STIWatch Newsletter, November 2024

The past few months have brought exciting developments in the field of Sexually Transmitted Infections (STIs). The World Health Organization released the global priorities for STIs, which included the need to develop low-cost, rapid, STI point-of-care tests, vaccines, and communication strategies to increase STI awareness, prevention, service engagement. But we continue to see a soaring rise in STI incidence and an underfunded infrastructure for researching new treatment, prevention and testing tools. It’s up to the global community to ensure that research and development continues to see funding for better, faster, less expensive tools to reduce the toll of STIs. Read on for resources and insights to guide your advocacy.  

Conference updates

The annual conference of the International AIDS Society in July highlighted the troubling trend in the soaring rise in STI incidence. A preconference, Mobilize for Action on Sexually Transmitted Infections addressed the urgent need to confront the global spike in STI rates, particularly syphilis, gonorrhea, chlamydia, and trichomoniasis. Dr. Jeanne Marrazzo, director of NIAID, when discussing the number of global deaths from syphilis, which is treatable, said, “I think some of the more staggering statistics here, in addition to the sheer number of new infections, is the fact that we had in 2022 over 200,000 syphilis-associated deaths, which to me is practically medieval.” The meeting hosted a rigorous debate exploring the question of implementing DoxyPEP, given there’s no efficacy data for cisgender women in light of fears of creating drug resistant strains of STIs from wider use of doxycycline. Strong arguments were made on both sides, but this controversy is one of the reasons AVAC recently published an Advocate’s Guide to Doxycycline to Prevent STIs. 

The STI Prevention Conference in Atlanta, Georgia convened attendees in-person for the first time in four years and discussed the rise in syphilis rates, emerging gonorrhea treatments, STI funding and policy initiatives, and doxycycline post-exposure prophylaxis (DoxyPEP). Notably, much discussion centered on NIAID’s support for a biorepository to advance diagnostic development. This biorepository would streamline access to necessary specimens to support the research and development of new diagnostics. 

Save the date

New resources

Discover STIWatch.org!

STIWatch.org is an updated platform designed to enhance understanding and advocacy for STI vaccine and diagnostics research, development, and rollout. It offers comprehensive information on common STIs, a clinical trials dashboard, advocacy priorities, and a range of resources and tools to support STI prevention and treatment efforts. 

STI Clinical Trials Dashboard

This dashboard provides information about trials focused on vaccines, diagnostics, and the use of doxycycline post-exposure prophylaxis (DoxyPEP) to detect, treat, and prevent chlamydia, gonorrhea, hepatitis B, herpes simplex virus (HSV), human papillomavirus, syphilis, trichomoniasis infections, and Mycoplasma genitalium.

Webinar Summary

Regulatory Pathways to Promote Access to STI Diagnostics. This webinar co-hosted with World Health Organization (WHO) supported researchers, product developers and the global advocacy community in identifying and discussing ways to bring new STI diagnostics to market with speed, equity and scale.

What We’re Reading

  • Special Issue: Sexually Transmitted Diseases. This leading journal celebrated 50 years by publishing a series of editorials that review the careers of some of the leading experts in the field. These stories are both inspiring and enlightening, highlighting the decades of efforts and growth in addressing STIs. AVAC’s own, Alison Footman, PhD, wrote about her experiences in the STI field and how instrumental mentorship has been in her career growth.
     
  • Gonorrhea point-of-care diagnostics technology and market landscape. This landscape report provides an overview of gonorrhea point-of-care diagnostics that can be offered closer to patients and communities and limit time to results and ultimately treatment. Gonorrhea touches on multiple public health priorities including the need to reduce STI rates, growing antimicrobial resistance, and its impact on sexual and reproductive outcomes and HIV transmission. 
     
  • FDA Marketing Authorization Enables Increased Access to First Step of Syphilis Diagnosis. The US Food and Drug Administration approved the first syphilis self-test. This is a monumental step in expanding syphilis testing options as infections have increased drastically over the past five years. Self-tests can provide people with the option to learn their syphilis status and seek additional testing and treatment options from a healthcare provider. 

Partner Spotlight

AVAC partners have been busy moving the needle to improve STI prevention, testing, and treatment options in their respective countries. The Latu Human Rights Foundation partnered with HEP Initiative Zambia on a symposium to foster ideas on how to better address viral hepatitis and integrate hepatitis B interventions into other government funded health programs.

To learn more about AVAC’s STI Program, visit STIWatch.org and avac.org/sti. Email sti@avac.org for questions or additional information. And to sign up for specific updates on STIs, click here.

Spotlight on MPTs Addressing STIs

This graphic outlines the development journey of multipurpose technologies (MPTs) that guard against STIs, including HIV, while also preventing pregnancy. It tracks the advancement of various potential products through different trial stages, emphasizing their combined protective roles. Excerpted from our Advocates’ Guide to Multipurpose Technologies.

At A Glance: The MPT R&D Pipeline

This graphic shows the status of products in development. Excerpted from our Advocates’ Guide to Multipurpose Technologies.

Advocates’ Guide to Multipurpose Prevention Technologies (MPTs)

Multipurpose prevention technologies (MPTs) are products designed to simultaneously address more than one sexual and reproductive health concern. This advocates’ guide shows the pipeline of products in development, discusses why MPTs are needed, investment, and what advocates can do to push for MPT development and introduction.

MPT R&D Funding 2018-2021

This graphic tracks funding levels for a variety of multipurpose technologies for several years. Excerpted from our Advocates’ Guide to Multipurpose Prevention Technologies.

STI Watch Newsletter, July 2024

AVAC’s quarterly newsletter of the latest in STI vaccines, diagnostics, and other prevention tools and strategies

In the second quarter of this year, there have been exciting new reports and updates on guidelines that could help better inform our efforts and ultimately reduce STIs. In May, the World Health Organization (WHO) released a new report highlighting increasing STI incidence rates globally. This report notes that syphilis, gonorrhea, chlamydia, and trichomoniasis account for more than one million infections daily. It also showed an increase in multi-drug resistant gonorrhea, highlighting the need for diagnostics to properly detect and treat infections. Two weeks later, the U.S. Centers for Disease Control and Prevention (CDC) released much-needed clinical guidelines on the use of doxycycline postexposure prophylaxis (DoxyPEP) for STI prevention—and AVAC launched the Advocates’ Guide to DoxyPEP, a helpful tool in understanding the science to date and considerations for future research and implementation. While STI prevention and treatment options remain limited, these updates represent progress in understanding who is impacted by STIs and developing interventions to meet their needs. 

STI Advocacy Updates

In October, AVAC awarded funding to seven advocacy partners in Southern and East Africa to identify and share needs for STI prevention in their communities. Partners presented this work to a global audience, which is helping to build an advocacy agenda to accelerate development of new STI vaccines, diagnostics, and other prevention tools and strategies. In June, AVAC provided additional funding to support the ongoing STI work of these partners. Lookout for additional details about their progress in the coming months.

With syphilis and congenital syphilis rising in many countries, AVAC is following the work of Healthy Futures Global, a non-profit focused on the prevention of vertical transmission of syphilis. They are partnering with the Philippine Department of Health to understand how best to implement testing for HIV and syphilis in pregnancy with the ultimate goal of testing all pregnant Filipinas for HIV and syphilis. Subscribe to their newsletter here. 

Upcoming Events

  • STI International Exchange (STIIX) Virtual Conference Series
    July 12, 2024
    In this virtual conference series STIIX will explore inequalities in sexual health and HIV across the United States and how to improve access to services for vulnerable communities. Registration is free and open to all.
  • AIDS 2024 Preconference: Mobilize for Action on Sexually Transmitted Infections!
    July 21, 2024
    The WHO, International AIDS Society (IAS), and International Union Against STIs (IUSTI) will host a pre-conference session during AIDS 2024 to explore pressing issues in STI prevention, testing, and treatment options. AVAC Senior Program Manager for STIs, Dr. Alison Footman, and AVAC Executive Director, Mitchell Warren, will speak at the pre-conference. In person and virtual participation are available if you are registered for AIDS 2024.
  • National Sexual Health Conference
    July 30-31, 2024
    This virtual conference creates opportunities to share information, efforts, research, and best practices related to sexual health across the lifespan.
  • IUSTI + STI Prevention
    September 16-20, 2024 Registration is now open for two important STI conferences in September – which unfortunately are running concurrently in different parts of the world!

    The 2024 STI Prevention Conference will bring 1,200 conference attendees to Atlanta, Georgia, from September 16-19, 2024. Abstracts are being accepted until March 29.

    The 25th IUSTI World Congress will take place September 17-20, 2024, in Sydney, Australia, and provide an opportunity to meet, discuss and learn about the latest research and innovation in sexual and reproductive health.
  • National Coalition for Sexual Health (NCSH) Annual Meeting
    September 26, 2024
    The virtual NCSH Annual Meeting will include two panels: 1. Overcoming Obstacles: Sexual Health Censorship and Misinformation on Social Media and 2. Increasing the Appeal of STI Prevention Tools: Both Old and the New, and a Q&A session with a leader from the Division of STD Prevention, CDC.

New Resources

Doxycycline, an oral antibiotic, can be used as a post-exposure prophylaxis, commonly referred to as DoxyPEP, when used to prevent the acquisition of some bacterial STIs after sex. Doxycycline is inexpensive, easily tolerated, and widely available. However, questions remain regarding who will benefit most from DoxyPEP and how to implement this strategy broadly to ensure equitable access and minimize antimicrobial resistance. This guide seeks to explore and address these critical questions. 

Webinar & Event Recordings

What We’re Reading

  • Dual Epidemics: Leveraging HIV Infrastructure to Support HPV prevention, Testing, and Cervical Cancer Elimination Goals. This policy brief explores the challenges in treatment, prevention and care of those affected by HIV and human papilloma virus (HPV), and the opportunities for integrated funding and service delivery to galvanize the attention and support needed to improve lives.  
  • Syphilis Has Surged for Reasons That Go Beyond the Pathogen That Causes It. This perspectives piece highlights the rising rates of syphilis and congenital syphilis cases. Data from 2022 showed that lack of timely testing and adequate treatment contributed to 88% of congenital syphilis cases in the U.S. Additionally, fewer people have a primary care clinician and are seeking care in emergency departments, where syphilis testing capabilities are limited. There is need for a more comprehensive, syndemic-based, and strategic approach that includes addressing social determinants of health to help better detect and treat syphilis cases. 
  • Gaps in the prevention of mother-to-child transmission of syphilis: a review of reported cases, South Africa, January 2020–June 2022. Within this study, authors found that syphilis testing and treatment among pregnant women in South Africa fell short of WHO’s congenital syphilis elimination goal where more than 95% of pregnant women receive at least one antenatal visit, more than 95% of pregnant women are tested for syphilis, and more than 95% of pregnant women with syphilis receive treatment. Barriers to syphilis treatment included presenting late to antenatal care and delays in receiving syphilis test results. On-site, rapid syphilis testing has shown to decrease treatment delays, especially in settings with limited laboratory facilities. 
  • Millions of Girls in Africa Will Miss HPV Shots After Merck Production Problem. Merck will deliver only 18.8 million of the 29.6 million doses it was contracted to deliver in 2024 to low- and middle-income countries (LMICs) after a manufacturing disruption. While Merck plans to deliver delayed doses in 2025, this continues to delay implementation of HPV vaccines in LMICs that have waited years to begin vaccinating adolescent girls against HPV, the leading cause of cervical cancer. 

To learn more about AVAC’s STI Program, visit STIWatch.org and avac.org/sti. Email sti@avac.org for questions or additional information. And to sign up for specific updates on STIs, click here.

Advocates’ Guide to Doxycycline to Prevent Bacterial STIs (DoxyPEP)

Doxycycline, an oral antibiotic commonly referred to as DoxyPEP, is a post-exposure prophylaxis used to prevent the acquisition of some bacterial STIs after sex. Doxycycline is inexpensive, easily tolerated, and widely available. However, questions remain regarding who will benefit most from DoxyPEP and how to implement this strategy broadly to ensure equitable access. This guide seeks to explore and address these critical questions.

Advocacy to Accelerate Prevention R&D for Sexually Transmitted Infections

AVAC Case for Support

AVAC accelerates the development and delivery of STI prevention options by fostering collaborations with STI and HIV research advocates, developing new STI vaccines and diagnostics, and creating tools to monitor STI research and investment activities.

STIWatch Newsletter, March 2024

The first quarter of 2024 ends with new research and questions on the future directions of STI vaccines and diagnostics. The Conference on Retroviruses and Opportunistic Infections (CROI) was the setting for positive news on the potential for early use of doxycycline to prevent STIs (DoxyPEP) in real-world settings and questions about its effectiveness in cisgender women given major evidence gaps. Important discussions and debates continued around the issue of antimicrobial resistance (AMR), as the field continues to grapple with the rollout of DoxyPEP. Presentations at CROI also highlighted the need for new diagnostics for syphilis as infections continue to increase globally and the need for STI advocacy efforts to ensure these infections get the attention and funding needed to develop vaccines and diagnostics that can prevent, detect, and treat these infections!    

In January, the US Centers for Disease Control and Prevention (CDC) released the STI surveillance data from 2022, which showed an increase in chlamydia and syphilis cases from 2021. Gonorrhea cases decreased between 2021 and 2022 by 9%. Alarmingly, 2022 congenital syphilis cases increased by 30% from 2021, signaling an urgent need for novel prevention, treatment, and testing methods.  

In Australia, a group of researchers published a response to the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine’s October 2023 statement on the use of DoxyPEP in Australia. The authors point to the potential threat of increasing AMR and the urgent need to implement measures to monitor DoxyPEP use and its impact.  

Read on for upcoming webinars, must-read resources supporting advocacy for improved funding and commitments for STI vaccines and diagnostics. Afterwards, test your knowledge with AVAC’s new STI Trivia quiz.  

New Report! STIs: A Review of the 2022 Vaccine and Diagnostic R&D Pipeline and Investments 

STI Vaccine and Diagnostic R&D Funding by Pathogen

A new AVAC report tracks funding trends in vaccine and diagnostics R&D, and pipeline investments for some of the most common STIs, including chlamydia, genital herpes, gonorrhea, hepatitis B, human papillomavirus (HPV), syphilis, and trichomoniasis. The report finds that STI research remains underfunded and neglected compared to other infectious diseases. Read the report to learn more.

STI Advocacy Updates

AVAC spoke with two cervical cancer advocates, Tamika Felder and Karen Nakawala, in January as part of its cervical cancer webinar series. Felder and Nakawala are breaking taboos and saving lives by empowering people to share their stories of survivorship and senseless loss. 

Felder, founder of Cervivor, Inc., was diagnosed with cervical cancer at 25, and turned her struggle into a mission, providing resources and a platform for those affected by the disease. Her impactful work and advocacy inspired Nakawala to found the Teal Sisters Foundation in 2020, following her successful treatment for cervical cancer. To learn more about Tamika and Karen, watch AVACs cervical cancer webinar. Thank you, Tamika and Karen for all that you do!  

January 18 marked HPV Awareness Day. AVAC and TogetHER for Health released an updated call to action to improve HPV vaccination among people living with HIV. In total, 31 organizations signed on to this call, urging global leadership to increase access to lifesaving HPV vaccines for people living with HIV.

Upcoming Events

STI Awareness Week is April 14 – 20!

Join us for two webinars focused on syphilis and DoxyPEP. These webinars are intended for health care providers, civil society organizations, public health officials, and others working in the STI/HIV fields. 

September 2024 STI Conferences

REGISTRATION IS NOW OPEN FOR TWO IMPORTANT STI CONFERENCES IN SEPTEMBER – WHICH UNFORTUNATELY ARE RUNNING CONCURRENTLY IN DIFFERENT PARTS OF THE WORLD!

The  2024 STI Prevention Conference will bring 1,200 conference attendees to Atlanta, Georgia, from September 16-19, 2024. Abstracts are being accepted until March 29. 

The  25th IUSTI World Congress  will take place September 17-20, 2024, in Sydney, Australia, and provide an opportunity to meet, discuss and learn about the latest research and innovation in sexual and reproductive health.  

What We’re Reading and Resources

  • Testing, testing: the advancing diagnostics for sexually transmitted infections. Diagnostics are urgently needed to detect STIs and this article examines several that are on the horizon. A US-Based company, Qvin is developing the Q-pad, a diagnostic menstrual pad with a removable strip to identify signs of diabetes and symptoms of high-risk human papillomavirus. Daye, a UK based gynecological start-up, launched a diagnostic product that is a tampon with the ability to screen for STIs. These advancements are exciting and serve as a reminder that advocacy is needed to ensure these products get to the people who need them. 
  • CARB-X Funds Visyby Medical to Develop a portable rapid diagnostic for Gonorrhea Including Antibiotic Susceptibility Combating Antibiotic-Resistant Bacteria Biopharmaceutical Accelerator (CARB-X) will award up to US$1.8 million to biotechnology company, Visby Medical, to develop a portable rapid polymerase chain reaction (PCR) diagnostic to detect gonorrhea and its susceptibility to ciprofloxacin, a former frontline oral antibiotic that can no longer treat gonorrhea infections resistant to this medication. Funding will also support development of a test for gonorrhea, chlamydia, and trichomoniasis in men based on urine samples.
  • Syphilis Complicating Pregnancy and Congenital Syphilis. This manuscript provides a review of syphilis during pregnancy and congenital syphilis. As syphilis and congenital syphilis infections continue to rise, novel approaches are needed to detect, prevent, and treat infections. Because syphilis disproportionately affects populations with limited access to healthcare, new and improved diagnostics and therapeutics will need to be embedded within a health framework that prioritizes equity to improve the diagnosis and treatment of congenital syphilis, a preventable disease.  
  • Near-to-patient-testing to inform targeted antibiotic use for sexually transmitted infections in a public sexual health clinic: the NEPTUNE cohort study. This study examines the effectiveness of a novel lateral flow assay for point-of-care detection of gonorrhea among people with symptoms. Lateral flow assays are tests that can detect the presence of proteins or antigens for specific infections, like COVID-19 and HIV. This test had excellent clinical sensitivity and specificity in detecting gonorrhea among male and female patients with symptoms. A test like this could provide an important tool to better detect infections in settings without direct access to laboratory testing and reduce overtreatment.
  • Breaking Barriers in STI Clinical Management: Addressing Resistance Challenges and Incorporating New Diagnostic Approaches. This on-demand webinar features Dr. Van Der Pol and Dr. William Geisler who share their insights on crucial aspects of STI clinical management, focusing on resistance challenges and new diagnostic approaches. 

To learn more about AVAC’s STI Program, visit STIWatch.org and avac.org/sti. Email sti@avac.org for questions or additional information. And to sign up for specific updates on STIs, click here.

STI Diagnostic R&D Funding by Pathogen

This bar chart shows STI diagnostic research & development funding by pathogen.

Excerpted from STIs: A Review of the 2022 Vaccine and Diagnostic R&D Pipeline and Investments, the full report is available at stiwatch.org/resource-tracking.