article · Venereology
Sexually transmitted infections disproportionately affect sex workers, including female, male, and transgender or gender-diverse individuals, due to occupational exposures, structural barriers, stigma, and criminalisation. Beyond HIV, pathogens such as Neisseria gonorrhoeae, Chlamydia trachomatis, Treponema pallidum, and viral hepatitis contribute substantial co-morbidity. Drug resistance presents critical biological and epidemiological hurdles, including bacterial antimicrobial resistance in gonorrhoea and chlamydia, antiretroviral resistance in HIV, and direct-acting antiviral resistance in hepatitis B and C. Reliance on syndromic management exhibits clear limitations when compared to molecular diagnostics, such as nucleic acid amplification tests, point-of-care tools, and genomic surveillance. Addressing these challenges requires integrating diagnostic stewardship into public health strategies aligned with the World Health Organization 2022 to 2030 Global Health Sector Strategies.
Managing sexually transmitted infections requires moving past symptom-based treatments toward precise testing. Drug-resistant strains of common infections threaten global public health, especially among vulnerable groups facing social and legal hurdles. Prioritising diagnostic stewardship and advanced testing methods helps ensure effective treatment, contains the spread of resistant pathogens, and supports international health targets across low- and middle-income regions.
The work highlights an application need for molecular diagnostic platforms, specifically point-of-care devices, nucleic acid amplification tests, and genomic surveillance tools. Potential users include healthcare providers, diagnostic laboratories, and public health programmes serving key populations. Because the abstract outlines a broad epidemiological perspective rather than a specific device or assay trial, these diagnostic applications appear at an early stage of adoption, requiring implementation and validation in resource-constrained environments.
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Infectious diseases remain a major global public health concern, disproportionately causing morbidity and mortality in low- and middle-income countries. Sexually Transmitted Infections (STIs) heavily affect sexually active populations. Sex workers, encompassing female sex workers (FSWs), male sex workers (MSWs), and transgender/gender-diverse individuals, face heightened vulnerabilities due to occupational exposures, structural barriers, stigma, and criminalization. While substantial focus has historically centered on HIV, non-HIV STIs such as Neisseria gonorrhoeae, Chlamydia trachomatis, Treponema pallidum, and viral hepatitis present significant co-morbidity. Crucially, drug resistance across these pathogens presents distinct biological and epidemiological challenges: bacterial antimicrobial resistance (AMR) in N. gonorrhoeae and C. trachomatis, antiretroviral (ARV) resistance in HIV, and direct-acting antiviral (DAA) resistance in hepatitis B and C. This perspective article synthesizes the current epidemiological landscape, critiques the reliance on syndromic management over molecular diagnostics (e.g., NAATs, point-of-care, and genomic surveillance), highlights diagnostic stewardship, and outlines priority public health strategies aligned with the WHO 2022–2030 Global Health Sector Strategies.
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DOI: 10.3390/venereology5030019
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