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Cefixime + doxycycline is less effective against pharyngeal gonorrhoea than ceftriaxone + azithromycin
In a randomised controlled trial, 161 patients diagnosed with uncomplicated urogenital, rectal or pharyngeal gonorrhoea were treated with either single-dose cefixime (800 mg) plus doxycycline (100 mg two times per day for 7 days) or single-dose ceftriaxone (1 g) plus single-dose azithromycin (2 g). At week 1, both treatment arms achieved 100% microbiological clearance. However, by week 3, the cefixime-doxycycline arm demonstrated reduced effectiveness with 92% culture negativity and 87% Nucleic Acid Amplification Tests (NAAT) negativity. This regimen was especially less effective for pharyngeal gonorrhoea cases, achieving only 46% clearance. The ceftriaxone-azithromycin arm maintained a 100% negative rate in both tests. No serious adverse events were reported, underscoring the safety of both treatments.
Bížová B, Procházka P, Nyčová E, et al. Single-dose cefixime 800 mg plus doxycycline 100 mg twice a day for 7 days compared with single-dose ceftriaxone 1 g plus single-dose azithromycin 2 g for treatment of urogenital, rectal and pharyngeal gonorrhoea: a randomised clinical trial. Clin Microbiol Infect. 2024;30:211–5.
A 6-monthly injectable regimen of teropavimab, zinlirvimab and lenacapavir against HIV-1: insights from a phase 1b study
This proof-of-concept study investigated a novel antiretroviral treatment (ART) combination suitable for two times per year dosing: two broadly neutralising antibodies, teropavimab and zinlirvimab, plus the capsid inhibitor lenacapavir. Eligible participants were virologically suppressed, had CD4 counts ≥500 cells/mm3, and were pre-screened for viral susceptibility to both neutralising antibodies. After stopping their current ART regimen, 21 individuals were randomly assigned to one dose of subcutaneous lenacapavir plus an oral loading dose, intravenous teropavimab (30 mg/kg), and one of two dose levels of intravenous zinlirvimab (10 mg/kg or 30 mg/kg). Injection-site reactions were common, but over 26 weeks no serious adverse events were reported. One participant (lower dose zinlirvimab) experienced viral rebound, followed by resuppression on resuming ART. These promising results support ongoing clinical development of the combination.
Eron JJ, Little SJ, Crofoot G, et al. Safety of teropavimab and zinlirvimab with lenacapavir once every 6 months for HIV treatment: a phase 1b, randomised, proof-of-concept study. Lancet HIV. 2024;11:e146–55.
The global burden of HPV vaccine inequity and HPV disease
Cervical cancer remains a leading cause of cancer mortality, particularly in low-income and middle-income countries. This modelling study, using WHO and UNICEF data, evaluated the lifetime projections of cervical cancer in relation to Human Pailloma Virus (HPV) vaccine coverage in 84 countries. Between 2010 and 2022, average vaccine coverage varied from 1% to 93% within countries. The analysis reveals significant inequities in HPV vaccine coverage, particularly favouring high-income countries with lower cervical cancer burdens. In contrast, countries with a high burden of cervical cancer had relatively lower coverage. The health impact of vaccination varied across the 84 countries, ranging from 2 to 34 deaths, 4 to 47 cases and 40 to 735 disability-adjusted life years (DALYs) averted per 1000 vaccinated adolescent girls over their lifetime. It is hoped that the new single-dose schedule recommended by WHO will improve equitable vaccine distribution.
Abbas K, Yoo KJ, Prem K, Jit M. Equity impact of HPV vaccination on lifetime projections of cervical cancer burden among cohorts in 84 countries by global, regional, and income levels, 2010–22: a modelling study. EClinicalMedicine. 2024;70:102 524.
Should asymptomatic three-site screening for N. gonorrhoeae and C. trachomatis be abandoned in PrEP users?
International guidelines recommend that men who have sex with men and transgender women receiving HIV pre-exposure prophylaxis (PrEP) undergo a three-site testing for Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) every 3 months (3×3). This randomised trial compared the effect of screening (n=506) versus non-screening (n=508) on the incidence of NG/CT in PrEP users in Belgium. Participants attended quarterly for 12 months; NG/CT were tested at each visit (at months 3, 6 and 9 after enrolment) in both arms, but results were only provided to the non-screening arm if symptomatic. Overall NG/CT incidence was 0.205 cases per 100 person-days in the non-screening arm versus 0.155 in the screening arm (incidence rate ratio 1.32; 95% CI 1.07 to 1.63). The difference was driven by higher CT incidence in the non-screening arm. Participants in the non-screening arm consumed significantly fewer antimicrobial drugs. Further research is needed to evaluate the role of asymptomatic screening in this population.
Vanbaelen T, Tsoumanis A, Florence E, et al. Effect of screening for Neisseria gonorrhoeae and Chlamydia trachomatis on incidence of these infections in men who have sex with men and transgender women taking HIV pre-exposure prophylaxis (the Gonoscreen study): results from a randomised, multicentre, controlled trial. Lancet HIV. 2024;11:e233–e244.
The CD4:CD8 ratio predicts cancer risk in treated people with HIV
The study explored the association between CD4:CD8 ratios and the 12-month risk of malignancies in ART-treated people living with HIV in the European RESPOND cohort. Malignancies were divided into AIDS-defining malignancies (ADM), non-ADMs, smoking-related malignancies, infection-related malignancies and body mass index-related malignancies. Among over 30 000 individuals, CD4:CD8 ratios <0.5 (vs >1.0) were associated with increased risks of ADMs and infection-related cancers, independent of CD4 cell counts. Elevated CD8 cell counts were not significant markers for malignancies, whereas CD4 counts <350 cells/mm3, unsuppressed viraemia and CD4:CD8 ratios <0.5 were associated with a higher risk of various cancers. These findings suggest the importance of monitoring CD4:CD8 ratios in HIV care.
Chammartin F, Mocroft A, Egle A, et al. Measures of longitudinal immune dysfunction and risk of AIDS and non-AIDS defining malignancies in antiretroviral-treated people with Human Immunodeficiency Virus. Clin Infect Dis. 2024;78:995–1004.
Published in STI: both vaccination and changes in sexual behaviour modulate mpox epidemiology
Investigators at Center for Disease Control and Prevention (CDC) modelled the impact of sexual behaviour adaptations and vaccination on mpox cases during the 2022 outbreak in the USA. The model included data on JYNNEOS vaccine administration and reported reductions in partner acquisition by gay, bisexual and other men-who-have-sex-with-men (MSM). The model evidenced that initial decreases in mpox cases were primarily due to behavioural adaptation, while vaccination was instrumental in ultimately controlling the outbreak. The combined effect of behaviour changes and vaccination averted approximately 84% of the potential cases. Anticipating vaccination by 28 days from the planned appointment would have decreased cumulative cases by 34%; conversely delaying vaccination by 28 days would have increased cumulative cases by 27%. The findings highlight the synergistic role of behavioural interventions and widespread vaccination efforts to control and rapidly conclude outbreaks.
Clay PA, Asher JM, Carnes N, et al. Modelling the impact of vaccination and sexual behaviour adaptations on mpox cases in the USA during the 2022 outbreak. Sex Transm Infect. 2024;100:70–6.
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Footnotes
Handling editor Anna Maria Geretti
X @GvillaDr
Contributors All authors contributed to the selection of articles and to the writing of summaries. SR submitted the final version to the journal and is the guarantor.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Commissioned; internally peer reviewed.