STI Crisis: WHO's New Blueprint for Global Research and Innovation

The WHO's report on global research priorities for sexually transmitted infections outlines the urgent need for innovation and research to tackle the widespread and impactful STI burden. The report emphasizes critical research areas in diagnosis, prevention, management, and epidemiology, particularly in resource-limited settings. It calls for increased investment and global collaboration to reduce the STI impact on public health.

The World Health Organization (WHO) has unveiled its latest research priorities to combat sexually transmitted infections (STIs), a pressing public health issue impacting millions worldwide. The report, "WHO Global Research Priorities for Sexually Transmitted Infections," emphasizes the urgent need for innovation and research to tackle the STI burden, especially in low- and middle-income countries (LMICs) and among marginalized communities.

The Hidden Crisis of STIs

Every day, over a million new STI cases are recorded globally, highlighting a silent epidemic. In 2020 alone, approximately 374 million new infections occurred from four curable STIs: syphilis, chlamydia, gonorrhoea, and trichomoniasis. Viral STIs, including human papillomavirus (HPV) and herpes simplex virus (HSV), affect hundreds of millions more, posing long-lasting and often lifelong health challenges.

The burden of STIs extends beyond infection rates, profoundly affecting sexual and reproductive health. Women, adolescents, and marginalized populations disproportionately bear the brunt of these infections, facing increased risks of infertility, adverse pregnancy outcomes, and significant psychosocial impacts. Despite the extensive reach and impact of STIs, global progress in reducing their prevalence and associated consequences has been slow.

A Strategic Approach to STI Research

In response to these challenges, WHO's global strategy on STIs for 2022-2030 positions research and innovation at the forefront of the global response. A comprehensive research priority-setting exercise conducted in 2022 identified critical areas that require immediate attention.

The priority-setting process was thorough and inclusive, involving open-ended surveys, scoring by a wide range of stakeholders, and consolidation of research areas into four key domains: diagnosis, prevention, management, and epidemiology. The process aimed to address the most significant gaps in STI prevention, control, and management, particularly in resource-constrained settings.

Key Research Priorities

Diagnosis

Effective STI diagnosis is fundamental to controlling their spread and improving health outcomes. The report emphasizes the need for low-cost, rapid point-of-care tests for various STIs, including gonorrhoea and chlamydia. It also highlights the importance of distinguishing between active and latent syphilis infections and detecting antimicrobial resistance in pathogens like Neisseria gonorrhoeae.

Prevention

Long-term control of STIs hinges on innovative prevention strategies. The development of multipurpose prevention technologies that can prevent both STIs and pregnancy is a top priority. Additionally, the creation of vaccines for gonorrhoea, HSV, syphilis, and chlamydia is crucial. Effective communication strategies to increase STI awareness and engagement with prevention services are also essential.

Management

Current treatment challenges, particularly the rise of antimicrobial resistance, necessitate new therapeutic approaches. The development of novel treatments for drug-resistant gonorrhoea and alternatives to benzathine penicillin for syphilis are urgent needs. The report also calls for innovative strategies for managing sexual partners of those infected to reduce reinfections and ongoing transmission.

Epidemiology

Robust epidemiologic data underpin all efforts to combat STIs. Accurate prevalence and incidence estimates, as well as understanding the burden of disease outcomes, are critical. The report stresses the need to evaluate healthcare-seeking behavior, monitor antimicrobial resistance, and assess the societal costs associated with STIs. This data will help target prevention efforts and measure the impact of interventions.

Addressing STI Challenges During Outbreaks

The importance of STI research was underscored by the 2022 multicountry outbreak of mpox (monkeypox), highlighting how sexual transmissibility can play a key role in the spread of infections. The report identifies specific research needs related to mpox, including evaluating vaccine efficacy, understanding treatment effectiveness, and addressing barriers to prevention and care.

A Call to Action

The WHO report is a call to action for focused investment and innovation to tackle the global STI epidemic. It underscores that without significant research and investment, STIs will continue to adversely impact the sexual and reproductive health of millions worldwide. This call is particularly urgent for women and neonates, adolescents and young people, people living in LMICs, and marginalized populations.

To achieve global goals and reduce the STI burden, the report encourages researchers to focus on the identified priority areas and calls on donors to support this extensive research effort. Global collaboration and investment are vital to addressing STIs effectively and advancing sexual and reproductive health for all.