Integrating rapid sexually transmitted infection diagnostics into pre-exposure prophylaxis services to strengthen HIV prevention and public health systems
1
GROW Research Institute for Oncology and Reproduction, Universiteit Maastricht, Maastricht, Netherlands
2
Centre for Microbiology Research, Kenya Medical Research Institute, Kenya, Kenya
Popul. Med. 2026;8(Supplement Supplement 1):A1599
ABSTRACT
ABSTRACT:
Sexually transmitted infections (STIs) continue to be underdiagnosed in many low-resource settings where limited access to diagnostics reinforces reliance on syndromic management (1). This contributes to missed infections, increased biological susceptibility to HIV acquisition, and unnecessary antibiotic use (2). To generate public health evidence that can strengthen integrated HIV and sexual health services, we assessed the prevalence and co-infection patterns of six common stis among people using pre-exposure prophylaxis (PrEP) and evaluated the performance of a rapid multiplex PCR assay suitable for near-patient use. Between 24 march and 30 april 2025, we enrolled 400 hiv-negative PrEP users aged 15 years and older from public sector and community-based sexual health services. Participants self-collected urine samples for detection of chlamydia trachomatis, neisseria gonorrhoeae, trichomonas vaginalis, mycoplasma genitalium, mycoplasma hominis, and ureaplasma species using a multiplex PCR platform. Results were compared with reference laboratory PCR assays, and limit-of-detection analyses were performed. demographic, behavioral, and sexual health data were collected to explore population-level patterns. Overall sti prevalence was high at 69.3 percent, and 27.9 percent of participants had more than one detectable organism. Prevalence estimates were 14.3 percent for chlamydia trachomatis, 2.5 percent for neisseria gonorrhoeae, 4.8 percent for trichomonas vaginalis, 4.0 percent for mycoplasma genitalium, 20.9 percent for mycoplasma hominis, and 59.0 percent for ureaplasma species. Women had significantly higher proportions of trichomonas vaginalis, mycoplasma hominis, and ureaplasma species, while men who have sex with men had the highest proportion of mycoplasma genitalium. The diagnostic platform demonstrated high concordance with reference PCR assays and detected up to 10 targets per reaction. These findings highlight a substantial and frequently undetected STI burden within PrEP networks. Integrating rapid molecular diagnostics into sexual health and HIV prevention services could enhance early detection, support antimicrobial stewardship, and strengthen public health system responsiveness in low-resource settings (3).
Sexually transmitted infections (STIs) continue to be underdiagnosed in many low-resource settings where limited access to diagnostics reinforces reliance on syndromic management (1). This contributes to missed infections, increased biological susceptibility to HIV acquisition, and unnecessary antibiotic use (2). To generate public health evidence that can strengthen integrated HIV and sexual health services, we assessed the prevalence and co-infection patterns of six common stis among people using pre-exposure prophylaxis (PrEP) and evaluated the performance of a rapid multiplex PCR assay suitable for near-patient use. Between 24 march and 30 april 2025, we enrolled 400 hiv-negative PrEP users aged 15 years and older from public sector and community-based sexual health services. Participants self-collected urine samples for detection of chlamydia trachomatis, neisseria gonorrhoeae, trichomonas vaginalis, mycoplasma genitalium, mycoplasma hominis, and ureaplasma species using a multiplex PCR platform. Results were compared with reference laboratory PCR assays, and limit-of-detection analyses were performed. demographic, behavioral, and sexual health data were collected to explore population-level patterns. Overall sti prevalence was high at 69.3 percent, and 27.9 percent of participants had more than one detectable organism. Prevalence estimates were 14.3 percent for chlamydia trachomatis, 2.5 percent for neisseria gonorrhoeae, 4.8 percent for trichomonas vaginalis, 4.0 percent for mycoplasma genitalium, 20.9 percent for mycoplasma hominis, and 59.0 percent for ureaplasma species. Women had significantly higher proportions of trichomonas vaginalis, mycoplasma hominis, and ureaplasma species, while men who have sex with men had the highest proportion of mycoplasma genitalium. The diagnostic platform demonstrated high concordance with reference PCR assays and detected up to 10 targets per reaction. These findings highlight a substantial and frequently undetected STI burden within PrEP networks. Integrating rapid molecular diagnostics into sexual health and HIV prevention services could enhance early detection, support antimicrobial stewardship, and strengthen public health system responsiveness in low-resource settings (3).
| eISSN: | 2654-1459 |
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