STDs anno 2024

During the first plenary session at EADV 2024, Prof Dr Henry de Vries, dermatologist at the Amsterdam University Medical Center with a special interest for sexually transmitted diseases (STDs), discussed the previous achievements, remaining challenges and future perspectives related to the management of STDs.

Over the last decade, the introduction of biomedical interventions, such as treatment as prevention (TasP) and pre-exposure prophylaxis (PrEP) has led to a marked decrease in the incidence of new HIV infections across Europe. In parallel with that, however, there has been a rise in the incidence of bacterial STDs, such as syphilis and gonorrhoeae. Importantly, the rising incidence of these bacterial STDs predates the introduction of TasP and PrEP and can therefore not be attributed to changes in the sexual behavior of individuals due to these biomedical interventions.

Arguably one of the main challenges related to STDs for the years to come relates to antimicrobial resistance. In fact, due to the development of resistance, patients with gonorrhoeae now only have one effective antibiotic left (ceftriaxone). Recently, however, researchers have also identified a gonorrhoeae strain with resistance to this ‘last resort’ antibiotic. To address this issue, several studies are currently evaluating alternative treatment strategies for patients with gonorrhoeae. In this respect, two large studies have recently demonstrated non-inferiority of ertapenem and zoliflodacin to ceftriaxone in the treatment of gonorrhoeae.2,3 In addition to this, efforts are underway to develop vaccines that specifically target Neisseria gonorrhoeae.

Prof de Vries ended his plenary talk with a look at the near future. In this respect, he first touched upon the fact that The Netherlands will abandon routine testing for chlamydia in asymptomatic patients presenting in sex health centers from 2025 onwards. The latter is based on long-term data showing that asymptomatic chlamydia is not associated with the development of serious, late sequelae. Furthermore, the classic test-to-treat strategy for chlamydia drives up the consumption of antibiotics and hence also the risk for the development of microbial resistance. On a final note, the potential of doxyPEP was discussed. In essence, doxyPEP is a doxycycline-based ‘morning after pill’ that can protect against bacterial STDs. Studies have indicated that this agent effectively protects against syphilis and chlamydia, but unfortunately not against gonorrhoeae. For the moment, however, there are no data on the long-term effect of doxyPEP and concerns have also been raised on its effect on the microbiome. Despite the promising data that have been generated with doxyPEP, Prof de Vries therefore concludes that it is still too early to incorporate this strategy in routine practice.