Research news in clinical context
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* Stefano Rusconi
* Rayner K J Tan
* Francesca Ceccherini-Silberstein

## Syphilis cases are concentrated in three men who have sex with men (MSM) population groups in Europe: PrEP (Pre-Exposure Prophylaxis) users, sex workers and people living with HIV

In this two-wave web-based survey of European MSM (n=278 256 participants across 31 countries), the proportion of respondents self-reporting a syphilis diagnosis in the previous 12 months rose from 2.3% in 2010 to 4.5% in 2017. In adjusted analyses, factors associated with a syphilis diagnosis comprised STI screening in the previous month versus no screening (adjusted OR (aOR) 25.76), HIV PrEP use (aOR 3.02), living with HIV (aOR 2.67), selling sex (aOR 1.45) and a greater number of non-steady condomless anal intercourse (CAI) partners (aOR 1.01 for each additional partner). The association between PrEP use and a syphilis diagnosis was mediated by a higher likelihood of recent STI screening and a greater number of non-steady CAI partners, both of which increased substantially in 2017 compared with 2010.

Mendez-Lopez A, Stuckler D, *et al*. Social and behavioural determinants of syphilis: Modelling based on repeated cross-sectional surveys from 2010 and 2017 among 278,256 MSM in 31 European countries. *Lancet Reg Health Eur* 2022;22:100483. doi: 10.1016/j.lanepe.2022.100483.

## Published in STI: inequities in access to sexual and reproductive health care persisted during the COVID-19 pandemic in Britain

In this cross-sectional web-based survey, 3869 sexually active participants aged 18–44 years in Britain self-reported on unmet need for condoms and uptake of chlamydia and HIV testing and cervical cancer screening in March–April 2021. Overall, 6.9% of women and 16.2% of men reported unmet need for condoms because of the pandemic, and this was more likely among young people, MSM and people of black ethnicity. Comparing the results with those of the British National Survey of Sexual Attitudes 2010–2012 (Natsal-3, n=8551), patterns of differential access remained, with younger participants, those reporting condomless sex with new partners, and MSM being more likely to test for chlamydia and HIV. While the pandemic might not have exacerbated inequalities in access, large inequalities persisted, typically affecting those at greatest STI and HIV risk.

Dema E, Sonnenberg P, Gibbs J, et al. How did the COVID-19 pandemic affect access to condoms, chlamydia and HIV testing, and cervical cancer screening at a population level in Britain? (Natsal-COVID). Sex Transm Infect 2022 Aug 18:sextrans-2022-055516. doi: 10.1136/sextrans-2022-055516. Online ahead of print.

## Low uptake of STI testing among sexually active high school students in the USA

Using data from the national Youth Risk Behaviour Survey, investigators reported the first national estimates of STI testing (other than HIV) among a representative sample of 2501 sexually active US high school students and examined the relationships between testing and the characteristics of sex, age, race and ethnicity, sexual identity and sex of sexual contact. In 2019, 20% reported STI testing in the previous 12 months. Proportions were higher for women (26%) than men (14%), and among women, they increased with age, from 13%,≤15 years, to 37% ≥18 years. For men, there were no differences by characteristics. For both men and women, sexual behaviours (eg, condom use and number of partners) modulated STI testing. There is a need to improve implementation of STI screening guidelines, particularly for sexually active female adolescents and young MSM.

Liddon N, Pampati S, Dunville R, *et al*. Annual STI Testing Among Sexually Active Adolescents. *Pediatrics* 2022;149(5):e2021051893

## Cross-talk between mRNA SARS-CoV-2 vaccination and the HIV reservoir

Inducing HIV reactivation from latency so that it may be targeted by the immune response is part of ‘shock and kill’ strategies aiming at curing HIV infection. In this study of people living with HIV and receiving antiretroviral therapy, SARS-CoV-2 vaccination with BNT162b2 was followed by activation of the RIG-I (retinoic acid-inducible gene-I)/TLR (toll like receptor)–TNF (tumor necrosis factor)-α–NFκb (nuclear factor kappa-light-chain-enhancer of activated B cells) innate pathway and transcription of HIV provirus from peripheral blood mononuclear cells, without infected cell activation and with minimal perturbation of host transcription. There was transient expansion and activation of primarily Nef-specific effector CD8 T cells and decreases in cell-associated HIV mRNA, suggesting killing or suppression of cells transcribing HIV. Of note, there was no significant depletion of intact proviruses. These findings raise hopes that mRNA-based HIV therapeutic vaccines may benefit from intrinsic latency reversing activity and support the central role of Nef-specific CD8 T cells.

Stevenson EM, Terry S, Copertino D, *et al.* SARS CoV-2 mRNA vaccination exposes latent HIV to Nef-specific CD8+ T-cells. *Nat Commun* 2022;13:4888. doi: 10.1038/s41467-022-32376-z.

## Effectiveness of the 4CMenB vaccine against gonorrhoea among young people

In 2018–2019, South Australia implemented the four-component serogroup B meningococcal (4CMenB) vaccine for infants, young children and people aged 15–20 years. As *Neisseria meningitidis* serogroup B and *N. gonorrhoeae* share cross-reactive outer membrane proteins, researchers analysed the effectiveness of 4CMenB against gonorrhoea in 53 356 adolescents and young adults who received at least one vaccine dose, including 46 083 who received two doses. Linking data from the regional disease notification database, they compared people with gonorrhoea as cases (n=512) and those with chlamydia as controls (n=3140), concluding that 4CMenB was 33% effective against gonorrhoea (95% CI 8 to 51) versus no vaccine. In North America, 4CMenB was also found to be moderately (40–59%) effective against gonorrhoea among adolescents and young adults.1 2 While many unknowns remain, the data support the concept of a gonorrhoea-specific vaccine.

Wang B, Giles L, Andraweera P, *et al.* Effectiveness and impact of the 4CMenB vaccine against invasive serogroup B meningococcal disease and gonorrhoea in an infant, child, and adolescent programme: an observational cohort and case-control study. Lancet Infect Dis 2022;22:1011–1020. doi: 10.1016 /S1473-3099(21)00754-4. Epub 2022 Apr 12.

## Monkeypox outbreak across 41 countries in the WHO European region

Between 7 March and 22 August 2022, 21 098 cases of monkeypox virus infection were reported through the European Surveillance System. The median age was 37 years (IQR 31–44). Where data were available, most infections (99%, 17 685/17 896) were in men, and most men (97%, 8771/9053) self-identified as MSM; transmission occurred mainly (94%, 6385/6797) through close contact during sexual activities; and most people (82%, 2577/3152) had never received smallpox vaccination. Hospitalisation was uncommon (overall rate 10/1000), but three cases were admitted to intensive care and two died with encephalitis. People reported to be living with HIV accounted for 37% (3070/8257) of cases; their hospitalisation rate was 12/1000 cases vs 10/1000 for 8257 HIV-negative people (p=0.441). Ongoing studies are tracking epidemiological trends, disease severity among people with underlying conditions and the effectiveness of smallpox vaccines.

Vaughan AM, Cenciarelli O, Colombe S, *et al.* A large multi-country outbreak of monkeypox across 41 countries in the WHO European Region, 7 March to 23 August 2022. *Euro Surveill* 2022 Sep;27(36). doi: 10.2807/1560–7917.ES.2022.27.36.2200620.

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## Footnotes

*   Handling editor Anna Maria Geretti

*   Twitter @raynerkjtan

*   Contributors All authors contributed to the selection of articles and to the writing of summaries. SR submitted the final version to the journal.

*   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.

## References

1.   Abara WE , Bernstein KT , Lewis FMT , et al . Effectiveness of a serogroup B outer membrane vesicle meningococcal vaccine against gonorrhoea: a retrospective observational study. Lancet Infect Dis 2022;22:1021–9.[doi:10.1016/S1473-3099(21)00812-4](http://dx.doi.org/10.1016/S1473-3099(21)00812-4) pmid:http://www.ncbi.nlm.nih.gov/pubmed/35427490 
    
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2.   Longtin J , Dion R , Simard M , et al . Possible impact of wide-scale vaccination against serogroup B Neisseria meningitidis on gonorrhea incidence rates in one region of Quebec, Canada. Open Forum Infect Dis 2017;4:S734–5.[doi:10.1093/ofid/ofx180.002](http://dx.doi.org/10.1093/ofid/ofx180.002) 
    
    [CrossRef](http://sti.bmj.com/lookup/external-ref?access_num=10.1093/ofid/ofx180.001&link_type=DOI)