Through statistical analyses of information from the Centers for Disease Control, as well as pharmaceutical industry sales data, investigators found that US states with higher AIDS prevalence experienced significantly larger increases in syphilis after highly active antiretroviral therapy (HAART) became widely available—with these increases concentrated among men, while rates among women continued to decline—suggesting that changes in sexual behavior following the reduced perceived risk of HIV had broader public health effects.

Data indicated that in the absence of HAART, there would have been 81% fewer syphilis cases between 1996 and 2008.

“With syphilis now at a 60‐year high, these findings offer timely insight into how life‐saving innovations can reshape population behavior and highlight the need for complementary public‐health strategies,” said corresponding author David Beheshti, PhD, of the University of Texas at San Antonio.

URL upon publication: https://onlinelibrary.wiley.com/doi/10.1002/hec.70100

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Q: How would you summarize your study for a lay audience?

Although adolescents and young adults comprise only one quarter of the sexually active population in the United States, approximately half of new sexually transmitted infections (STIs) are diagnosed in people of these ages. Compared to older adults, little is known about how teens and young adults access and use services like STI screening and treatment, sexual health vaccinations and HIV pre-exposure prophylaxis (PrEP). PrEP is a preventive medicine for people who do not have HIV but are at increased risk of exposure.

Our study examined how people of different ages and genders used sexual health services in a Boston-based clinic that provides free, comprehensive services across six hospital- and community-based sites. While our study focused on a single metropolitan area, our findings reflect broader national challenges in sexual health service utilization.

Q: What question were you investigating?

We set out to learn whether adolescents and young adults who interacted with the Massachusetts General Hospital Sexual Health Clinic utilized sexual health services differently than older adults. We also aimed to identify opportunities to increase patient engagement and deliver existing services more consistently and equitably to those who need them most.

Q: What methods or approach did you use?

We analyzed data from 7,949 visits to the Sexual Health Clinic, made by 4,004 individuals, between January 2019 to June 2021. We grouped data on visits, STI diagnoses, PrEP use and health insurance by age and gender. We then used statistical analysis to examine how outcomes—such as being prescribed preventive PrEP—were associated with factors like age and gender.

Q: What did you find?

We found that among patients at increased risk for HIV exposure, PrEP prescribing differed by age and gender. For example, cisgender males who were 26 years old or under with PrEP indications were prescribed the medicine at slightly higher rates (86%) than their counterparts over age 26 (83%). However, among cisgender females at increased risk, only 20% of those at or under age 26 were prescribed PrEP compared to 72% of those over age 26.

Looking at the data from another angle, we discovered that young cisgender females (at or under age 26) were 63% less likely to be prescribed PrEP during their visits than young cisgender males. Additionally, only 17% of visits attended by even younger cisgender females (under age 22) who were candidates for PrEP received it.

Q: What are the implications?

Addressing disparities by age, gender and race/ethnicity in HIV prevention—via PrEP prescriptions—is critical. Significant gaps for young cisgender females with PrEP indications reflect opportunities for improved programming tailored to this population, with the potential to avert new HIV diagnoses.

Gaps between PrEP need and prescription may also reflect patient preferences or other barriers such as the need for quarterly visits for oral PrEP or anticipated costs. They could also reflect provider-related barriers, such as limited knowledge of the drug or failure to consider PrEP for individuals other than men who have sex with men. Policy efforts focused on alleviating these barriers may help reduce HIV incidence by improving how well PrEP reaches those who would benefit from it.

Q: What are the next steps?

Future work should explore why PrEP prescription rates among young cisgender females are much lower than their counterparts, as well as evaluate targeted interventions to improve PrEP access for indicated young women.

Authorship: In addition to Neilan and Ard, Mass General Brigham authors include Yiqi Qian, Grace Chamberlin, Scott E. Hadland, Madhava Narasimhadevara, Vandana Madhavan and Fatma M. Shebl.

Paper cited: Neilan, A., et al. “Differences in Sexual Health Clinic Services by Age and Gender in Metropolitan Boston.” Sexually Transmitted Diseases. DOI: 10.1097/OLQ.0000000000002275

Funding: This work was supported by the Morton N. Swartz Transformative Scholar Award in Infectious Diseases, the Claflin Distinguished Scholars Award and the Eunice Kennedy Shriver National Institute for Child Health and Human Development (K08 HD094638-S).

Disclosures: None.

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The guideline is published on World AIDS Day, December 1, 2025, to raise awareness of new approaches to prevention.

Pre-exposure prophylaxis involves an HIV-negative person starting antiretroviral medications before potential HIV exposures occur in order to prevent infection. Postexposure prophylaxis involves taking 28 days of antiretrovirals right after a potential exposure to HIV.

“Canada is not at all on track to achieve its goal of eliminating HIV as a public health threat by 2030. Our aim with this guideline is to support front-line health care providers, policy-makers, community members, and others in expanding the use of these safe and effective tools for preventing HIV,” says Dr. Darrell Tan, lead author and infectious disease physician at St. Michael’s Hospital, Toronto, Ontario. “A wide array of PrEP and PEP options now exists in Canada. We need to urgently expand their use until all people have equitable access to prevention strategies that they find suitable.”

HIV infections in Canada are concentrated in specific populations, with 38% of new infections in gay, bisexual, and other men having sex with men (GBM); 25% in people who inject drugs (PWID); and 4% in GBM-PWID. More than one-third of infections occur in females. Some Indigenous communities are particularly heavily affected, with more cases in Saskatchewan and Manitoba than the national average.

The guideline, an update to 2017 guidance, was developed through the Canadian Institutes of Health Research (CIHR) Pan-Canadian Network for HIV and STBBI (sexually transmitted and blood-borne infections) Clinical Trials Research (CTN+). It includes easy reference tables with recommendations on medication regimens, indications, monitoring, and more.

Key differences from the 2017 guideline include the “explicit inclusion of self-identified need as a reason for PrEP initiation” and the expanding range of available PrEP choices, with newer regimens including an injection given every 2 months.

The authors’ aim is to support clinical decision-making in primary care, infectious diseases, emergency medicine, sexual health, nursing, pharmacy, and related disciplines, as well as community workers who promote PrEP and PEP.

“Because lack of PrEP and PEP awareness among key populations and clinicians is a common barrier to implementation, public health officials, professional societies, and other trusted authorities should play leadership roles in promoting these strategies in collaboration with community organizations and tracking uptake in conjunction with HIV surveillance data,” the authors write. “Information should be framed in a positive light to counteract the stigma and apprehension that sometimes surround PrEP and PEP.”

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A report from Cambridge’s Minderoo Centre for Technology and Democracy argues that the financial worth of this data is “vastly underestimated” by users who supply profit-driven companies with highly intimate details in a market lacking in regulation.

The report’s authors caution that cycle tracking app (CTA) data in the wrong hands could result in risks to job prospects, workplace monitoring, health insurance discrimination and cyberstalking – and limit access to abortion.

They call for better governance of the booming ‘femtech’ industry to protect users when their data is sold at scale, arguing that apps must provide clear consent options rather than all-or-nothing data collection, and urge public health bodies to launch alternatives to commercial CTAs.

“Menstrual cycle tracking apps are presented as empowering women and addressing the gender health gap,” said Dr Stefanie Felsberger, lead author of the report from Cambridge’s Minderoo Centre. “Yet the business model behind their services rests on commercial use, selling user data and insights to third parties for profit.”

“There are real and frightening privacy and safety risks to women as a result of the commodification of the data collected by cycle tracking app companies.”

As most cycle tracking apps are targeted at women aiming to get pregnant, the download data alone is of huge commercial value, say researchers, as – along with home buying – no other life event is linked to such dramatic shifts in consumer behaviour.

In fact, data on pregnancy is believed to be over two hundred times more valuable than data on age, gender or location for targeted advertising. The report points out that period tracking could also be used to target women at different points in their cycle. For example, the oestrogen or ‘mating’ phase could see an increase in cosmetics adverts.

Just the three most popular apps had estimated global download figures of a quarter of a billion in 2024. So-called femtech – digital products focused on women’s health and wellbeing – is estimated to reach over US$60 billion by 2027, with cycle tracking apps making up half of this market.

With such intense demand for period tracking, the report argues that the UK’s National Health Service (NHS) should develop its own transparent and trustworthy app to rival those from private companies, with apps allowing permission for data to be used in valid medical research.

“The UK is ideally positioned to solve the question of access to menstrual data for researchers, as well as privacy and data commodification concerns, by developing an NHS app to track menstrual cycles,” said Felsberger, who points out that Planned Parenthood in the US already has its own app, but the UK lacks an equivalent.

“Apps that are situated within public healthcare systems, and not driven primarily by profit, will mitigate privacy violations, provide much-needed data on reproductive health, and give people more agency over how their menstrual data is used.”

“The use of cycle tracking apps is at an all-time high,” said Prof Gina Neff, Executive Director of Cambridge’s Minderoo Centre. “Women deserve better than to have their menstrual tracking data treated as consumer data, but there is a different possible future.”

“Researchers could use this data to help answer questions about women’s health. Care providers could use this data for important information about their patients’ health. Women could get meaningful insights that they are searching for,” Neff said.

In the UK and EU, period tracking data is considered “special category”, as with that on genetics or ethnicity, and has more legal safeguarding. However, the report highlights how in the UK, apps designed for women’s health have been used to charge women for illegally accessing abortion services*

In the US, data about menstrual cycles has been collected by officials in an attempt to undermine abortion access.** Despite this, data from CTAs are regulated simply as “general wellness” and granted no special protections.

“Menstrual tracking data is being used to control people’s reproductive lives,” said Felsberger. “It should not be left in the hands of private companies.”

Investigations by media, non-profit, and consumer groups have revealed CTAs sharing data with third parties ranging from advertisers and data brokers to tech giants such as Facebook and Google.

The report cites work published last month from Privacy International showing that, while the major CTA companies have updated their approach to data sharing, device information is still collected in the UK and US with “no meaningful consent”.

Despite data protection improvements, the report suggests that user information is still shared with third parties such as cloud-based delivery networks that move the data around, and outside developers contracted to handle app functionalities.

At the very least, commercial apps could include delete buttons, says Felsberger, allowing users to erase data in the app as well as the company servers, helping protect against situations – from legal to medical – where data could be used against them.

“Menstrual tracking in the US should be classed as medical data,” said Felsberger. “In the UK and EU, where this data is already afforded special category status, more focus needs to be placed on enforcing existing regulation.”

The report stresses the need to improve public awareness and digital literacy around period tracking. The researchers argue that schools should educate students on medical data apps and privacy, so young people are less vulnerable to health hoaxes.

The report ‘The High Stakes of Tracking Menstruation’ is authored by Dr Stefanie Felsberger with a foreword by Professor Gina Neff and published by the Minderoo Centre for Technology and Democracy (MCTD).

Notes:

*Case studies – UK:

Women accessing illegal abortions:

According to the British Pregnancy Advisory Service (BPAS), from 1967 to 2002 only three women were convicted of having an illegal abortion in England and Wales, but since then the number has increased drastically.  Abortion provider MSI reports of almost ‘60 criminal inquiries in England and Wales since 2018, compared with almost zero before’.

The increased number of investigations does not mean more illegal abortions are taking place, but indicates increased police focus on miscarriages and unexplained cases of pregnancy loss, leaving judges ‘flabbergasted’ as to why some cases reached court.

Women suspected of illegal abortions are pushed into tests during hospital stays after procedures without legal representation. Police have also repeatedly requested data from abortion providers on people who have been turned away from a BPAS clinic because they were over the legal limit for an abortion (which the BPAS has refused to provide). Those under investigation routinely have their phones and other electronic devices confiscated. Police have also made requests for data from menstrual tracking applications in the course of police investigations.

Abortion civil rights organisations have raised their concerns over the use of CTA data in investigations. It is not only data from CTAs, but also text messages and search history that have been used in investigations. Nonetheless, the threat of CTA data being used in police investigations in the UK is of great concern to users. This is taking place in a context where the UK government has put pressure on tech companies to develop inbuilt backdoors into the encrypted services they offer.

**Case studies – US:

Tracking data as court evidence

In 2015, Jeannine Risley reported being sexually assaulted at her boss’ home where the police found a knife, overturned furniture, and a bottle of vodka. She informed police that she lost her FitBit in the struggle with the assailant. When her FitBit was recovered and its data downloaded, the tracker’s movement and heart rate data was taken as contradictory evidence to Risley’s testimony. Risley was charged with making a false report to the police and fabricating evidence.

Preventing abortion access in the United States

Two cases in the US have demonstrated the continuing use of menstrual data against those with periods. In Missouri, the state’s health department kept track of the menstrual cycles of patients in an attempt to investigate failed abortions. Officials also tracked medical ID numbers, gestational age of foetuses, and dates of medical procedures. The investigation led to the withholding of St. Louis’ Planned Parenthood license and led to a state hearing. During President Trump’s first administration, the Office of Refugee Resettlement tracked and monitored the menstrual cycles of unaccompanied minors seeking asylum as part of efforts to prevent them from accessing abortions, even in cases of rape.  The spreadsheet containing dates of menstrual cycles, how long people had been pregnant, whether sex had been consensual, and if they had requested abortion access was made available to the public through a freedom of information request and published by MSNBC.

While in these examples the data did not come from menstrual trackers, but was compiled by others about people’s menstrual cycle, it illustrates how central menstrual tracking data is in efforts to prevent access to abortion services.

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According to Ana Carolina Beleza, one of the authors of the article, there is still a strong taboo surrounding the subject. This leads many women to underestimate the impact of these symptoms on their health, daily life, and sex life. The research noted the contradiction between the prevalence and consequences of vulvovaginal problems. This is because, in addition to asking the participants if they had the symptoms, the questionnaire included scores on how they impacted different aspects of life.

“Even women who reported pain during sex rated the problem as having a low impact on their lives. The scores used to measure the impact of this and other symptoms were much lower than expected, revealing a worrying normalization. It’s important to note that experiencing pain during sex isn’t normal and should be investigated through clinical approaches. The tendency to normalize vulvovaginal symptoms underscores the need for more intimate health education, whether in schools or in healthcare,” argues Beleza, who coordinates the Center for Studies in Physiotherapy in Women’s Health (NEFISM) at UFSCar.

This study, supported by FAPESP, is the first to demonstrate the prevalence of vulvovaginal symptoms in young Brazilian women. According to the results, the most commonly reported symptoms were vaginal discharge (63%), itching (54%), burning (31%), vaginal dryness (30%), vaginal odor (28%), irritation (27%), and pain during intercourse (20%). Fewer than 30% of the participants reported having none of these problems.

The reported issues can have various causes, such as infections, as well as hormonal, dermatological, or muscular changes. While treatable, they can negatively affect emotional well-being, sexual function, self-confidence, and social life.

“This is an issue that requires a more global view, as it involves other aspects that go beyond health, such as cultural and emotional questions and a lack of knowledge about one’s own health,” says Clara Maria de Araujo Silva, the first author of the article and a researcher at NEFISM-UFSCar.

The taboo surrounding vulvovaginal symptoms is reflected in the limited number of studies on the subject. “This is the first one carried out in Brazil and for this age group. Even so, it was a surprise to see the high prevalence of vulvovaginal symptoms among young women. In this age group, symptoms such as pain and burning aren’t expected, since there are no hormonal changes associated with menopause, for example,” says Beleza.

Social determinants of health

The study suggests that, although symptoms are prevalent across all social and educational strata, they may be even more prevalent among women with lower incomes and education levels.

“This opens up a series of questions that we can investigate in future studies. We want to identify other factors, such as income, education, employment, housing conditions, and access to health services, that could influence the occurrence of symptoms. Based on this understanding, it’ll be possible to devise measures to reduce this prevalence and strategies so that these symptoms are no longer normalized,” predicts Beleza.

About FAPESP

The São Paulo Research Foundation (FAPESP) is a public institution with the mission of supporting scientific research in all fields of knowledge by awarding scholarships, fellowships and grants to investigators linked with higher education and research institutions in the state of São Paulo, Brazil. FAPESP is aware that the very best research can only be done by working with the best researchers internationally. Therefore, it has established partnerships with funding agencies, higher education, private companies, and research organizations in other countries known for the quality of their research and has been encouraging scientists funded by its grants to further develop their international collaboration.

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But even with this positive news about increasing use of pre-exposure prophylaxis or PrEP, the study also suggests that health care providers and public health agencies could do more to promote consistent use of these medications.

The new study, done by a team at the University of Michigan Medical School, uses national pharmacy data to look at prescriptions for oral PrEP from 2016 to 2023 among people ages 18 to 25. It’s published in the Journal of General Internal Medicine.

At the start of the study period, 26 of every 100,000 U.S. young adults filled a prescription for PrEP, but this rose to more than 208 by the end of 2023. Prescription dispensing was lower for those ages 18 to 21 than for those ages 22 to 25.

However, the length of time that a person kept refilling their prescription dropped by more than two weeks during this time. This may suggest inconsistent use of PrEP, or trouble keeping up with the regular appointments and tests needed to continue the medication.

It’s the first large study to focus just on this age group, which has an especially high risk of HIV transmission. PrEP, when taken consistently and as prescribed, can reduce the chances of acquiring HIV through sex by 99%.

It’s also an age group that doesn’t see the doctor often, notes Nina Hill, M.D., the lead author of the study.

Hill is a general internist and pediatrician at U-M, a National Clinician Scholar at the U-M Institute for Healthcare Policy and Innovation, and a postdoctoral fellow in the Susan B. Meister Child Health Evaluation and Research Center.

“This is a patient population we often neglect in health care, because we we don’t think about them belonging to pediatric care or adult care, and their stage of cognitive development means they underestimate their STI risk in general — yet they’re one of the highest risk groups for a new diagnosis of HIV,” she said. “We’re encouraged to see more prescribing over time, but the question remains: are we getting it to the highest-risk patients?”

She notes the number of steps needed to get to consistent PrEP use: getting screened by a provider or online screening tool to determine if PrEP is appropriate, seeing a provider for the initial exam and tests for HIV and other sexually transmitted infections (STIs), receiving and filling a prescription, and keeping up with regular tests of kidney function, HIV and other STIs every three to six months.

Even patients who decide to take their PrEP pills on an episodic rather than daily basis – before time periods when they will be sexually active with new partners, for instance – need to have consistent access.

Either way, she says, it’s important for young adults, their health care providers, and the adults they trust most to discuss their sexual health, and to be aware of the availability of PrEP and its power to prevent HIV.

More about the findings

In all, Hill and her colleagues looked at 1.45 million prescriptions dispensed to nearly 240,000 young adults with an average age of 22. Most (87%) were male, but Hill notes that certain women are also at risk for HIV and might be eligible for PrEP.

Just over a third of the young adults taking PrEP lived in the southern U.S., an area where HIV transmission is especially high. And the rate of PrEP dispensing started lowest but rose fastest in this region during the study period.

The study covers a period when the first PrEP medication, introduced in 2012 under the brand name Truvada, also became available as a generic drug in 2020, and a second oral PrEP option called Descovy went on the market in 2019. Though an injectable form of PrEP received approval in 2021, few young adults received this treatment so they were excluded from the study.

More than 70% of the prescriptions during the study period were for Truvada or its generic equivalent.

Hill and her colleagues also looked at what kind of health care provider prescribed PrEP to each person who filled a prescription.

Nurse practitioners accounted for 39% of prescriptions, with family medicine or general practitioners accounting for 22%, and internal medicine physicians and physician assistants accounting for 14% and 11%, respectively.

Although emergency medicine physicians accounted for a very small percentage overall, the number of prescriptions written by them increased tenfold during the study period.

PrEP has been recommended since 2019 by the U.S. Preventive Services Task Force for adolescents and adults who have an increased risk of acquiring HIV.  All individuals should be screened for HIV at least once in their lifetime between ages 15 and 65 years. Under the Affordable Care Act, most insurance programs must make PrEP and HIV screening available to patients at no cost if they meet USPSTF criteria.

However, the status of that coverage is the subject of a case called Braidwood v. Kennedy that was recently heard before the U.S. Supreme Court; a ruling is expected soon.

More information about PrEP is available via the HIV.gov site: https://www.hiv.gov/hiv-basics/hiv-prevention/using-hiv-medication-to-reduce-risk/pre-exposure-prophylaxis .

Hill and senior author Kao-Ping Chua, M.D., Ph.D., and their co-author Sijia He, M.S., are part of the Susan B. Meister Child Health Evaluation and Research Center, which Chua directs. Hill is supported by the National Clinician Scholars Program, the Susan B. Meister Child Health Evaluation and Research Center, and a training grant (T32HS000053) from the Agency for Healthcare Research and Quality.

National Trends in HIV Pre-Exposure Prophylaxis Dispensing to Young Adults, 2016–2023, Journal of General Internal Medicine, DOI:10.1007/s11606-025-09574-8

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And more than 200 million 15-49 year olds probably had at least one symptomatic outbreak of the infection in 2020, the latest year for which figures are available, the data analysis suggests.

The findings prompt the researchers to call for the development of new treatments and vaccines to control the spread of the infection and lessen its health and financial toll, given that currently available options have only had a modest impact at the population level, they say.

There are 2 types of herpes simplex virus—type 1 (HSV-1) and type 2 (HSV-2)–both of which are highly infectious, incurable, and last a lifetime.

HSV-1 is primarily spread in childhood by mouth contact, resulting in ‘cold sores’ in or around the mouth. But it can sometimes cause more serious neurological, eye, skin and mucous membrane complications. And it is increasingly being spread through sexual contact at older ages, say the researchers.

HSV-2 is almost entirely sexually transmitted through skin to skin contact, and is the leading cause of recurrent painful genital blisters. And although rare, both HSV-1 and HSV-2 can be passed onto newborns, often proving fatal.

In a bid to update previous estimates of the global incidence and prevalence of genital HSV infection, the researchers incorporated a series of recent comprehensive systematic reviews and pooled data analyses published up to March 2022

And they deployed mathematical modelling to estimate the global and regional incidence and prevalence of genital HSV infection and related symptoms in 2020.

Based on the available data, the researchers estimated that globally 26 million 15–49 year olds were newly infected with HSV-2 infection, and an estimated 520 million had existing infection—just over 13% of those in this age group.

An estimated 17 million 15–49 year olds acquired HSV-1 infection genitally, and an estimated 376 million (10% of those in this age group) had existing infection in 2020.

In all, two-thirds of the global population up to the age of 49—-nearly 4 billion people—-were infected (mostly orally) with HSV-1 in 2020, the researchers estimated.

The researchers estimated that the total global numbers of new and existing HSV infections among 15–49 year olds in 2020 were 42 million and 846 million, respectively.

And the estimated number of 15–49 year olds who had at least one episode of genital sores in 2020 was 188 million for those infected with HSV-2, and 17 million for those infected with genital HSV-1, adding up to a total of 205 million.

The researchers acknowledge various limitations to their findings, including the scarcity of data for people at either end of the age spectrum and relatively wide ranges for some of their estimates.

But they nevertheless conclude: “HSV infections are widely prevalent in all global regions, leading to a significant burden of [genital ulcer disease] with repercussions on psychosocial, sexual, and reproductive health, neonatal transmission, and HIV transmission. However, hardly any specific programmes for HSV prevention and control exist, even in resource-rich countries.”

They add: “There is a need for HSV prophylactic and therapeutic vaccines as a strategic approach to control transmission and to curb the disease and economic burdens of these infections.”

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The study, published in Social Psychiatry and Psychiatric Epidemiology, indicates that 13 per cent of people who used antidepressants reported a reduction in genital sensitivity, compared to one per cent of users of other psychiatric medications.

“It’s gone under the radar for so long, largely due to stigma, shame and embarrassment,” says Yassie Pirani, an SFU alumnus and lead author on the study. “For some, it resolves with time, but for a lot of people, it doesn’t go away. I’ve spoken with somebody who developed this syndrome at age 33. He’s 66 years old now and nothing’s changed.”

Post-SSRI sexual dysfunction (PSSD) is an under-researched and under-reported syndrome of persistent sexual dysfunction caused by SSRI and SNRI antidepressant use, where sexual function does not return to normal after the patient stops using the medication.

“I’ve talked to teenagers who get this and it’s devastating. There’s no way to under to state how harrowing an experience this is for people. It’s not just about the numb genitals – it’s about what it means for having relationships, to be rendered impotent without your consent. It is a serious harm.”

Pirani says the illness is a spectrum. For some, it’s mild, their genitals feel less sensation, maybe 80 per cent of what used to be. While in more severe cases, it’s complete numbness.

The study was nested within a larger survey (~9,600 mainly LGBTQ young people in Canada and the U.S.) that focused on mental health, conversion therapy, and other factors that shape experiences related to gender and sexuality during adolescence and early adulthood.

“This study reminds us that pharmacological interventions play a role in shaping the sexual experiences of youth, and improved understanding and education is urgently needed,” says Travis Salway, an SFU associate professor in the Faculty of Health Sciences and the study’s principal investigator.

As part of the community survey, participants were asked if they’d ever taken antidepressant drugs and stopped and subsequently experienced a number of PSSD-compatible symptoms. Research regarding PSSD is complicated by the fact that many PSSD symptoms, like low libido, can also be attributed to depression. However, genital numbness, known as genital hypothesia, is a primary symptom of PSSD that is not associated with depression.

“There’s no medical explanation for why people should experience numbness in their genitals due to depression or anxiety (or other common conditions for which SSRIs/SNRIs are prescribed),” Salway explains. “The frequency of genital hypothesia in those who had past use of antidepressants was more than 10 times greater than the frequency that we saw in those who had used another psychiatric medication (such as antipsychotics or sedatives).”

Part of the problem, as Pirani sees it, is an informed consent-accountability gap. While antidepressants are commonly prescribed to help people struggling with anxiety, obsessive-compulsive disorder, post-traumatic stress disorder, panic disorder, phobias, chronic pain, depression and other conditions, people aren’t being warned of the risks.

The findings underscore the need for more robust patient and prescriber education practices and warnings so that patients can decide for themselves if the risk is worth it.

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The five-year, multi-center study is funded by a $9.2 million National Institutes of Health grant and will compare the effectiveness of a recently approved medication, secnidazole, against the current standard treatment, metronidazole, using a 1,200-person cohort across Louisiana, Alabama and Florida. Despite decades of use as the primary trichomoniasis medication, treatment by metronidazole continues to have a 10% breakthrough rate.

“More than 10 percent of people who take the recommended treatment still have it. That is just unacceptable. We need better options” said Dr. Patty Kissinger, professor of epidemiology at Tulane School of Public Health and Tropical Medicine. “The problem is trichomoniasis is the most common treatable STI, but there are often no symptoms, and the CDC has not recommended screening among asymptomatic people, so the public doesn’t know about it.”

Trichomoniasis, which infects about 156 million people annually worldwide, is caused by trichomonas vaginalis, a parasite that thrives in the genital tract of both men and women and causes inflammation. Those infected have a 1.5 times higher susceptibility to HIV. For expecting mothers, it can cause pre-term birth and increase risk for perinatal morbidity. African American women are also four times more likely to have trichomoniasis.

“Trichomoniasis affects millions but remains a highly neglected STI,” Kissinger said. “We’re hoping this study leads to better treatment options and increased awareness that we hope will encourage more screening.”

Because of the lack of inclusion in STI screenings and scant symptoms, those infected can go years before realizing they have trichomoniasis.

This is the third in a series of studies funded by the NIH to refine treatment for trichomoniasis. This is the first study in the series to include men in its cohort and the first-ever study to compare the effectiveness of secnidazole with metronidazole.

Questions remain as to why metronidazole continues to have a high breakthrough rate. The prior NIH studies found that metronidazole is most effective when administered in multiple doses, but the breakthrough rate may be attributed to patients missing doses or having sex with partners before treatment is completed, creating a cycle of reinfection.

The secnidazole treatment would only require one dose, although some concerns remain about the cost of the medication, Kissinger said.

Trichomoniasis affects more than 3 million people in the United States and is particularly prevalent in the Deep South where the study is being conducted.

“We need better treatments for this STI,” Kissinger said. “If this is successful, we could control it and encourage more screening that could reduce perinatal morbidity and maybe even reduce the chances of some people getting HIV.”

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The paper, which publishes July 1^st in the journal BMC Global and Public Health, calls for greater investment in prevention of herpes transmission, including concerted efforts to develop effective vaccines against this common virus.

Corresponding author Nathorn Chaiyakunapruk, PharmD, PhD, professor of pharmacotherapy, and Haeseon Lee, PharmD, research fellow in pharmacotherapy, both at the College of Pharmacy of University of Utah Health, performed the research in collaboration with the World Health Organization and other academic institutions. They detail the associated economic cost estimates for genital herpes globally and by region.

Herpes is caused by infection with one of two types of the herpes simplex virus (HSV). Around two thirds of people (67%) aged 0-49 globally have HSV-1, according to the latest published statistics. It is mostly acquired in childhood, spreads by oral contact and causes infections in or around the mouth (oral herpes or cold sores). Adults can acquire genital HSV-1 infection through sexual contact if they were not infected during childhood. Type 2 spreads by sexual contact and causes genital herpes. Approximately 13% of the world’s population aged 15–49 years are living with HSV-2 infection.

In addition to sores and blisters, HSV can cause other more serious complications requiring healthcare attention, including a rare chance of mother to child transmission during childbirth, and increased risk of HIV infection.

More information on herpes: https://www.who.int/news-room/fact-sheets/detail/herpes-simplex-virus

Let’s Talk Herpes video explainer: https://www.youtube.com/watch?v=U_r36QCnTPY

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In January, the Centers for Disease Control and Prevention (CDC) reported that syphilis cases had risen 80 percent over the five years from 2018 to 2022, totaling more than 200,000 in 2022, the last year for which data are available.

Yet just over half of U.S. adults (54%) know that a case of syphilis can be permanently cured and most either mistakenly think there is a vaccine to prevent it (16%) or are unsure (45%), according to the Annenberg Public Policy Center’s new survey findings on sexually transmitted infections (STIs). The survey of U.S. adults finds that many are familiar with some ways they can protect themselves from syphilis but lack familiarity with its symptoms and signs.

The survey also finds areas of uncertainty about other STIs, including whether they can be cured and whether vaccines exist. Only a third of the public knows that HPV (human papillomavirus) cannot be permanently cured and a third of the public does not know there is a vaccine to prevent it. (The CDC reports that the HPV vaccine has the potential to prevent more than 90% of HPV-attributable cancers.) Two years after a global outbreak of mpox, formerly called monkeypox, most people do not know whether it can be cured (it can be) or whether a vaccine exists (it does).

“With the rising number of syphilis cases, knowing the causes, symptoms, and treatment for it assumes added importance,” said Kathleen Hall Jamieson, director of the Annenberg Public Policy Center (APPC) of the University of Pennsylvania.

APPC’s latest Annenberg Science and Public Health (ASAPH) Knowledge survey, conducted from April 18-24, 2024, questioned a national probability sample of over 1,500 empaneled U.S. adults about their knowledge about sexually transmitted infections, with more extensive questions about knowledge and treatment of syphilis and HIV. See the survey toplines.

Protecting oneself from contracting syphilis

What people do know: When asked to select which, among the following, are ways that individuals can protect themselves from contracting syphilis, most people got the answers right – selecting the correct ways and skipping the wrong answers:

• 78% correctly chose abstinence, or not engaging in sex
• 77% correctly chose using a condom
• 94% correctly did NOT select oral contraception (the pill)
• 89% correctly did NOT select wearing a diaphragm
• 78% correctly did NOT choose getting a vaccine (there is none)

But 71% did not select using only clean needles, which is one of the ways to protect oneself from contracting syphilis.

Failing to recognize symptoms of syphilis

What people don’t know: When asked to select usual syphilis signs and symptoms from a list, less than a third of survey respondents selected any of these symptoms (according to the CDC, all are symptoms of types of syphilis):

• 30% selected “firm, round, painless sores”
• 28% selected “swollen lymph nodes”
• 27% selected “fever”
• 16% selected “weight loss”
• 13% selected “dizziness or lightheadedness” [the CDC says it’s a sign of otosyphilis]
• 12% selected “blurry vision” [the CDC says it’s a sign of ocular syphilis]

How can HIV be spread?

The survey finds that U.S. adults are generally knowledgeable about how HIV (human immunodeficiency virus) can be spread. Asked to select from a list which of these methods are ways in which HIV can be spread:

• 95% know HIV can be spread through unprotected sex
• 90% know HIV can be spread by sharing needles
• 67% know HIV can be spread from an infected person to their child while giving birth

Respondents also know that the following means are not ways in which HIV can be spread:

• 89% correctly did NOT select by exposure to airborne droplets that are coughed or sneezed into the air by an infected person.
• 88% correctly did NOT select from touching a surface contaminated by the virus
• 85% correctly did NOT select by using the “party drugs” known as poppers

However, only 1 in 3 adults (33%) knows that HIV can also be spread from an infected parent breastfeeding a child.

How can you get an STI?

The survey finds that U.S. adults are generally familiar with how you can get an STI. Asked to select from which of the following activities you can get an STI:

• 98% know you can get it from vaginal sex
• 89% know you can get it from oral sex
• 93% know you can get it from anal sex
• 91% know you can get it from genital-to-genital contact

In addition, 44% selected kissing as a way to get an STI (generally not, but it may be a risk factor for oral gonorrhea) and 21% chose sitting on a toilet (which is not a form of transmission).

Can it be cured and is there a vaccine?

Large majorities of the public know that six out of eight infections considered in the survey are sexually transmitted infections, including syphilis, HPV, HIV, gonorrhea, genital herpes, and chlamydia – with the exceptions being mpox (which 39% identified as sexually transmitted) and Zika (which 12% identified as sexually transmitted). Zika is a mosquito-borne infection that also can be sexually transmitted. Although mpox cases have declined since the 2022 outbreak, “low-level [U.S.] transmission continued,” according to public health officials, who in June urged continuing vigilance, especially among men who have sex with men.

The public is not sure whether some of the STI infections can be permanently cured or whether a vaccine exists to prevent them. Over half know that gonorrhea (65%), chlamydia (63%) and syphilis (54%) can be cured, but under a third (29%) know that mpox can be cured. But:

• 91% are not sure whether Zika can be cured or think it can be (it can’t be cured)
• 65% are not sure whether HPV can be cured or think it can be (it can’t be cured)
• 42% are not sure whether genital herpes can be cured or think it can be (it can’t be cured)
• 26% are not sure whether HIV can be cured or think it can be (it can’t be cured)

Asked whether a vaccine exists to prevent these infections, only for HPV is a majority of the public aware (67%) that there is one, while 44% knows there is a vaccine for mpox. For these other infections there is no vaccine and most of the public is either not sure or incorrect:

• Zika: 80% do not know there’s no vaccine (69% not sure, 11% say yes there is)
• Syphilis: 61% do not know there’s no vaccine (45% not sure, 16% yes)
• HIV: 52% do not know there’s no vaccine (33% not sure, 19% yes)
• Gonorrhea: 57% do not know there’s no vaccine (43% not sure, 14% yes)
• Genital herpes: 55% do not know there’s no vaccine (40% not sure, 15% yes)
• Chlamydia: 59% do not know there’s no vaccine (45% not sure, 14% yes)

Other knowledge about STIs

Much of the public does have a reasonable level of background knowledge about STIs. Large majorities know that someone with an STI can spread the STI to others even if there are no symptoms (91% true); that medication can control HIV and prevent disease progression (87% true); that an STI can be passed from a person who is pregnant to their baby (78% true); and that HPV can lead to cancer in women (69%). And they know it is false to say that unless you have sex with a lot of people you can’t get an STI (85% false) and that it is false to say that if a person had gonorrhea he or she is immune from getting it again (68% false).

The questions with the greatest uncertainty involve HIV. Just 42% know that most people in the United States with HIV do not develop AIDS (36% not sure) and 38% know it is easier to get HIV if a person has another STI (41% not sure).

APPC’s ASAPH survey

The survey data come from the 19^th wave of a nationally representative panel of 1,522 U.S. adults, first empaneled in April 2021, conducted for the Annenberg Public Policy Center by SSRS, an independent market research company. This wave of the Annenberg Science and Public Health Knowledge (ASAPH) survey was fielded April 18-24, 2024, and has a margin of sampling error (MOE) of ± 3.5 percentage points at the 95% confidence level. All figures are rounded to the nearest whole number and may not add to 100%. Combined subcategories may not add to totals in the topline and text due to rounding.

Download the toplines and methodology statement.

The policy center has been tracking the American public’s knowledge, beliefs, and behaviors regarding vaccination, Covid-19, flu, maternal health, climate change, and other consequential health issues through this survey panel for over three years. In addition to Jamieson, the APPC team includes Shawn Patterson Jr., who analyzed the data; Patrick E. Jamieson, director of the Annenberg Health and Risk Communication Institute, who developed the questions; and Ken Winneg, managing director of survey research, who supervised the fielding of the survey.

The Annenberg Public Policy Center was established in 1993 to educate the public and policy makers about communication’s role in advancing public understanding of political, science, and health issues at the local, state, and federal levels.

IMAGE: IN A SURVEY ABOUT KNOWLEDGE OF SEXUALLY TRANSMITTED INFECTIONS, A NATIONAL PROBABILITY SAMPLE OF U.S. ADULTS WAS SHOWN A LIST OF SYMPTOMS AND ASKED TO CHOOSE WHICH AMONG THEM ARE USUAL SIGNS AND SYMPTOMS OF SYPHILIS. ALL OF THE LISTED SIGNS AND SYMPTOMS ARE ASSOCIATED WITH SYPHILIS — BUT LESS THAN A THIRD OF THOSE SURVEYED SELECTED ANY OF THEM. FROM THE ANNENBERG PUBLIC POLICY CENTER’S ASAPH SURVEY IN APRIL 2024.

view more CREDIT: ANNENBERG PUBLIC POLICY CENTER

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With individuals experiencing a variety of feelings and emotions related to the prospect of disclosure, the research shows that only around half or fewer individuals felt able to disclose their diagnosis to a partner before sexual engagement.

Peer-reviewed results, published today in The Journal of Sex Research, also show a similar number of people believed they should have to disclose having a STI to a partner prior to engaging in sexual intercourse.

In order to stop the spread of such infections studied – which excludes HIV – the expert team from the University of Tennessee are calling for comprehensive sex education to be provided throughout life: from youth to late adulthood.

“Many individuals lack sufficient comprehensive sex education,” the authors state in the paper.

“Rather than being taught how to correctly use prophylaxis, identify its limitations, and understand the scope and transmissibility of STIs, youth are only encouraged to be abstinent.

“Individuals diagnosed with STIs may be in vulnerable positions and may face difficult decisions, the outcomes of which can be harmful to their identity and relationships.

“The process of disclosure is complex. Certain contexts, particularly committed relationships, elicit disclosure, whereas others inhibit disclosure. Disclosure is an interpersonal process that involves not just the individual faced with the decision to disclose, but the intended receiver.”

Overall, they say their findings “highlight the need for continuous comprehensive sexual health education throughout the life course and an increase in the number of (US) states that offer comprehensive sex education”.

Around one in five people in the US have a STI at any one time with more than 26 million incidents reported to health services.
Chlamydia, gonorrhoea and syphilis have been at record levels for several years and continue to rise, according to official data.

Methods recommended by the Centers for Disease Control and Prevention to prevent infections include talking to partners about sexual histories such as disclosure of an active STI, as well as using prophylaxis (such as using condoms, oral dams, vaccines

Some public health agencies including in the US recommend disclosure about an active STI.

However, this new review – which looked at 32 papers – shows fear can prevent many people revealing their diagnosis.

Other reasons included: people believing that condom-use is protection enough; a lack of obligation such as a one-night-stand situation; and fear of being broken up with. Some even described ‘passing’ as uninfected to avoid having to tell.

People who disclosed to their partner did so out of love, feelings of moral obligation, or relationship-related reasons, such as greater levels of commitment, relationship quality, length of time together, and feelings of closeness

Disclosers used a variety of ways to tell people their STI status. Non-disclosers used strategies to pass as uninfected, withdraw from relationships, and using STI outbreaks to time sexual activity.

In the review, herpes and HPV were featured the most, while chlamydia, gonorrhoea and trichomoniasis were also common. The results also revealed that the experiences of people on the receiving end of STI disclosures are not well-represented in such studies.

“One of the key factors that determines whether an individual will disclose is the intended receiver. How the receiver will react and respond and the relationship with the receiver can be critical influences on the discloser,” the authors add.

“As such, it is imperative that we investigate the experiences of receivers to understand the process of STI disclosure more comprehensively. This is so that we may continue to improve sexual health education and care for all.”

Existing research on STIs has limitations such as a lack of data on sexual orientation. As such, the aim of the review authors was to fill knowledge gaps and identify areas for future study.

Their focus was on the self-disclosure of STIs to current and former partners. Disclosure is the voluntary or involuntary sharing of personal information with another individual such as the fact they have an STI.

This differs from partner notification, which is similar to contact tracing and can involve the use of anonymous messaging services.

Limitations of the paper included only English-speaking research being reviewed, as well as the limited number of reviewers.

Going forwards, the authors suggest that future research should take care to adopt a destigmatizing approach.

“Initiating sexual health conversations is everyone’s responsibility,” they conclude.

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