Current Opinion in Infectious Diseases最新文献

Purpose of review: Sexually transmitted dermatophytosis represents an emerging and underrecognized clinical entity within the broader context of sexually transmitted infections.

Recent findings: Traditionally transmitted through direct or indirect contact, certain dermatophyte species - particularly Trichophyton mentagrophytes ITS-genotype VII and Trichophyton indotineae - are increasingly implicated in infections among sexually active populations, especially men who have sex with men. These infections often present with atypical and highly inflammatory lesions, mimic common dermatoses, and pose significant diagnostic and therapeutic challenges due to frequent misidentification and sometimes antifungal resistance.

Summary: This review synthesizes current data on the epidemiology, clinical features, management strategies, and public health implications of sexually transmitted dermatophytosis. As global reports rise, heightened clinical awareness is imperative for early detection, accurate diagnosis, and effective treatment.

Purpose of review: Despite the proven efficacy of preexposure prophylaxis (PrEP), global coverage remains far below targets, with the greatest gaps among key and underserved populations. This review is timely as it highlights how inequitable access undermines progress toward ending AIDS by 2030 and introduces the "O for KP" framework - a preferential option for key populations and the underserved . This equity-focused principle redefines program success by how well services reach and sustain those most structurally excluded.

Recent findings: We synthesized evidence on persistent barriers faced by men who have sex with men, transgender people, migrants, people who inject drugs, and others disproportionately affected by HIV. Effective strategies include community-led and peer-driven approaches, integration of gender-affirming and harm reduction services, digital and self-care innovations, task-sharing, and supportive policy reforms. Methods such as human-centred design, preference research, behavioural science frameworks, and implementation science tools have been critical in tailoring and scaling interventions.

Summary: Adopting an O for KP lens requires shifting beyond pilots and aggregate coverage metrics to approaches that centre the most underserved. Embedding community leadership, diversifying delivery models, and reforming restrictive policies are essential to maximize PrEP's impact and ensure progress toward global HIV prevention goals.

Purpose of review: Bacterial vaginosis (BV) is a common vaginal dysbiosis linked to increased risk of HIV, other sexually transmitted infections (STIs), and adverse obstetric outcomes. Standard antibiotic therapy often induces symptom remission, but recurrence rates exceed 50% within 6 months. The purpose of this review is to discuss recent clinical trials that demonstrate improved outcomes when compared to treatment according to current management guidelines and outline potential future therapies.

Recent findings: Strong evidence supporting transmission of bacteria associated with the dysbiotic state of BV between sexual partners has accumulated over time. A recent clinical study (StepUp) demonstrated overwhelming evidence that treating male partners with combined oral and topical antibiotics significantly reduces BV recurrence in their female partners, highlighting the role of sexual transmission. Recent guideline updates reflect these advances: the American College of Obstetricians and Gynecologists now advises partner therapy for recurrent BV, signaling a shift toward partner-inclusive management strategies. In parallel, live biotherapeutic products (LBPs) and vaginal microbiota transplantation (VMT) show promise in restoring a stable, Lactobacillus crispatus-dominant microbiome. Novel approaches targeting metabolic vulnerabilities of BV-associated bacteria and L. iners, and nonantibiotic agents like metastable iron sulfides are in early development.

Summary: Several advances in managing recurrent BV have shown promise in improving care of this condition. They represent a shift toward microbiome-informed, durable, and woman-controlled therapies. Strategies combining these along with continued development of promising novel approaches to treatment will be needed to optimize care of patients and reduce global BV burden.

Purpose of review: Genital herpes is a major worldwide public health problem with more than four billion people infected with either herpes simplex virus type 1 (HSV-1) or type 2 (HSV-2). To reduce HSV infections, which greatly impact people of all ages, a thorough understanding of the epidemiology, viral life cycle and correlates of immune protection are essential. This review highlights advances in these areas including new research in vaccine development and potential future strategies for a cure.

Recent findings: Historically, HSV-2 was the predominant cause of genital infection, but HSV-1 now accounts for more than half of all new infections worldwide. HSV-1 is less likely than HSV-2 to cause clinical recurrences; however, both can be transmitted perinatally, particularly during primary infection. Neonatal infection may result in disseminated and/or neurologic disease with significant morbidity despite antiviral therapy. Resistance to current antivirals may emerge particularly among immunocompromised patients, highlighting the need for new approaches for treatment and prevention. Prior vaccine trial failures and new research indicate that neutralizing antibodies, long considered the correlate for protection, are not sufficient, and that polyfunctional antibodies with cytolytic activity as well as cellular immune responses will be needed for effective prophylactic and therapeutic vaccines.

Summary: HSV infections are usually asymptomatic but the viruses uniformly establish latency with periodic reactivation and the potential for long-term neurologic sequelae. Molecular diagnostics, which has replaced viral culture, has demonstrated that reactivation is more common than previously appreciated. Thus, new approaches to treatment and prevention and ultimately cure are needed.

Purpose of review: Tuberculosis (TB) is the leading cause of illness in people with HIV (PWH), with many survivors experiencing lasting lung damage. Post-TB lung disease (PTLD) is a challenge in this group, where additional respiratory insults, poor nutrition and healthcare access barriers may compound disability. In this scoping review, we explore the burden and patterns PTLD in PWH versus HIV-negative individuals through meta-analysis and narrative synthesis, and describe mechanisms of HIV-associated PTLD with emerging prevention, care strategies, and research priorities.

Recent findings: HIV infection was associated with lower or equivalent PTLD burden across most spirometry, radiology and functional outcomes; however, despite higher rates of pulmonary TB in PWH, studies directly comparing PTLD in PWH versus HIV-negative individuals are few. Sub-analyses, including role of antiretroviral therapy, CD4 count and recurrent TB, were limited by data availability. Neutrophil-driven matrix metalloproteinase activity, cytokine dysregulation, and immune reconstitution is implicated in HIV-associated lung damage; host-directed therapies with potential for attenuating PTLD are under evaluation, though representation of PWH is limited. Gaps persist in integrating PTLD care into HIV-TB services, and longitudinal data are needed to define recovery trajectories and inform strategies for prevention and management.

Summary: PTLD in PWH shows variable burden and requires multidisciplinary integrated care. Inflammatory mechanisms and care gaps underscore the need for targeted research.

Purpose of review: Haemophilus ducreyi remains an important, though often overlooked, cause of genital ulcer disease (GUD), particularly in contexts where syndromic management limits pathogen-specific diagnosis. Although its incidence has markedly declined in high-income countries, the pathogen persists in resource-limited regions, where it is frequently co-endemic with Treponema pallidum and herpes simplex virus. A review is timely to synthesize new insights into its biology and clinical relevance.

Recent findings: Over the past two decades, the recognized epidemiological spectrum of H. ducreyi has expanded to include nonsexually transmitted cutaneous ulcers in children in tropical regions. Genomic and microbiological studies have clarified its population structure, revealing two major lineages with limited divergence between genital and cutaneous isolates. Advances in the characterization of virulence determinants and host-pathogen interactions provide an integrated view of its persistence, immune evasion, and ecological adaptability.

Summary: These developments have direct implications for the refinement of diagnostics, the optimization of therapeutic strategies, and the strengthening of surveillance systems in endemic areas. Revisiting the role of H. ducreyi in both genital and cutaneous ulcers is essential to anticipate its future public health impact.

Purpose of review: Trial design during the novel coronavirus-19 (COVID-19) pandemic was stymied by significant uncertainty about the natural history of the virus, at-risk populations, and optimal patient care by investigators and clinicians alike.

Recent findings: Three main types of trial design were invoked to address both the variable clinical disease and the evolving viral landscape, and to fit the respective health systems deploying the trials. These included adaptive trial design, platform trials, and master protocols. Strengths and challenges faced with each are discussed in more detail in the main text.

Summary: Future pandemics will almost certainly continue to arise. Similarly, the landscape will continue to evolve alongside our understanding of the disease. Designing trials that remain scientifically rigorous and practical while still addressing the changing natural history of the disease continues to pose a challenge.

Purpose of review: To synthesize current evidence on menopause in women living with HIV, highlighting the biological, psychosocial, and structural determinants of health, and to identify research and implementation gaps to inform integrated models of care.

Recent findings: With increasing life expectancy, more women with HIV are transitioning through menopause. Data from international cohorts suggest that menopause may occur approximately three years earlier in women with HIV than in HIV-negative peers. Symptom burden - including vasomotor, psychological, and sexual health disturbances - appears greater and is compounded by stigma, multimorbidity, and socioeconomic disadvantage. Evidence on the safety of menopausal hormone therapy, drug-drug interactions with antiretroviral therapy, and long-term cardiometabolic and bone outcomes remains sparse, particularly in low-income and middle-income countries (LMICs). Intersectional inequities affecting racially minoritized and migrant women are increasingly recognized but under-researched.

Summary: Menopause in women with HIV remains an under-prioritized aspect of care despite its significant clinical and psychosocial implications. Future efforts should focus on longitudinal and interventional studies, integration of menopause assessment within HIV services, and culturally sensitive, multidisciplinary care models that address inequities across global settings.

Purpose of review: Gonorrhea is the second most prevalent bacterial sexually transmitted infection globally. The proliferation of antimicrobial-resistant strains has severely limited treatment options. New treatment modalities against multidrug-resistant gonococcal infections to reduce the rate of transmission and the risk of complications are urgently needed. This review summarizes ongoing efforts in the development of new antibiotics and alternative treatment approaches, including repurposing drugs, biologics, and small molecules.

Recent findings: Gepotidacin and zoliflodacin are topoisomerase inhibitors that have shown promise in phase 3 clinical trials and are pending FDA approval for the treatment of uncomplicated gonorrhea. These drugs are active against currently circulating multidrug-resistant isolates and provide much-needed oral treatment options. Monoclonal antibodies have increasingly been deployed for treating infections. The identification of bactericidal human monoclonal antibodies with efficacy in preclinical animal models provides optimism for their development as passive immunoprophylactics. Several small molecules with activity against Neisseria gonorrhoeae have been identified; the identification of drugs using artificial intelligence is a particularly exciting advance.

Summary: Recent advances in the development of antibiotics, biologics and small molecules against gonorrhea provide optimism against the stark background of multidrug-resistant gonorrhea. Ongoing surveillance remains critical to evaluate the efficacy of newly introduced treatments.