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:T7b8,To evaluate the odds of congenital syphilis in neonates of mothers with a history of adequately treated prepregnancy syphilis compared with those with no prepregnancy history of syphilis. We conducted a retrospective cohort study of deliveries within a large multihospital health care system in the southern United States from January 2015 to December 2023. Pregnant individuals were stratified based on whether there was a prepregnancy history of adequately treated syphilis infection. Propensity score full matching was performed, retaining all 382 patients with prior treated syphilis, with covariates including maternal age, neighborhood Area Deprivation Index, tobacco use, insurance payer, prenatal visits, and gestational age at delivery. The primary outcome was congenital syphilis as defined by Centers for Disease Control and Prevention case criteria; secondary outcomes included maternal syphilis infection during pregnancy and neonatal administration of a single intramuscular dose of penicillin-G. Among 57,925 pregnancies, 382 patients (0.66%) had a history of adequately treated syphilis before pregnancy. Congenital syphilis occurred in 26 of 382 (6.8%) pregnancies in women with prior treated syphilis compared with 40 of 57,543 (0.1%) without (adjusted odds ratio [aOR] 19.61; 95% CI, 4.57-84.25). This is equivalent to 6,806 per 100,000 live births in those with a prior history compared with 70 per 100,000 live births in those with no prior history. Maternal syphilis reinfection occurred in 68 of 382 (17.8%) with prior treated syphilis compared with 258 of 57,543 (0.4%) without (aOR 11.92; 95% CI, 5.89-24.10). A history of treated syphilis infection before pregnancy was associated with dramatically increased risks of congenital syphilis and maternal syphilis reinfection during pregnancy. These findings challenge assumptions about the protective effects of prior treatment and support enhanced surveillance strategies for this high-risk population.31:Ta07, OBJECTIVE: To evaluate the odds of congenital syphilis in neonates of mothers with a history of adequately treated prepregnancy syphilis compared with those with no prepregnancy history of syphilis. METHODS: We conducted a retrospective cohort study of deliveries within a large multihospital health care system in the southern United States from January 2015 to December 2023. Pregnant individuals were stratified based on whether there was a prepregnancy history of adequately treated syphilis infection. Propensity score full matching was performed, retaining all 382 patients with prior treated syphilis, with covariates including maternal age, neighborhood Area Deprivation Index, tobacco use, insurance payer, prenatal visits, and gestational age at delivery. The primary outcome was congenital syphilis as defined by Centers for Disease Control and Prevention case criteria; secondary outcomes included maternal syphilis infection during pregnancy and neonatal administration of a single intramuscular dose of penicillin-G. RESULTS: Among 57,925 pregnancies, 382 patients (0.66%) had a history of adequately treated syphilis before pregnancy. Congenital syphilis occurred in 26 of 382 (6.8%) pregnancies in women with prior treated syphilis compared with 40 of 57,543 (0.1%) without (adjusted odds ratio [aOR] 19.61; 95% CI, 4.57–84.25). This is equivalent to 6,806 per 100,000 live births in those with a prior history compared with 70 per 100,000 live births in those with no prior history. Maternal syphilis reinfection occurred in 68 of 382 (17.8%) with prior treated syphilis compared with 258 of 57,543 (0.4%) without (aOR 11.92; 95% CI, 5.89–24.10). CONCLUSION: A history of treated syphilis infection before pregnancy was associated with dramatically increased risks of congenital syphilis and maternal syphilis reinfection during pregnancy. These findings challenge assumptions about the protective effects of prior treatment and support enhanced surveillance strategies for this high-risk population. 25:[[["$","script","0",{"type":"application/ld+json","dangerouslySetInnerHTML":{"__html":"{\"@context\":\"https://schema.org\",\"@type\":\"CollectionPage\",\"name\":\"Syphilis: condition Research & Clinical Takeaways\",\"description\":\"Explore peer-reviewed papers on Syphilis (condition). Clinician-written summaries and actionable practice insights. Updated daily.\",\"url\":\"https://www.reachrx.ai/hub/tag/condition/Syphilis\",\"breadcrumb\":{\"@type\":\"BreadcrumbList\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https://www.reachrx.ai\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Research Hub\",\"item\":\"https://www.reachrx.ai/hub\"},{\"@type\":\"ListItem\",\"position\":3,\"name\":\"Conditions\",\"item\":\"https://www.reachrx.ai/hub/tag/condition\"},{\"@type\":\"ListItem\",\"position\":4,\"name\":\"Syphilis\",\"item\":\"https://www.reachrx.ai/hub/tag/condition/Syphilis\"}]}}"}}]],["$","$L2f",null,{"title":"Syphilis: Research & Clinical Takeaways","description":"Discover peer-reviewed research on Syphilis with concise clinician summaries and next-step guidance.","papers":[{"doi":"10.1007/s10508-026-03497-z","pmid":"42595941","title":"Healthcare Professionals’ Perspectives on the Direct Referral Pathway for Syphilis Management in Western Sydney","journal_title":"Archives of Sexual Behavior","journal_issn":"0004-0002","published_at":"2026-08-13T00:00:00.000Z","url":"https://doi.org/10.1007/s10508-026-03497-z","source_score":5,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-08-20T06:47:54.179Z","updated_at":"2026-08-20T06:47:54.179Z","tags":[{"paper_doi":"10.1007/s10508-026-03497-z","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1007/s10508-026-03497-z","tag_type":"category","value":"Psychology, Clinical","value_numeric":null},{"paper_doi":"10.1007/s10508-026-03497-z","tag_type":"condition","value":"Congenital Syphilis","value_numeric":null},{"paper_doi":"10.1007/s10508-026-03497-z","tag_type":"condition","value":"Syphilis","value_numeric":null},{"paper_doi":"10.1007/s10508-026-03497-z","tag_type":"generic","value":"penicillin G benzathine","value_numeric":null},{"paper_doi":"10.1007/s10508-026-03497-z","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1007/s10508-026-03497-z","tag_type":"level_of_evidence","value":"5","value_numeric":null},{"paper_doi":"10.1007/s10508-026-03497-z","tag_type":"modality","value":"Care Coordination","value_numeric":null},{"paper_doi":"10.1007/s10508-026-03497-z","tag_type":"modality","value":"Public Health Case Management","value_numeric":null},{"paper_doi":"10.1007/s10508-026-03497-z","tag_type":"sample_size","value":"n=31","value_numeric":31},{"paper_doi":"10.1007/s10508-026-03497-z","tag_type":"sex","value":"female","value_numeric":null},{"paper_doi":"10.1007/s10508-026-03497-z","tag_type":"study_design","value":"Evidence Brief (Systematic Literature Review + Survey)","value_numeric":null},{"paper_doi":"10.1007/s10508-026-03497-z","tag_type":"warning","value":"Level of evidence assigned as 5 (expert report/narrative review with survey) due to the evidence brief format and very limited peer-reviewed literature base.","value_numeric":null},{"paper_doi":"10.1007/s10508-026-03497-z","tag_type":"warning","value":"Sample size of n=31 refers to PHU survey respondents, not a clinical trial cohort; the two peer-reviewed studies cited had much smaller samples (n=76 and n=131/24).","value_numeric":null},{"paper_doi":"10.1007/s10508-026-03497-z","tag_type":"warning","value":"The 'impact_flag' of practice_changing is applied cautiously — the recommendations are consensus/expert-level given the thin RCT evidence base.","value_numeric":null},{"paper_doi":"10.1007/s10508-026-03497-z","tag_type":"warning","value":"The paper listed in the DOI/title metadata is a qualitative study on a Western Sydney referral pathway, but the full text provided is actually a Public Health Ontario evidence brief on syphilis management in women and pregnant people — these are two different documents. Summaries and tags reflect the actual full text (the Ontario evidence brief), not the abstract.","value_numeric":null}],"summaries":{"what_studied":"This evidence brief (Public Health Ontario, 2025) reviewed peer-reviewed and grey literature, and surveyed 31 of 34 Ontario public health units (PHUs), to identify effective public health case and contact management approaches for syphilis in women of childbearing age and pregnant people, with a focus on preventing congenital syphilis.","key_result":"Only 2 relevant peer-reviewed studies were found. One (Munro et al., 2017; n=131 pre + 24 intervention) showed an electronic referral pathway with a designated coordinator improved initial contact from 64% to 96% (p<0.001). A Florida electronic notification system (Matthias et al., 2019) resolved missing pregnancy status in 63/76 (82.9%) women over 9 months. Ontario PHU survey: 93.5% had pregnancy-specific syphilis policies; 44% of maternal cases linked to congenital syphilis (2020–2022) were lost to public health follow-up. Between 2014 and 2023, congenital syphilis cases rose from ~1.5/year to 23 cases in 2022.","limitations":"- Peer-reviewed evidence base is extremely thin (only 2 relevant studies identified from 397 screened); no formal quality appraisal of included studies was performed.\n- Survey results are descriptive only; proportional uptake of specific strategies by PHU could not be reported.\n- Approaches from other jurisdictions may not transfer directly to Ontario given differences in health system structure and funding.","practice_takeaway":"Prioritize documenting pregnancy status for all women of childbearing age with syphilis, and flag pregnant cases for same-day, high-priority follow-up — this single step underpins every downstream intervention to prevent congenital syphilis. Designating a single staff member for pregnant syphilis cases and building formal referral pathways to sexual health and prenatal care appear to improve treatment uptake and reduce loss to follow-up, even without robust RCT evidence."}},{"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":"10.1111/1742-6723.70298","pmid":"42324065","title":"Screening for Asymptomatic Sexually Transmitted Infections in Emergency Departments: An Integrative Review of Public Health Outcomes","journal_title":"Emergency Medicine Australasia","journal_issn":"1742-6731","published_at":"2026-06-21T00:00:00.000Z","url":"https://doi.org/10.1111/1742-6723.70298","source_score":2,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-28T13:27:19.430Z","updated_at":"2026-06-28T13:27:19.430Z","tags":[{"paper_doi":"10.1111/1742-6723.70298","tag_type":"age_group","value":"mixed","value_numeric":null},{"paper_doi":"10.1111/1742-6723.70298","tag_type":"category","value":"Emergency Medicine","value_numeric":null},{"paper_doi":"10.1111/1742-6723.70298","tag_type":"condition","value":"Chlamydia","value_numeric":null},{"paper_doi":"10.1111/1742-6723.70298","tag_type":"condition","value":"Gonorrhoea","value_numeric":null},{"paper_doi":"10.1111/1742-6723.70298","tag_type":"condition","value":"HIV","value_numeric":null},{"paper_doi":"10.1111/1742-6723.70298","tag_type":"condition","value":"Sexually Transmitted Infections","value_numeric":null},{"paper_doi":"10.1111/1742-6723.70298","tag_type":"condition","value":"Syphilis","value_numeric":null},{"paper_doi":"10.1111/1742-6723.70298","tag_type":"generic","value":"opt-out STI screening","value_numeric":null},{"paper_doi":"10.1111/1742-6723.70298","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1111/1742-6723.70298","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1111/1742-6723.70298","tag_type":"modality","value":"Infectious Disease Screening","value_numeric":null},{"paper_doi":"10.1111/1742-6723.70298","tag_type":"sample_size","value":"n=20","value_numeric":20},{"paper_doi":"10.1111/1742-6723.70298","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1111/1742-6723.70298","tag_type":"study_design","value":"Integrative Review","value_numeric":null},{"paper_doi":"10.1111/1742-6723.70298","tag_type":"warning","value":"Level of evidence assigned as 3 (systematic/integrative review of lower-quality studies); the integrative review design, mixed methods inclusion, and single-reviewer process place it below a full systematic review or meta-analysis.","value_numeric":null},{"paper_doi":"10.1111/1742-6723.70298","tag_type":"warning","value":"Sample size (n=20) refers to the number of included studies in the review, not individual participants — total patient numbers across studies are not reported in the abstract.","value_numeric":null},{"paper_doi":"10.1111/1742-6723.70298","tag_type":"warning","value":"The predominance of US studies may limit generalisability to Australian or other non-US healthcare contexts, despite the review's focus on Australian ED applicability.","value_numeric":null},{"paper_doi":"10.1111/1742-6723.70298","tag_type":"warning","value":"The review used a single reviewer for study selection and appraisal, which is a notable methodological limitation acknowledged by the authors.","value_numeric":null}],"summaries":{"what_studied":"An integrative review (2012–2024, 20 studies) synthesised evidence on opportunistic, opt-out screening for asymptomatic STIs and bloodborne viruses (chlamydia, gonorrhoea, syphilis, HIV) in emergency departments (EDs), examining detection rates, cost-effectiveness, barriers, and implementation strategies.","key_result":"Routine opt-out ED screening reliably increased case detection of *Chlamydia trachomatis*, *Neisseria gonorrhoeae*, syphilis, and HIV and was cost-effective across studies; behaviour-based eligibility better aligned screening with true transmission risk than identity- or population-based approaches, which frequently misclassified exposure.","limitations":"- Findings are heavily skewed by a predominance of US studies, limiting direct applicability to Australian or other health systems.\n- Limited longitudinal follow-up across included studies prevents assessment of downstream public health impact.\n- Entire review conducted by a single reviewer, increasing risk of selection and appraisal bias.","practice_takeaway":"ED clinicians should consider embedding routine, opt-out, behaviour-based STI/BBV screening into standard workflows, supported by self-collection options, confidentiality safeguards, and electronic prompts — these features consistently improve both acceptance and yield. Population- or identity-based eligibility criteria alone should be avoided, as they miss high-risk individuals."}},{"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":"10.1007/s10508-026-03455-9","pmid":"42236635","title":"High-Risk Sexual Contacts in Nepal and India Among Male Labor Migrants: Findings from the 2024 National Survey in Nepal","journal_title":"Archives of Sexual Behavior","journal_issn":"0004-0002","published_at":"2026-06-03T00:00:00.000Z","url":"https://doi.org/10.1007/s10508-026-03455-9","source_score":5,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-15T13:21:48.513Z","updated_at":"2026-06-15T13:21:48.513Z","tags":[{"paper_doi":"10.1007/s10508-026-03455-9","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1007/s10508-026-03455-9","tag_type":"category","value":"Psychology, Clinical","value_numeric":null},{"paper_doi":"10.1007/s10508-026-03455-9","tag_type":"condition","value":"Hepatitis C","value_numeric":null},{"paper_doi":"10.1007/s10508-026-03455-9","tag_type":"condition","value":"HIV Infection","value_numeric":null},{"paper_doi":"10.1007/s10508-026-03455-9","tag_type":"condition","value":"Sexually Transmitted Infections","value_numeric":null},{"paper_doi":"10.1007/s10508-026-03455-9","tag_type":"condition","value":"Syphilis","value_numeric":null},{"paper_doi":"10.1007/s10508-026-03455-9","tag_type":"impact_flag","value":"safety_signal","value_numeric":null},{"paper_doi":"10.1007/s10508-026-03455-9","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1007/s10508-026-03455-9","tag_type":"modality","value":"Behavioral Intervention","value_numeric":null},{"paper_doi":"10.1007/s10508-026-03455-9","tag_type":"modality","value":"Condom Promotion","value_numeric":null},{"paper_doi":"10.1007/s10508-026-03455-9","tag_type":"modality","value":"HIV Testing","value_numeric":null},{"paper_doi":"10.1007/s10508-026-03455-9","tag_type":"sample_size","value":"n=1872","value_numeric":1872},{"paper_doi":"10.1007/s10508-026-03455-9","tag_type":"sex","value":"male","value_numeric":null},{"paper_doi":"10.1007/s10508-026-03455-9","tag_type":"study_design","value":"Cross-Sectional Survey","value_numeric":null},{"paper_doi":"10.1007/s10508-026-03455-9","tag_type":"warning","value":"Study design is cross-sectional with self-reported behavioral outcomes; causality and generalizability are limited.","value_numeric":null},{"paper_doi":"10.1007/s10508-026-03455-9","tag_type":"warning","value":"Syphilis prevalence (2.1%) and HCV prevalence (38.4%) are based on subgroups only (symptomatic men and ever-injectors, respectively), not the full sample — these figures should not be interpreted as population-level estimates for all male labor migrants.","value_numeric":null},{"paper_doi":"10.1007/s10508-026-03455-9","tag_type":"warning","value":"The DOI publication year in the URL (03455-9) and article date (2026) are consistent, but the 'Received' date is listed as July 2025, suggesting a relatively short peer-review cycle; full text was not available for review.","value_numeric":null}],"summaries":{"what_studied":"A 2024 national HIV bio-behavioral survey of 1,872 male labor migrants (MLM) across all 7 provinces of Nepal evaluated risky sexual behaviors — including sex with female sex workers (FSW) — plus HIV, syphilis, and HCV prevalence using household-level multi-stage cluster sampling in 14 high-migration districts.","key_result":"6.6% of MLM reported sex with an FSW in the past 12 months (range: 1.1% in Lumbini to 10.3% in Sudurpaschim); condom use at last FSW contact was 63.9% in Nepal vs. 93.8% in India. HIV prevalence was 0.2%, syphilis prevalence among symptomatic men was 2.1%, and HCV prevalence was 38.4% among those who had ever injected drugs.","limitations":"- Syphilis and HCV testing were restricted to symptomatic/high-risk subgroups, so prevalence estimates are not population-representative.\n- Self-reported sexual behavior data are subject to social desirability bias, likely underestimating FSW contact rates.\n- Sampling was limited to 14 districts with highest migration density; findings may not generalize to all Nepali labor migrants.","practice_takeaway":"Clinicians and public health programs working with Nepali male labor migrants should prioritize condom promotion — especially within Nepal, where use at FSW contact (63.9%) lags far behind India (93.8%). HIV testing, STI screening, and harm reduction for people who inject drugs should be integrated into migrant health services, with particular focus on Sudurpaschim and Karnali provinces where FSW contact rates are highest."}},{"doi":"10.1503/cmaj.251757","pmid":"42156116","title":"Uptake of prenatal syphilis screening and its determinants in Ontario, Canada: a population-based retrospective cohort study","journal_title":"Canadian Medical Association Journal","journal_issn":"0820-3946","published_at":"2026-05-18T00:00:00.000Z","url":"https://doi.org/10.1503/cmaj.251757","source_score":172,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-05-26T13:35:16.995Z","updated_at":"2026-05-26T13:35:16.995Z","tags":[{"paper_doi":"10.1503/cmaj.251757","tag_type":"age_group","value":"mixed","value_numeric":null},{"paper_doi":"10.1503/cmaj.251757","tag_type":"category","value":"Medicine, General & Internal","value_numeric":null},{"paper_doi":"10.1503/cmaj.251757","tag_type":"condition","value":"Congenital Syphilis","value_numeric":null},{"paper_doi":"10.1503/cmaj.251757","tag_type":"condition","value":"Syphilis","value_numeric":null},{"paper_doi":"10.1503/cmaj.251757","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1503/cmaj.251757","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1503/cmaj.251757","tag_type":"sample_size","value":"n=551706","value_numeric":551706},{"paper_doi":"10.1503/cmaj.251757","tag_type":"sex","value":"female","value_numeric":null},{"paper_doi":"10.1503/cmaj.251757","tag_type":"study_design","value":"Retrospective Cohort Study","value_numeric":null},{"paper_doi":"10.1503/cmaj.251757","tag_type":"warning","value":"No drug or therapeutic intervention is evaluated; 'impact_flag: practice_changing' is applied based on public health screening policy implications rather than a treatment trial.","value_numeric":null},{"paper_doi":"10.1503/cmaj.251757","tag_type":"warning","value":"Study is limited to OHIP-eligible Ontario residents; results may not generalize to uninsured, undocumented, or non-Ontario Canadian populations.","value_numeric":null},{"paper_doi":"10.1503/cmaj.251757","tag_type":"warning","value":"Syphilis test results (positive/negative) were not available in the data — only whether testing occurred; thus, true infection rates and treatment outcomes cannot be assessed from this study.","value_numeric":null}],"summaries":{"what_studied":"Population-based retrospective cohort of 551,706 pregnancies (>20 weeks, live births or stillbirths) in Ontario, Canada, from January 2018 to December 2023, examining rates and timing of prenatal syphilis screening and identifying individual-level and external factors associated with missed or late (third trimester or at delivery) screening.","key_result":"91.9% of pregnancies were screened at least once, but only 78.9% received first-trimester screening — meaning 1 in 5 pregnancies missed timely screening. Key risk factors for screening only at delivery included: age 15–19 vs. 30–39 years at conception (adjusted RR 4.01, 95% CI 3.33–4.81), recent injection or general drug use (adjusted RR 3.78, 95% CI 3.11–4.59), and lowest neighbourhood income quintile (adjusted RR 1.59, 95% CI 1.40–1.80). Prior syphilis testing within 1 year before conception was associated with *missing* pregnancy screening altogether (adjusted RR 2.12, 95% CI 2.08–2.16). Coverage improved over time: missed screening fell from 10.9% in 2018 to 5.5% in 2023.","limitations":"- OHIP eligibility requirement led to exclusion of ~110,774 pregnancies (including many newcomers and racialized individuals), likely **overestimating** overall screening coverage.\n- Administrative data could not capture midwifery billing, reasons for late/missed screening, or key social determinants of health (e.g., housing instability).\n- Substance use identification relied on health-services contact, missing those who never sought related medical care.","practice_takeaway":"Teens, people who use substances, and those in low-income neighbourhoods are at highest risk for late or missed prenatal syphilis screening — target these groups with opportunistic and point-of-care testing at every health encounter during pregnancy, including ED visits, walk-in clinics, and community harm-reduction settings. Prior negative syphilis testing should not substitute for universal prenatal screening, as providers may be incorrectly perceiving recently tested patients as low risk."}},{"doi":"10.1097/aog.0000000000006314","pmid":"42096714","title":"History of Treated Syphilis Before Pregnancy and Risk of Congenital Syphilis","journal_title":"Obstetrics & Gynecology","journal_issn":"0029-7844","published_at":"2026-05-07T00:00:00.000Z","url":"https://doi.org/10.1097/aog.0000000000006314","source_score":7,"is_retracted":false,"is_open_access":false,"raw_metadata":{"ooir":{"day":"2026-05-12","doi":"10.1097/aog.0000000000006314","days":"7","issn":"0029-7844","rank":"3","field":"Clinical Medicine","score":"7","category":"Obstetrics & Gynecology","categories":["Obstetrics & Gynecology"],"_categories":["Obstetrics & Gynecology"]},"pubmed":{"doi":"10.1097/AOG.0000000000006314","title":"History of Treated Syphilis Before Pregnancy and Risk of Congenital Syphilis.","journal":"Obstetrics and gynecology","methods":"","results":"Among 57,925 pregnancies, 382 patients (0.66%) had a history of adequately treated syphilis before pregnancy. Congenital syphilis occurred in 26 of 382 (6.8%) pregnancies in women with prior treated syphilis compared with 40 of 57,543 (0.1%) without (adjusted odds ratio [aOR] 19.61; 95% CI, 4.57-84.25). This is equivalent to 6,806 per 100,000 live births in those with a prior history compared with 70 per 100,000 live births in those with no prior history. Maternal syphilis reinfection occurred in 68 of 382 (17.8%) with prior treated syphilis compared with 258 of 57,543 (0.4%) without (aOR 11.92; 95% CI, 5.89-24.10).","abstract":"$30","keywords":[],"pubmed_id":"42096714","conclusions":"A history of treated syphilis infection before pregnancy was associated with dramatically increased risks of congenital syphilis and maternal syphilis reinfection during pregnancy. These findings challenge assumptions about the protective effects of prior treatment and support enhanced surveillance strategies for this high-risk population.","publication_date":"2026-05-07T00:00:00"},"crossref":{"DOI":"10.1097/aog.0000000000006314","URL":"https://doi.org/10.1097/aog.0000000000006314","ISSN":["0029-7844","1873-233X"],"link":[{"URL":"https://journals.lww.com/10.1097/AOG.0000000000006314","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"page":null,"type":"journal-article","issue":null,"score":1,"title":["History of Treated Syphilis Before Pregnancy and Risk of Congenital Syphilis"],"author":[{"given":"J. Drew","family":"Toppin","sequence":"first","affiliation":[]},{"given":"Shannon","family":"McCloskey","sequence":"additional","affiliation":[]},{"given":"Talia","family":"Suner","sequence":"additional","affiliation":[]},{"given":"Brian","family":"James","sequence":"additional","affiliation":[]},{"given":"Meenakshi","family":"Mishra","sequence":"additional","affiliation":[]},{"given":"Mariella","family":"Gastanduy","sequence":"additional","affiliation":[]},{"given":"Joseph R.","family":"Biggio","sequence":"additional","affiliation":[]},{"given":"Frank B.","family":"Williams","sequence":"additional","affiliation":[]}],"issued":{"date-parts":[[2026,5,8]]},"member":"276","prefix":"10.1097","source":"Crossref","volume":null,"created":{"date-time":"2026-05-07T21:01:20Z","timestamp":1778187680000,"date-parts":[[2026,5,7]]},"indexed":{"date-time":"2026-05-07T21:12:52Z","timestamp":1778188372801,"date-parts":[[2026,5,7]]},"subject":[],"abstract":"$31","language":"en","relation":{},"resource":{"primary":{"URL":"https://journals.lww.com/10.1097/AOG.0000000000006314"}},"subtitle":[],"assertion":[{"name":"received","group":{"name":"publication_history","label":"Publication History"},"label":"Received","value":"2026-02-04"},{"name":"accepted","group":{"name":"publication_history","label":"Publication History"},"label":"Accepted","value":"2026-04-02"}],"deposited":{"date-time":"2026-05-07T21:01:22Z","timestamp":1778187682000,"date-parts":[[2026,5,7]]},"issn-type":[{"type":"print","value":"0029-7844"},{"type":"electronic","value":"1873-233X"}],"published":{"date-parts":[[2026,5,8]]},"publisher":"Ovid Technologies (Wolters Kluwer Health)","reference":[{"DOI":"10.1371/journal.pone.0211720","key":"R1-20260507","year":"2019","issue":null,"author":"Korenromp","volume":"14","first-page":"e0211720","unstructured":null,"article-title":"Global burden of maternal and congenital syphilis and associated adverse birth outcomes—estimates for 2016 and progress since 2012","journal-title":"PLoS One","doi-asserted-by":"crossref"},{"DOI":"10.1016/j.ajog.2022.07.041","key":"R2-20260507","year":"2022","issue":null,"author":"Eppes","volume":"227","first-page":"822","unstructured":null,"article-title":"Syphilis in pregnancy: an ongoing public health threat","journal-title":"Am J Obstet Gynecol","doi-asserted-by":"crossref"},{"DOI":"10.1371/journal.pone.0102203","key":"R3-20260507","year":"2014","issue":null,"author":"Qin","volume":"9","first-page":"e102203","unstructured":null,"article-title":"Reported estimates of adverse pregnancy outcomes among women with and without syphilis: a systematic review and meta-analysis","journal-title":"PLoS One","doi-asserted-by":"crossref"},{"DOI":"10.1056/NEJMra2202762","key":"R5-20260507","year":"2024","issue":null,"author":"Stafford","volume":"390","first-page":"242","unstructured":null,"article-title":"Syphilis complicating pregnancy and congenital syphilis","journal-title":"N Engl J Med","doi-asserted-by":"crossref"},{"DOI":"10.15585/mmwr.rr7004a1","key":"R6-20260507","year":"2021","issue":null,"author":"Workowski","volume":"70","first-page":"1","unstructured":null,"article-title":"Sexually transmitted infections treatment guidelines, 2021","journal-title":"MMWR Recomm Rep","doi-asserted-by":"crossref"},{"DOI":"10.1097/00007435-197910000-00003","key":"R7-20260507","year":"1979","issue":null,"author":"Fiumara","volume":"6","first-page":"243","unstructured":null,"article-title":"Serologic responses to treatment of 128 patients with late latent syphilis","journal-title":"Sex Transm Dis","doi-asserted-by":"crossref"},{"DOI":"10.1016/j.ajog.2016.11.1052","key":"R8-20260507","year":"2017","issue":null,"author":"Rac","volume":"216","first-page":"352","unstructured":null,"article-title":"Syphilis during pregnancy: a preventable threat to maternal-fetal health","journal-title":"Am J Obstet Gynecol","doi-asserted-by":"crossref"},{"DOI":"10.1097/AOG.0000000000003788","key":"R9-20260507","year":"2020","issue":null,"author":"Adhikari","volume":"135","first-page":"1121","unstructured":null,"article-title":"Syphilis in pregnancy","journal-title":"Obstet Gynecol","doi-asserted-by":"crossref"},{"DOI":"10.7326/M13-2946","key":"R12-20260507","year":"2014","issue":null,"author":"Kind","volume":"161","first-page":"765","unstructured":null,"article-title":"Neighborhood socioeconomic disadvantage and 30-day rehospitalization: a retrospective cohort study","journal-title":"Ann Int Med","doi-asserted-by":"crossref"},{"DOI":null,"key":"R13-20260507","year":"2019","issue":null,"author":"Margerison","volume":"41","first-page":"545","unstructured":null,"article-title":"County-level factors associated with maternal and infant mortality in the USA: systematic review of studies using the CDC WONDER database","journal-title":"J Public Health (Oxf)","doi-asserted-by":null},{"DOI":"10.1001/jama.2018.11785","key":"R14-20260507","year":"2018","issue":null,"author":"Curry","volume":"320","first-page":"911","unstructured":null,"article-title":"Screening for syphilis infection in pregnant women: US Preventive Services Task Force reaffirmation recommendation statement","journal-title":"JAMA","doi-asserted-by":"crossref"},{"DOI":"10.1590/1413-81232015209.20332014","key":"R15-20260507","year":"2015","issue":null,"author":"Hebmuller","volume":"20","first-page":"2867","unstructured":null,"article-title":"Subsequent pregnancies in women with previous gestational syphilis","journal-title":"Ciencia Saude Coletiva","doi-asserted-by":"crossref"},{"DOI":null,"key":"R16-20260507","year":"2020","issue":null,"author":"Matthias","volume":"47","first-page":"670","unstructured":null,"article-title":"Syphilitic reinfections during the same pregnancy—Florida, 2018","journal-title":"Sex Transm Dis","doi-asserted-by":null}],"short-title":[],"update-policy":"https://doi.org/10.1097/lww.0000000000001000","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"original-title":[],"container-title":["Obstetrics & Gynecology"],"reference-count":13,"published-online":{"date-time":null,"timestamp":null,"date-parts":[[2026,5,8]]},"references-count":13,"short-container-title":[],"is-referenced-by-count":0},"unpaywall":{"doi":"10.1097/aog.0000000000006314","is_oa":false,"title":"History of Treated Syphilis Before Pregnancy and Risk of Congenital Syphilis","updated":"2026-05-08T16:02:47+00:00","published_date":"2026-05-07","best_oa_location":null}},"created_at":"2026-05-13T13:19:31.590Z","updated_at":"2026-05-14T15:13:26.918Z","tags":[{"paper_doi":"10.1097/aog.0000000000006314","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1097/aog.0000000000006314","tag_type":"brand","value":"Bicillin","value_numeric":null},{"paper_doi":"10.1097/aog.0000000000006314","tag_type":"category","value":"Obstetrics & Gynecology","value_numeric":null},{"paper_doi":"10.1097/aog.0000000000006314","tag_type":"condition","value":"Congenital Syphilis","value_numeric":null},{"paper_doi":"10.1097/aog.0000000000006314","tag_type":"condition","value":"Syphilis","value_numeric":null},{"paper_doi":"10.1097/aog.0000000000006314","tag_type":"generic","value":"penicillin G","value_numeric":null},{"paper_doi":"10.1097/aog.0000000000006314","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1097/aog.0000000000006314","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1097/aog.0000000000006314","tag_type":"modality","value":"Antibiotic","value_numeric":null},{"paper_doi":"10.1097/aog.0000000000006314","tag_type":"sample_size","value":"n=57925","value_numeric":57925},{"paper_doi":"10.1097/aog.0000000000006314","tag_type":"sex","value":"female","value_numeric":null},{"paper_doi":"10.1097/aog.0000000000006314","tag_type":"study_design","value":"Retrospective Cohort Study","value_numeric":null},{"paper_doi":"10.1097/aog.0000000000006314","tag_type":"warning","value":"Propensity score matching retained all 382 exposed patients but the control group is much larger; balance on unmeasured confounders (e.g., sexual risk behaviors, partner treatment status) cannot be confirmed.","value_numeric":null},{"paper_doi":"10.1097/aog.0000000000006314","tag_type":"warning","value":"The brand tag 'Bicillin' is inferred from the context of intramuscular penicillin-G use; the paper does not explicitly name a brand.","value_numeric":null},{"paper_doi":"10.1097/aog.0000000000006314","tag_type":"warning","value":"The wide confidence interval for the primary outcome (aOR 4.57–84.25) reflects small absolute numbers of congenital syphilis cases in the prior-treatment group (n=26), so the point estimate should be interpreted cautiously.","value_numeric":null}],"summaries":{"what_studied":"This retrospective cohort study evaluated whether a history of adequately treated prepregnancy syphilis increases the odds of congenital syphilis and maternal reinfection, comparing 382 pregnant individuals with prior treated syphilis to 57,543 without, across a large multihospital system in the southern US (January 2015–December 2023).","key_result":"Congenital syphilis occurred in 6.8% (26/382) of those with prior treated syphilis vs. 0.1% (40/57,543) without (aOR 19.61; 95% CI 4.57–84.25; 6,806 vs. 70 per 100,000 live births). Maternal reinfection during pregnancy occurred in 17.8% vs. 0.4% (aOR 11.92; 95% CI 5.89–24.10).","limitations":"- Single health care system in the southern US limits generalizability to other regions or demographics.\n- Retrospective design cannot establish causation; residual confounding is possible despite propensity score matching.\n- \"Adequate treatment\" before pregnancy was defined by chart documentation, which may misclassify some cases.","practice_takeaway":"Pregnant patients with any prior history of treated syphilis should be considered high-risk and flagged for enhanced surveillance and more frequent serologic screening throughout pregnancy. Prior successful treatment should **not** be taken as reassurance against reinfection or congenital syphilis risk."}},{"doi":"10.1016/s1473-3099(26)00123-4","pmid":"42107388","title":"Durability of doxycycline effectiveness against gonorrhoea after implementation of post-exposure prophylaxis in southern California, USA: a retrospective, test-negative, observational study","journal_title":"The Lancet Infectious Diseases","journal_issn":"1473-3099","published_at":"2026-05-07T00:00:00.000Z","url":"https://doi.org/10.1016/s1473-3099(26)00123-4","source_score":15,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-05-13T13:19:25.857Z","updated_at":"2026-05-13T13:19:25.857Z","tags":[{"paper_doi":"10.1016/s1473-3099(26)00123-4","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1016/s1473-3099(26)00123-4","tag_type":"category","value":"Infectious Diseases","value_numeric":null},{"paper_doi":"10.1016/s1473-3099(26)00123-4","tag_type":"condition","value":"Antimicrobial Resistance","value_numeric":null},{"paper_doi":"10.1016/s1473-3099(26)00123-4","tag_type":"condition","value":"Chlamydia","value_numeric":null},{"paper_doi":"10.1016/s1473-3099(26)00123-4","tag_type":"condition","value":"Gonorrhoea","value_numeric":null},{"paper_doi":"10.1016/s1473-3099(26)00123-4","tag_type":"condition","value":"Sexually Transmitted Infections","value_numeric":null},{"paper_doi":"10.1016/s1473-3099(26)00123-4","tag_type":"condition","value":"Syphilis","value_numeric":null},{"paper_doi":"10.1016/s1473-3099(26)00123-4","tag_type":"generic","value":"doxycycline","value_numeric":null},{"paper_doi":"10.1016/s1473-3099(26)00123-4","tag_type":"impact_flag","value":"safety_signal","value_numeric":null},{"paper_doi":"10.1016/s1473-3099(26)00123-4","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1016/s1473-3099(26)00123-4","tag_type":"modality","value":"Post-Exposure Prophylaxis","value_numeric":null},{"paper_doi":"10.1016/s1473-3099(26)00123-4","tag_type":"modality","value":"Tetracycline Antibiotic","value_numeric":null},{"paper_doi":"10.1016/s1473-3099(26)00123-4","tag_type":"sample_size","value":"n=26582","value_numeric":26582},{"paper_doi":"10.1016/s1473-3099(26)00123-4","tag_type":"sex","value":"male","value_numeric":null},{"paper_doi":"10.1016/s1473-3099(26)00123-4","tag_type":"study_design","value":"Retrospective Observational Study (Test-Negative Design)","value_numeric":null},{"paper_doi":"10.1016/s1473-3099(26)00123-4","tag_type":"warning","value":"Effectiveness estimates for gonorrhoea sub-periods have wide confidence intervals, particularly for early pre-implementation phase (95% CI 2.7–65.8), limiting precision of temporal trend conclusions.","value_numeric":null},{"paper_doi":"10.1016/s1473-3099(26)00123-4","tag_type":"warning","value":"The study includes transgender women assigned male at birth, but sex tag is marked 'male' per biological assignment used in eligibility criteria — clinicians should note this population distinction.","value_numeric":null},{"paper_doi":"10.1016/s1473-3099(26)00123-4","tag_type":"warning","value":"The test-negative design controls for healthcare-seeking behaviour but cannot fully adjust for unmeasured sexual risk behaviour differences between doxy-PEP users and non-users.","value_numeric":null}],"summaries":{"what_studied":"This retrospective, test-negative observational study evaluated real-world effectiveness of doxycycline post-exposure prophylaxis (doxy-PEP) against chlamydia, gonorrhoea, and syphilis among 26,582 MSM and transgender women in Kaiser Permanente Southern California (Jan 2023–Jun 2025), and whether gonorrhoea effectiveness was durable over time as tetracycline resistance spread.","key_result":"Doxy-PEP was effective against chlamydia (66.5%, 95% CI 53.6–75.9) and syphilis (60.7%, 95% CI 28.3–78.5), but showed no meaningful protection against gonorrhoea overall (−1.8%, 95% CI −18.5 to 12.5). Gonorrhoea effectiveness dropped from 42.3% before statewide implementation to −15.0% by Jan–Jun 2025, closely tracking a rise in tetM prevalence: effectiveness fell from 47.2% when tetM was present in 20–29.9% of isolates to −8.5% when tetM reached ≥50% of isolates.","limitations":"- Observational design cannot fully exclude confounding (e.g., sexual behaviour differences between doxy-PEP users and non-users).\n- tetM prevalence data were derived from local surveillance isolates, which may not perfectly represent the full circulating strain population.\n- Doxy-PEP use was defined by prescription fills, not confirmed adherence or timing of doses.","practice_takeaway":"Clinicians prescribing doxy-PEP should counsel MSM and transgender women that protection against gonorrhoea may be minimal or absent in settings where tetracycline-resistant *N. gonorrhoeae* is prevalent (≥50% tetM). Sustained benefits against chlamydia and syphilis remain, so risk-benefit discussions should be individualized and local AMR surveillance data should inform ongoing doxy-PEP recommendations."}},{"doi":"10.1016/s2352-3018(26)00010-x","pmid":"42061386","title":"Trends in incidence of HIV and other sexually transmissible infections among transgender people in Australia: a retrospective 10-year national clinical cohort study","journal_title":"The Lancet HIV","journal_issn":"2352-3018","published_at":"2026-04-27T00:00:00.000Z","url":"https://doi.org/10.1016/s2352-3018(26)00010-x","source_score":10,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-05-07T22:50:09.859Z","updated_at":"2026-05-07T22:50:09.859Z","tags":[{"paper_doi":"10.1016/s2352-3018(26)00010-x","tag_type":"age_group","value":"mixed","value_numeric":null},{"paper_doi":"10.1016/s2352-3018(26)00010-x","tag_type":"category","value":"Infectious Diseases","value_numeric":null},{"paper_doi":"10.1016/s2352-3018(26)00010-x","tag_type":"condition","value":"Chlamydia","value_numeric":null},{"paper_doi":"10.1016/s2352-3018(26)00010-x","tag_type":"condition","value":"Gonorrhoea","value_numeric":null},{"paper_doi":"10.1016/s2352-3018(26)00010-x","tag_type":"condition","value":"HIV Infection","value_numeric":null},{"paper_doi":"10.1016/s2352-3018(26)00010-x","tag_type":"condition","value":"Sexually Transmissible Infections","value_numeric":null},{"paper_doi":"10.1016/s2352-3018(26)00010-x","tag_type":"condition","value":"Syphilis","value_numeric":null},{"paper_doi":"10.1016/s2352-3018(26)00010-x","tag_type":"generic","value":"emtricitabine/tenofovir","value_numeric":null},{"paper_doi":"10.1016/s2352-3018(26)00010-x","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1016/s2352-3018(26)00010-x","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1016/s2352-3018(26)00010-x","tag_type":"modality","value":"Pre-Exposure Prophylaxis","value_numeric":null},{"paper_doi":"10.1016/s2352-3018(26)00010-x","tag_type":"sample_size","value":"n=553,760","value_numeric":553760},{"paper_doi":"10.1016/s2352-3018(26)00010-x","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1016/s2352-3018(26)00010-x","tag_type":"study_design","value":"Retrospective Cohort Study","value_numeric":null},{"paper_doi":"10.1016/s2352-3018(26)00010-x","tag_type":"warning","value":"The sample_size tag reflects the total across all three cohorts (7,284 transgender + 152,144 GBM + 394,332 heterosexual = 553,760); the primary transgender cohort alone is n=7,284. Clinicians should interpret results for non-binary people cautiously due to the small subgroup size (n=399). The generic drug tag uses a class representative; the paper does not specify a single PrEP formulation by name.","value_numeric":null}],"summaries":{"what_studied":"A 10-year retrospective clinical cohort study (2014–2023) across 87 Australian health services examined HIV and STI incidence trends and risk factors among 7,284 transgender people, compared with 152,144 cisgender gay/bisexual men and 394,332 cisgender heterosexual people.","key_result":"HIV incidence among transgender people fell 93.9%, from 1.19 to 0.07 per 100 person-years (IRR per year 0.72, 95% CI 0.66–0.79). Transgender women had the highest HIV incidence (0.37/100 PY); transgender men had the lowest (0.20/100 PY). HIV incidence was comparable between transgender people and cisgender gay/bisexual men (0.33 vs 0.29/100 PY; adjusted IRR 0.87). PrEP was protective against HIV (adjusted IRR 0.40) but associated with higher STI incidence (adjusted IRR 1.38). Chlamydia, gonorrhoea, and syphilis incidences were largely stable over time.","limitations":"Transgender people were largely excluded from national public health surveillance, so this cohort relies on clinical health records from self-selected services, which may not be fully representative. Non-binary people were a small subgroup (n=399), limiting subgroup analyses. Behavioural data were clinic-reported and may underestimate risk exposures.","practice_takeaway":"Clinicians should prioritize PrEP access for transgender women, who carry the highest HIV burden, while actively screening for bacterial STIs given stable and high chlamydia and gonorrhoea rates. HIV and STI guidelines should be updated to explicitly include transgender populations."}}],"initialOffset":9,"fetchConfig":{"kind":"tags","tags":[{"tag_type":"condition","value":"Syphilis"}]},"breadcrumbItems":[{"name":"Home","href":"/"},{"name":"Research Hub","href":"/hub"},{"name":"Conditions","href":"/hub/tag/condition"},{"name":"Syphilis"}],"hrefConfig":{"basePath":"/hub/papers","webViewQueryParams":{"hub_ctx":"tag","hub_tag_type":"condition","hub_tag_value":"Syphilis"}}}]]

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