type\":\"ListItem\",\"position\":3,\"name\":\"Conditions\",\"item\":\"https://www.reachrx.ai/hub/tag/condition\"},{\"@type\":\"ListItem\",\"position\":4,\"name\":\"Gonorrhea\",\"item\":\"https://www.reachrx.ai/hub/tag/condition/Gonorrhea\"}]}}"}}]],["$","$L2f",null,{"title":"Gonorrhea: Research & Clinical Takeaways","description":"Discover peer-reviewed research on Gonorrhea with concise clinician summaries and next-step guidance.","papers":[{"doi":"10.1093/ofid/ofag409","pmid":"42553573","title":"A Multidesign Study of 4CMenB Vaccine Effectiveness and Impact on Meningococcal Carriage and Gonorrhea in Northern Territory Adolescents and Young People","journal_title":"Open Forum Infectious Diseases","journal_issn":"2328-8957","published_at":"2026-08-04T00:00:00.000Z","url":"https://doi.org/10.1093/ofid/ofag409","source_score":7,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-08-09T13:25:11.710Z","updated_at":"2026-08-09T13:25:11.710Z","tags":[{"paper_doi":"10.1093/ofid/ofag409","tag_type":"age_group","value":"adolescent","value_numeric":null},{"paper_doi":"10.1093/ofid/ofag409","tag_type":"brand","value":"Bexsero","value_numeric":null},{"paper_doi":"10.1093/ofid/ofag409","tag_type":"category","value":"Infectious Diseases","value_numeric":null},{"paper_doi":"10.1093/ofid/ofag409","tag_type":"condition","value":"Gonorrhea","value_numeric":null},{"paper_doi":"10.1093/ofid/ofag409","tag_type":"condition","value":"Invasive Meningococcal Disease","value_numeric":null},{"paper_doi":"10.1093/ofid/ofag409","tag_type":"condition","value":"Meningococcal Carriage","value_numeric":null},{"paper_doi":"10.1093/ofid/ofag409","tag_type":"generic","value":"4CMenB","value_numeric":null},{"paper_doi":"10.1093/ofid/ofag409","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1093/ofid/ofag409","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1093/ofid/ofag409","tag_type":"modality","value":"Meningococcal B Vaccine","value_numeric":null},{"paper_doi":"10.1093/ofid/ofag409","tag_type":"sample_size","value":"n=30650","value_numeric":30650},{"paper_doi":"10.1093/ofid/ofag409","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1093/ofid/ofag409","tag_type":"study_design","value":"Multidesign Observational Study (Cohort + Longitudinal Carriage Study)","value_numeric":null},{"paper_doi":"10.1093/ofid/ofag409","tag_type":"warning","value":"Aboriginal and Torres Strait Islander participants had significantly lower 2-dose uptake (5.9%) vs non-Aboriginal participants (13.2%), which may affect subgroup-specific VE interpretation.","value_numeric":null},{"paper_doi":"10.1093/ofid/ofag409","tag_type":"warning","value":"The impact_flag 'practice_changing' is applied cautiously: the NT has already launched a funded 4CMenB infant and adolescent program based partly on these findings, suggesting real-world policy impact, though VE is modest (~38%).","value_numeric":null},{"paper_doi":"10.1093/ofid/ofag409","tag_type":"warning","value":"The study design is described as 'multidesign' combining a population-level cohort analysis with a longitudinal carriage substudy — these are methodologically distinct and results should be interpreted separately for each component.","value_numeric":null},{"paper_doi":"10.1093/ofid/ofag409","tag_type":"warning","value":"Vaccine uptake was only 9.6% (2-dose), which is much lower than anticipated; this limits the precision of VE estimates and may affect generalizability.","value_numeric":null}],"summaries":{"what_studied":"This multidesign study assessed 4CMenB (Bexsero) vaccine effectiveness (VE) against gonorrhea and its impact on oropharyngeal meningococcal carriage among adolescents aged 14–19 years in the Northern Territory (NT), Australia, using linked population-level notification/immunization data (n=30,650) and a longitudinal carriage cohort (n=2,526) from 2021–2024.","key_result":"Two-dose 4CMenB reduced gonococcal notifications by 38.4% (aHR 0.62, 95% CI: 0.47–0.81; VE 95% CI: 18.6–53.4%). Overall meningococcal carriage increased from 4.0% to 6.2% (OR 1.68, 95% CI: 1.14–2.48), driven by genogroup B and nongroupable strains; carriage of disease-associated strains remained stable.","limitations":"- Only 9.6% of the 30,650-person cohort received 2 doses (low uptake, partly due to COVID-19 disruptions), limiting statistical power and potentially biasing comparisons.\n- No behavioral risk data (sexual history, STI testing frequency) were available, leaving residual confounding uncontrolled.\n- The carriage cohort had 57% missing 12-month swab data, requiring multiple imputation under a missing-at-random assumption that cannot be verified.","practice_takeaway":"4CMenB offers modest but real-world–confirmed protection against gonorrhea (~38% VE), especially relevant for adolescent women in high-burden settings where infections are often asymptomatic and can cause serious sequelae. Clinicians in high-gonorrhea-prevalence regions should consider 4CMenB vaccination programs, noting that protection may wane after 4–5 years."}},{"doi":"10.1016/j.ajem.2026.07.043","pmid":"42527162","title":"The emergency department visit as an opportunity for sexually transmitted infection screening and linkage to care in early pregnancy","journal_title":"The American Journal of Emergency Medicine","journal_issn":"0735-6757","published_at":"2026-07-24T00:00:00.000Z","url":"https://doi.org/10.1016/j.ajem.2026.07.043","source_score":7,"is_retracted":false,"is_open_access":null,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":false},"created_at":"2026-08-21T06:28:07.173Z","updated_at":"2026-08-21T06:28:07.173Z","tags":[{"paper_doi":"10.1016/j.ajem.2026.07.043","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1016/j.ajem.2026.07.043","tag_type":"category","value":"Emergency Medicine","value_numeric":null},{"paper_doi":"10.1016/j.ajem.2026.07.043","tag_type":"condition","value":"Chlamydia","value_numeric":null},{"paper_doi":"10.1016/j.ajem.2026.07.043","tag_type":"condition","value":"Congenital Syphilis","value_numeric":null},{"paper_doi":"10.1016/j.ajem.2026.07.043","tag_type":"condition","value":"Ectopic Pregnancy","value_numeric":null},{"paper_doi":"10.1016/j.ajem.2026.07.043","tag_type":"condition","value":"Gonorrhea","value_numeric":null},{"paper_doi":"10.1016/j.ajem.2026.07.043","tag_type":"condition","value":"HIV","value_numeric":null},{"paper_doi":"10.1016/j.ajem.2026.07.043","tag_type":"condition","value":"Sexually Transmitted Infections","value_numeric":null},{"paper_doi":"10.1016/j.ajem.2026.07.043","tag_type":"condition","value":"Syphilis","value_numeric":null},{"paper_doi":"10.1016/j.ajem.2026.07.043","tag_type":"impact_flag","value":"safety_signal","value_numeric":null},{"paper_doi":"10.1016/j.ajem.2026.07.043","tag_type":"level_of_evidence","value":"4","value_numeric":null},{"paper_doi":"10.1016/j.ajem.2026.07.043","tag_type":"sample_size","value":"n=1770","value_numeric":1770},{"paper_doi":"10.1016/j.ajem.2026.07.043","tag_type":"sex","value":"female","value_numeric":null},{"paper_doi":"10.1016/j.ajem.2026.07.043","tag_type":"study_design","value":"Retrospective Cohort Study","value_numeric":null},{"paper_doi":"10.1016/j.ajem.2026.07.043","tag_type":"warning","value":"PNC access was based on patient-reported plans at the ED visit, not verified follow-up attendance.","value_numeric":null},{"paper_doi":"10.1016/j.ajem.2026.07.043","tag_type":"warning","value":"Small absolute numbers for syphilis (n=5) limit precision of the 80% missed-testing figure.","value_numeric":null},{"paper_doi":"10.1016/j.ajem.2026.07.043","tag_type":"warning","value":"The study only captured delivery outcomes for patients who returned to the same hospital, so STI rates and PNC access may be underestimated for the full ED cohort.","value_numeric":null}],"summaries":{"what_studied":"This retrospective study evaluated STI screening rates, diagnosis, and prenatal care (PNC) linkage among pregnant patients visiting a large urban ED, focusing on those who later delivered at the same hospital (n=401) or had ectopic pregnancies (n=69), with an average gestational age of 9 weeks at ED presentation.","key_result":"STI testing rates in the ED were low: only 13.2% were tested for HIV, 4.7% for syphilis, and 22.9% for gonorrhea/chlamydia. Over half (54.5%) of the 32 patients with gonorrhea/chlamydia and 80% of the 5 with syphilis were missed—not tested during their ED visit. Only 49.1% reported plans to access PNC.","limitations":"Retrospective design limits causal inference; outcomes only captured for patients who delivered at the same hospital, likely undercounting the full cohort; PNC access was based on self-reported plans, not confirmed follow-up.","practice_takeaway":"The ED visit in early pregnancy is a missed screening window—consider implementing routine opt-out STI testing (HIV, syphilis, gonorrhea/chlamydia) for pregnant patients presenting to the ED. Pairing screening with active PNC linkage could reduce preventable complications like congenital syphilis in underserved populations."}},{"doi":"10.1016/j.ajem.2026.07.041","pmid":"42526298","title":"Post-exposure prophylaxis prescription fill rate among STI-positive adolescent sexual assault patients in the emergency department","journal_title":"The American Journal of Emergency Medicine","journal_issn":"0735-6757","published_at":"2026-07-22T00:00:00.000Z","url":"https://doi.org/10.1016/j.ajem.2026.07.041","source_score":1,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-07-31T13:36:53.261Z","updated_at":"2026-07-31T13:36:53.261Z","tags":[{"paper_doi":"10.1016/j.ajem.2026.07.041","tag_type":"age_group","value":"adolescent","value_numeric":null},{"paper_doi":"10.1016/j.ajem.2026.07.041","tag_type":"age_group","value":"pediatric","value_numeric":null},{"paper_doi":"10.1016/j.ajem.2026.07.041","tag_type":"category","value":"Emergency Medicine","value_numeric":null},{"paper_doi":"10.1016/j.ajem.2026.07.041","tag_type":"condition","value":"Chlamydia","value_numeric":null},{"paper_doi":"10.1016/j.ajem.2026.07.041","tag_type":"condition","value":"Gonorrhea","value_numeric":null},{"paper_doi":"10.1016/j.ajem.2026.07.041","tag_type":"condition","value":"Sexual Assault","value_numeric":null},{"paper_doi":"10.1016/j.ajem.2026.07.041","tag_type":"condition","value":"Sexually Transmitted Infection","value_numeric":null},{"paper_doi":"10.1016/j.ajem.2026.07.041","tag_type":"condition","value":"Trichomoniasis","value_numeric":null},{"paper_doi":"10.1016/j.ajem.2026.07.041","tag_type":"impact_flag","value":"safety_signal","value_numeric":null},{"paper_doi":"10.1016/j.ajem.2026.07.041","tag_type":"level_of_evidence","value":"4","value_numeric":null},{"paper_doi":"10.1016/j.ajem.2026.07.041","tag_type":"modality","value":"Antibiotic","value_numeric":null},{"paper_doi":"10.1016/j.ajem.2026.07.041","tag_type":"modality","value":"Post-Exposure Prophylaxis","value_numeric":null},{"paper_doi":"10.1016/j.ajem.2026.07.041","tag_type":"sample_size","value":"n=459","value_numeric":459},{"paper_doi":"10.1016/j.ajem.2026.07.041","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1016/j.ajem.2026.07.041","tag_type":"study_design","value":"Retrospective Descriptive Study","value_numeric":null},{"paper_doi":"10.1016/j.ajem.2026.07.041","tag_type":"warning","value":"Prescription outcome data was only available for 17 of 31 discharged adolescent STI-positive patients (~55%), meaning completion rates may not represent the full cohort and could be over- or underestimated.","value_numeric":null},{"paper_doi":"10.1016/j.ajem.2026.07.041","tag_type":"warning","value":"The paper is published in 2026; publisher full text was inaccessible — summary is based solely on the abstract and results sections provided.","value_numeric":null},{"paper_doi":"10.1016/j.ajem.2026.07.041","tag_type":"warning","value":"The study is single-center and the population is predominantly female and Hispanic/Latino, which may limit generalizability to other settings.","value_numeric":null}],"summaries":{"what_studied":"This retrospective, single-center study examined STI rates among pediatric sexual assault patients (ages 0–17) and PEP prescription fill rates among STI-positive adolescents (ages 12–17) seen in a pediatric ED from March 2022 to September 2024.","key_result":"Of 459 total patients, 39 (8.5%) tested positive for gonorrhea, chlamydia, or both; 34 were adolescents. Among the 17 adolescent STI-positive patients with known prescription outcomes, only 12 (70.6%) filled prescriptions, 10 (58.8%) started medications, and just 6 (35.3%) completed the full course.","limitations":"- Single-center, retrospective design limits generalizability.\n- Prescription outcome data was available for only 17 of 31 discharged adolescents, introducing significant ascertainment bias.\n- No comparison group or multivariate analysis to identify modifiable predictors of non-adherence.","practice_takeaway":"Over one-third of STI-positive adolescent sexual assault patients never filled their PEP prescription, and fewer than half completed treatment — consider dispensing medications directly in the ED rather than issuing prescriptions to take out. Systematic follow-up by SANE teams can identify gaps but alone is insufficient to ensure adherence."}},{"doi":"10.1056/nejmoa2516739","pmid":"42418797","title":"Meningococcal B Vaccine to Prevent\n Neisseria gonorrhoeae\n Infection","journal_title":"New England Journal of Medicine","journal_issn":"0028-4793","published_at":"2026-07-08T00:00:00.000Z","url":"https://doi.org/10.1056/nejmoa2516739","source_score":184,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-08-19T06:28:51.901Z","updated_at":"2026-08-19T06:28:51.901Z","tags":[{"paper_doi":"10.1056/nejmoa2516739","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1056/nejmoa2516739","tag_type":"brand","value":"Bexsero","value_numeric":null},{"paper_doi":"10.1056/nejmoa2516739","tag_type":"category","value":"Medicine, General & Internal","value_numeric":null},{"paper_doi":"10.1056/nejmoa2516739","tag_type":"condition","value":"Gonorrhea","value_numeric":null},{"paper_doi":"10.1056/nejmoa2516739","tag_type":"condition","value":"Sexually Transmitted Infection","value_numeric":null},{"paper_doi":"10.1056/nejmoa2516739","tag_type":"generic","value":"4-component meningococcal serogroup B vaccine","value_numeric":null},{"paper_doi":"10.1056/nejmoa2516739","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1056/nejmoa2516739","tag_type":"level_of_evidence","value":"1","value_numeric":null},{"paper_doi":"10.1056/nejmoa2516739","tag_type":"modality","value":"Meningococcal B Vaccine","value_numeric":null},{"paper_doi":"10.1056/nejmoa2516739","tag_type":"sample_size","value":"n=654","value_numeric":654},{"paper_doi":"10.1056/nejmoa2516739","tag_type":"sex","value":"male","value_numeric":null},{"paper_doi":"10.1056/nejmoa2516739","tag_type":"study_design","value":"Randomized Controlled Trial","value_numeric":null},{"paper_doi":"10.1056/nejmoa2516739","tag_type":"warning","value":"Prior observational studies suggested benefit from 4CMenB against gonorrhea — this RCT directly contradicts that signal; clinicians relying on those earlier studies should update their practice.","value_numeric":null},{"paper_doi":"10.1056/nejmoa2516739","tag_type":"warning","value":"Serious adverse events were numerically higher in the vaccine group (4.7% vs. 2.8%), but the paper does not characterize statistical significance or causality of this difference.","value_numeric":null},{"paper_doi":"10.1056/nejmoa2516739","tag_type":"warning","value":"The brand name 'Bexsero' is inferred from the known 4CMenB product; the paper does not explicitly name the brand.","value_numeric":null}],"summaries":{"key_result":"4CMenB showed no protective efficacy against gonorrhea: incidence was 48.1 vs. 47.8 events per 100 person-years in vaccine vs. placebo groups (IRR 1.01; 95% CI 0.80–1.26; P=0.97; vaccine efficacy −0.5%, 95% CI −26.2 to 19.9). No subgroup — symptomatic, asymptomatic, or by anatomical site — showed meaningful benefit. Serious adverse events were slightly higher in the vaccine group (4.7% vs. 2.8%).","what_studied":"This multicenter, double-blind, RCT (GoGoVax) enrolled 654 MSM at high risk for gonorrhea (recent gonorrhea or syphilis diagnosis, HIV-negative on PrEP or living with HIV) and randomized them 1:1 to two doses of 4CMenB vaccine or placebo, with quarterly STI screening including N. gonorrhoeae NAAT at urogenital, anorectal, and oropharyngeal sites over 2 years.","limitations":"- Trial enrolled only MSM, limiting generalizability to other populations (e.g., women, heterosexual men).\n- The study was conducted in a single country (Australia), which may affect applicability to settings with different gonorrhea strain diversity.\n- The confidence intervals are wide, leaving some residual uncertainty about the true effect size.","practice_takeaway":"4CMenB (Bexsero) should not be recommended or used off-label for gonorrhea prevention — this RCT directly refutes prior observational evidence of protection. Clinicians should rely on other proven prevention strategies (e.g., condoms, regular STI screening, doxycycline post-exposure prophylaxis where indicated) for high-risk MSM."}},{"doi":"10.1136/sextrans-2025-056889","pmid":"42248687","title":"Implementing STI point-of-care testing using a whole-system programme model: the ProSPiRO implementation research protocol","journal_title":"Sexually Transmitted Infections","journal_issn":"1368-4973","published_at":"2026-06-05T00:00:00.000Z","url":"https://doi.org/10.1136/sextrans-2025-056889","source_score":5,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-10T14:24:21.782Z","updated_at":"2026-06-10T14:24:21.782Z","tags":[{"paper_doi":"10.1136/sextrans-2025-056889","tag_type":"age_group","value":"mixed","value_numeric":null},{"paper_doi":"10.1136/sextrans-2025-056889","tag_type":"category","value":"Infectious Diseases","value_numeric":null},{"paper_doi":"10.1136/sextrans-2025-056889","tag_type":"condition","value":"Chlamydia","value_numeric":null},{"paper_doi":"10.1136/sextrans-2025-056889","tag_type":"condition","value":"Gonorrhea","value_numeric":null},{"paper_doi":"10.1136/sextrans-2025-056889","tag_type":"condition","value":"HIV","value_numeric":null},{"paper_doi":"10.1136/sextrans-2025-056889","tag_type":"condition","value":"Sexually Transmitted Infections","value_numeric":null},{"paper_doi":"10.1136/sextrans-2025-056889","tag_type":"condition","value":"Syphilis","value_numeric":null},{"paper_doi":"10.1136/sextrans-2025-056889","tag_type":"condition","value":"Trichomoniasis","value_numeric":null},{"paper_doi":"10.1136/sextrans-2025-056889","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.1136/sextrans-2025-056889","tag_type":"level_of_evidence","value":"5","value_numeric":null},{"paper_doi":"10.1136/sextrans-2025-056889","tag_type":"modality","value":"Point-of-Care Diagnostics","value_numeric":null},{"paper_doi":"10.1136/sextrans-2025-056889","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1136/sextrans-2025-056889","tag_type":"study_design","value":"Implementation Research Protocol","value_numeric":null},{"paper_doi":"10.1136/sextrans-2025-056889","tag_type":"warning","value":"Sample size is not specified in the protocol abstract — the sample_size tag has been omitted accordingly.","value_numeric":null},{"paper_doi":"10.1136/sextrans-2025-056889","tag_type":"warning","value":"Study design classified as 'Implementation Research Protocol' rather than a standard interventional design; level of evidence reflects protocol/expert consensus tier.","value_numeric":null},{"paper_doi":"10.1136/sextrans-2025-056889","tag_type":"warning","value":"This is a study protocol; no clinical outcome or effectiveness data are reported. All findings are prospective and anticipated.","value_numeric":null}],"summaries":{"what_studied":"The ProSPiRO protocol describes a whole-system programme model to implement STI point-of-care tests (POCTs) — for *Chlamydia trachomatis*, *Neisseria gonorrhoeae*, *Trichomonas vaginalis*, and/or HIV/syphilis — across diverse settings (sexual/reproductive health, antenatal care, general practice) in multiple countries over 1 year, using co-designed, interest-holder-led workshops.","key_result":"This is a published protocol; no outcome data are yet available. Primary outcomes planned include changes in same-day diagnosis and treatment, patient/provider acceptability, service delivery capacity, and incremental cost consequences versus usual care.","limitations":"- Protocol only — no results yet; findings will depend on future implementation fidelity across diverse sites.\n- Sites self-select, which may introduce selection bias and limit generalizability.\n- Mixed-methods realist evaluation is inherently context-dependent, making cross-site comparisons complex.","practice_takeaway":"Clinicians and health systems planning to adopt STI POCTs can watch for ProSPiRO findings to guide sustainable, context-adapted integration across primary care and specialist settings. The structured workshop model may offer a replicable framework for co-designing POCT rollout with local stakeholders."}},{"doi":"10.1128/iai.00735-25","pmid":"42138646","title":"The role of type IV pilus in the interaction of\n Neisseria gonorrhoeae\n with a corneal epithelium tissue model","journal_title":"Infection and Immunity","journal_issn":"0019-9567","published_at":"2026-05-15T00:00:00.000Z","url":"https://doi.org/10.1128/iai.00735-25","source_score":6,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-22T13:24:12.881Z","updated_at":"2026-06-22T13:24:12.881Z","tags":[{"paper_doi":"10.1128/iai.00735-25","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1128/iai.00735-25","tag_type":"category","value":"Infectious Diseases","value_numeric":null},{"paper_doi":"10.1128/iai.00735-25","tag_type":"condition","value":"Gonococcal Keratitis","value_numeric":null},{"paper_doi":"10.1128/iai.00735-25","tag_type":"condition","value":"Gonorrhea","value_numeric":null},{"paper_doi":"10.1128/iai.00735-25","tag_type":"condition","value":"Ocular Infection","value_numeric":null},{"paper_doi":"10.1128/iai.00735-25","tag_type":"generic","value":"trifluoperazine","value_numeric":null},{"paper_doi":"10.1128/iai.00735-25","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.1128/iai.00735-25","tag_type":"level_of_evidence","value":"6","value_numeric":null},{"paper_doi":"10.1128/iai.00735-25","tag_type":"modality","value":"Pilus Retraction Agent","value_numeric":null},{"paper_doi":"10.1128/iai.00735-25","tag_type":"study_design","value":"In Vitro Experimental Study","value_numeric":null},{"paper_doi":"10.1128/iai.00735-25","tag_type":"warning","value":"Full page content was not extractable from the PDF — quantitative data (e.g., exact CFU counts, cytokine concentrations, sample sizes) could not be verified beyond what was stated in the abstract.","value_numeric":null},{"paper_doi":"10.1128/iai.00735-25","tag_type":"warning","value":"Study design classification as 'In Vitro Experimental Study' is based on cell/tissue model use; no animal or human subjects were involved.","value_numeric":null},{"paper_doi":"10.1128/iai.00735-25","tag_type":"warning","value":"Trifluoperazine is primarily known as an antipsychotic; its use here is investigational and not clinically approved for anti-infective purposes.","value_numeric":null}],"summaries":{"what_studied":"This study evaluated stratified, polarized hTCEpi-based corneal epithelium tissue models as a platform to study *Neisseria gonorrhoeae* infection, using four MS11 strain derivatives differing in type IV pilus expression to assess the role of pili in adherence, microcolony formation, cytokine response, and the effect of trifluoperazine (a pilus-retraction-inducing drug).","key_result":"Type IV pilus was required for early bacterial adherence; microcolony and biofilm formation led to tissue destruction. Infection raised IL-8 and TNF-α but not IL-6. Trifluoperazine significantly reduced adherent gonococci only when given simultaneously with bacteria — not after microcolonies had already formed.","limitations":"The model uses an immortalized cell line (hTCEpi), which may not fully replicate primary human corneal epithelium. Full-text page content was not extractable, limiting verification of quantitative data. No in vivo comparator or clinical validation is reported.","practice_takeaway":"Trifluoperazine's anti-adhesion effect is time-dependent — it works only before *N. gonorrhoeae* establishes microcolonies on corneal tissue. This suggests early intervention is critical; the hTCEpi tissue model offers a scalable platform for future drug screening against ocular gonorrhea."}},{"doi":"10.1016/j.annemergmed.2026.03.016","pmid":"42138675","title":"A Randomized Controlled Trial of a Digital Patient Decision Tool to Increase Sexually Transmitted Infection Testing in the Emergency Department","journal_title":"Annals of Emergency Medicine","journal_issn":"0196-0644","published_at":"2026-05-15T00:00:00.000Z","url":"https://doi.org/10.1016/j.annemergmed.2026.03.016","source_score":2,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-05-21T13:20:55.941Z","updated_at":"2026-05-21T13:20:55.941Z","tags":[{"paper_doi":"10.1016/j.annemergmed.2026.03.016","tag_type":"age_group","value":"adolescent","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.03.016","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.03.016","tag_type":"category","value":"Emergency Medicine","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.03.016","tag_type":"condition","value":"Chlamydia","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.03.016","tag_type":"condition","value":"Gonorrhea","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.03.016","tag_type":"condition","value":"Sexually Transmitted Infection","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.03.016","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.03.016","tag_type":"level_of_evidence","value":"2","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.03.016","tag_type":"modality","value":"Digital Decision Aid","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.03.016","tag_type":"sample_size","value":"n=139","value_numeric":139},{"paper_doi":"10.1016/j.annemergmed.2026.03.016","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.03.016","tag_type":"study_design","value":"Randomized Controlled Trial","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.03.016","tag_type":"warning","value":"Brand name 'STIckER' is an acronym/tool name, not a proprietary drug brand; tagged under modality instead.","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.03.016","tag_type":"warning","value":"The clinician-level (cluster) randomization with only 44 clinicians is a notable design limitation; the paper presents this as an RCT but the unit of randomization differs from the unit of analysis, which may affect interpretation of the confidence intervals.","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.03.016","tag_type":"warning","value":"The very wide CI for pharyngeal testing (1.30–28.66) reflects substantial uncertainty; the effect size should be interpreted cautiously.","value_numeric":null}],"summaries":{"what_studied":"This RCT evaluated STIckER, a smartphone-based digital decision aid, vs. usual care for increasing STI testing among sexually active adolescents and young adults (ages 14–24) in adult and pediatric EDs at a large urban academic medical center. Clinicians (n=44) were randomized to deliver the tool or usual care to enrolled patients (n=139).","key_result":"Participants in the STIckER arm were **1.76x more likely** to receive gonorrhea/chlamydia testing (95% CI 1.10–3.00) and **4.56x more likely** to receive pharyngeal testing (95% CI 1.30–28.66). They also reported greater clarity about testing options and higher satisfaction with ED care.","limitations":"- Small sample (n=139 patients, 44 clinicians) at a single urban academic center limits generalizability.\n- Clinician-level randomization rather than patient-level randomization may introduce cluster-level confounding.\n- Wide confidence intervals—especially for pharyngeal testing—suggest imprecision in effect estimates.","practice_takeaway":"Consider integrating a smartphone-based STI decision aid into ED triage or intake workflows for adolescents and young adults aged 14–24; it meaningfully increases gonorrhea/chlamydia and extragenital testing with high acceptability from both patients and clinicians."}},{"doi":"10.1093/infdis/jiaf557","pmid":"41334759","title":"Publicly Available\n Neisseria Gonorrhoeae\n Genomes Predominantly Represent In Vitro-Derived Nonpiliated Variants","journal_title":"The Journal of Infectious Diseases","journal_issn":"0022-1899","published_at":"2025-12-03T00:00:00.000Z","url":"https://doi.org/10.1093/infdis/jiaf557","source_score":10,"is_retracted":false,"is_open_access":false,"raw_metadata":{"ooir":{"day":"2026-01-06","doi":"10.1093/infdis/jiaf557","days":"7","issn":"0022-1899","rank":"6","field":"Clinical Medicine","score":"10","category":"Infectious Diseases","categories":["Infectious Diseases"],"_categories":["Infectious Diseases"]},"pubmed":{"doi":"10.1093/infdis/jiaf557","title":"Publicly Available Neisseria Gonorrhoeae Genomes Predominantly Represent In Vitro-Derived Nonpiliated Variants.","journal":"The Journal of infectious diseases","methods":"","results":"The finished genomes had one to nine pilS loci at conserved chromosomal locations. Only 52.13% of sequences contained a pilE gene, despite all genomes having other Type IV pilus genes. When the pilE was present, most defined conserved sequences were preserved. However, most predicted PilE protein sequences contained premature stop codons, which were found in several silent copies.","abstract":"$30","keywords":["Neisseria gonorrhoeae","pilE","pilS","antigenic variation","phase variation"],"pubmed_id":"41334759","conclusions":"","publication_date":"2025-12-03T00:00:00"},"crossref":{"DOI":"10.1093/infdis/jiaf557","URL":"https://doi.org/10.1093/infdis/jiaf557","ISSN":["0022-1899","1537-6613"],"link":[{"URL":"https://academic.oup.com/jid/advance-article-pdf/doi/10.1093/infdis/jiaf557/65726662/jiaf557.pdf","content-type":"application/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https://academic.oup.com/jid/advance-article-pdf/doi/10.1093/infdis/jiaf557/65726662/jiaf557.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"page":null,"type":"journal-article","issue":null,"score":1,"title":["Publicly Available\n Neisseria Gonorrhoeae\n Genomes Predominantly Represent In Vitro-Derived Nonpiliated Variants"],"author":[{"given":"Iryna","family":"Boiko","sequence":"first","affiliation":[{"name":"Department of Microbiology-Immunology, Feinberg School of Medicine, Northwestern University , Chicago, Illinois ,"}]},{"given":"Selma","family":"Metaane","sequence":"additional","affiliation":[{"name":"Department of Microbiology-Immunology, Feinberg School of Medicine, Northwestern University , Chicago, Illinois ,"}]},{"given":"H Steven","family":"Seifert","sequence":"additional","affiliation":[{"name":"Department of Microbiology-Immunology, Feinberg School of Medicine, Northwestern University , Chicago, Illinois ,"}]}],"funder":[{"id":[{"id":"10.13039/100000002","id-type":"DOI","asserted-by":"publisher"}],"DOI":"10.13039/100000002","name":"National Institutes of 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Diseases","value_numeric":null},{"paper_doi":"10.1093/infdis/jiaf557","tag_type":"condition","value":"Gonorrhea","value_numeric":null},{"paper_doi":"10.1093/infdis/jiaf557","tag_type":"level_of_evidence","value":"5","value_numeric":null},{"paper_doi":"10.1093/infdis/jiaf557","tag_type":"sample_size","value":"n=15186","value_numeric":15186},{"paper_doi":"10.1093/infdis/jiaf557","tag_type":"study_design","value":"Cross-Sectional","value_numeric":null},{"paper_doi":"10.1093/infdis/jiaf557","tag_type":"warning","value":"Design classification is approximate (genomic database analysis rather than a clinical cross-sectional study).","value_numeric":null},{"paper_doi":"10.1093/infdis/jiaf557","tag_type":"warning","value":"Key methodological details (e.g., criteria for pilE/pilS calling) are not provided in the excerpt.","value_numeric":null}],"summaries":{"what_studied":"Analysis of 15,186 Neisseria gonorrhoeae genomes in PubMLST (65 finished, 15,121 draft) to characterize pilE and pilS gene diversity.","key_result":"Among 15,186 genomes, only 52.13% contained a pilE gene despite other Type IV pilus genes, and finished genomes had 1–9 pilS loci at conserved chromosomal sites. When pilE was present, conserved regions were mostly preserved, yet most predicted PilE proteins had premature stop codons (also seen in several silent copies), and all strains possessed genes necessary for pilin antigenic variation.","limitations":"The dataset relied on public PubMLST genomes and was dominated by draft assemblies (15,121/15,186). The sequences predominantly represent in vitro–derived nonpiliated variants, which may limit inference about in vivo pilus expression and diversity.","practice_takeaway":"Interpret absence or truncation of pilE in public N. gonorrhoeae genomes with caution; it often reflects in vitro phase variation or pilE deletion rather than a stable clinical phenotype. Pilus-related virulence assessments from database genomes may underrepresent piliated variants."}}],"initialOffset":8,"fetchConfig":{"kind":"tags","tags":[{"tag_type":"condition","value":"Gonorrhea"}]},"breadcrumbItems":[{"name":"Home","href":"/"},{"name":"Research Hub","href":"/hub"},{"name":"Conditions","href":"/hub/tag/condition"},{"name":"Gonorrhea"}],"hrefConfig":{"basePath":"/hub/papers","webViewQueryParams":{"hub_ctx":"tag","hub_tag_type":"condition","hub_tag_value":"Gonorrhea"}}}]]

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