Sexual health for all: Lessons from the HIV & STI 2025 World Congress

This July, CATIE joined 1,500 researchers, advocates and policy makers from around the world for the STI and HIV 2025 World Congress in Montreal, Quebec. Held every two years, the event provides a venue for global leaders in sexual health research to discuss the latest evidence and most pressing challenges in STI prevention, testing and care. Four particularly timely and significant topics stood out, each with important implications for bacterial STI prevention, testing and treatment.

DoxyPEP for cis women

A key theme of the event was the lack of research on doxycycline post-exposure prophylaxis (doxyPEP) effectiveness in cis women and limitations of the only randomized clinical trial conducted so far. Although the trial found no prevention benefit against bacterial STIs, this may have been because study participants were not consistently taking doxyPEP as prescribed. The good news is that a new trial in the US will attempt to improve on the previous study’s methods by better addressing barriers to doxyPEP adherence.

For more information on doxyPEP, watch CATIE’s World Congress video.

Antimicrobial resistance

There was substantial discussion about the major global public health threat posed by antimicrobial resistance (AMR) and its implications for preventing and treating bacterial STIs. We heard opposing viewpoints about the possible impact of wide scale doxyPEP use on AMR. This was evident in the divergent statements and guidelines from medical and public health bodies, some providing cautious recommendations and others advising against doxyPEP. The discussion also explored how routinely screening gay, bisexual and other men who have sex with men (gbMSM) for chlamydia and gonorrhea might impact AMR, as the link between screening and increased antibiotic use has led some to reconsider this practice.  

CATIE’s World Congress video about AMR provides more information on this topic.

Vaccines

We also heard about current progress in bacterial STI vaccine development and the technical, financial and logistic challenges involved. Presenters discussed vaccine development for syphilis, gonorrhea and chlamydia, as well as regulatory and funding challenges. For example, presenters noted that early versions of these vaccines may only be partially effective, making them less appealing to the public. Panelists and presenters also discussed the relatively limited investment in development of vaccines for bacterial STIs, compared to viral STIs such as HPV.    

Check out CATIE’s World Congress video to hear more from leading vaccine experts.

Adapting to a new landscape

The theme of this year’s congress, “Sexual Health for All”, reminds us that global STI crises are fueled by inequity: inequity in STI burden and inequity in access to prevention, testing and treatment. The theme also serves as a call to redouble efforts to tackle these challenges amidst drastic cuts to international funding for sexual and reproductive health programs by the current U.S. administration.

Panelists emphasized the need to invest in regional data and governance, streamline approval processes for new medicines and technologies, and expand the adoption of innovations such as artificial intelligence and self-testing. Several speakers talked about the importance of building industry and community partnerships and tailoring messaging to the needs and perspectives of investors and users of new technologies.

For more on this topic, CATIE’s World Congress video delves deeper.

Why does this matter for Canada?

It is tempting to think Canada is insulated from global trends, but we should keep something in mind: just as inequity drives STI disparities globally, it also drives them within Canada.

GbMSM have long carried a disproportionate burden of bacterial STIs, reflecting persistent stigma, homophobia and barriers to accessing care. More recently, however, rising rates among heterosexual populations in Canada and other high-income countries remind us that inequities tied to gender, income and other social factors are also powerful drivers of sexual health outcomes.

This widening inequity highlights the continued urgency of addressing disparities linked to sexual identity, while also addressing a full range of social determinants, both globally and in Canada. This makes the challenges, tools and solutions discussed at the STI & HIV 2025 World Congress all the more relevant to our work in the sexual health sector. Ultimately, these lessons equip us to confront inequities head-on and build a more inclusive sexual health response.

 

Dan Miller is CATIE’s knowledge specialist in HIV care and STIs. He holds a master’s degree in public health from the Dalla Lana School of Public Health, University of Toronto and is an accomplished health services researcher and communicator.