Antimicrobial resistance to M genitalium has developed rapidly over the past few years and we now have very limited treatment options. It is therefore important to optimise the use of current therapies and rapidly evaluate new drugs as they become available. This presentation will review the rationale behind current treatment recommendations and discuss options for the future.

Metronidazole and tinidazole are the drugs of choice for the treatment of T. vaginalis, although resistance has been observed but is poorly understood. Treatment failure is usually assumed to result from poor adherence or re-infection but recent studies suggest it results from antimicrobial resistance quite frequently. Second-line agents for T. vaginalis treatment are suboptimal and management of recalcitrant cases can prove difficult, as will be illustrated in this presentation.

Multi-drug resistant (MDR) Neisseria gonorrhoeae (NG) is a global health threat. I will discuss approaches to the management of MDR NG infections, using examples of the recent cases in England, and also discuss the recent changes to the UK guidelines for the management of gonorrhoea.

From digitalisation to automation. Innovative technologies offer valuable opportunities for the diagnosis and management of STIs. Future sexual health services will need to harvest innovation to maximise their cost-effectiveness and reach. The latest developments in digital sexual health demonstrate that most services can be delivered remotely using online tools and e-sexual health interventions. The upcoming era of Artificial Intelligence, notably Machine Learning, is likely to aid clinicians and patients in making better decisions about accessing sexual healthcare. At this stage, acceptability and attitudes towards digital services play a key role in their design and implementations.

Using the example of "Do It London", the social marketing element of the Greater London HIV Prevention Programme, Paul will explore some of the challenges, opportunities and limitations of digital communications for promoting sexual health. Using examples from the evolution of the campaign since 2015, the talk will demonstrate the ways in which digital technologies can offer more cost effective and targeted methods of reaching key target audiences, compared to traditional media, and how they can enable more precise tailoring of campaign messaging to those audiences. Paul will also share some of the findings from the London experience, including metrics and user evaluation, which reveal the impact of the campaign to date and further unexplored areas for future digital interventions.

Since the introduction of ARV!s in the nineties, the percentage of STI!s and the requests for testing have been rising.In 1993 in the STI clinic in Amsterdam around 15.000 clients were tested, in 2005 25.000 and in 2018 nearly 52.000 tests were performed. In order to deal with this rising amount,a risk prioritizing system was introduced in 2008. Because of budgetary restrictions since 2015 only certain risk groups were allowed for testing. Among these groups are: Clients with STI related complaints ,Clients who are warned or referred because of a STI, Victims of sexual violence and Clients who are eligible for PEP.Even within these groups priorities had to be made which led to long waiting times in certain cases. Since 2014 this prioritization was started online and today around 90% of the clients make an appointment this way. The goal was to manage 5000 clients extra with the same budget and the same amount of registered nurses and the extension of the amount of medical assistants. After a visit to the Deen Street Clinic in 2015 a plan was made to ask for the medical history on line as well.This will save time in the clinic which can be used for clients who really need more attention (counseling and sexual education). There are several problems to be solved. What to do with people with limited digital literacy? What to do with people who are pretending to belong to certain risk groups in order to get an appointment? Our main goal remains to be focussing on vulnerable and key populations like MSM, adolescents, refugees and commercial seks workers. To deal with the growing demand of testing and to improve quality, digital health will be of great use but it will not solve all existing problems immediately…

STIs disproportionately affect those with barriers to accessing services and are associated with health inequalities (deprivation, non-white ethnicity and geographic factors). Although online sexual healthcare offers considerable potential for health gains and aligns with digital- and self-managed strategies, evidence for its effectiveness is lacking, particularly related to clinical outcomes, impact on health inequalities, patient experience, and economic parameters. Both health literacy and digital literacy are needed to access care online effectively but little is known about patterns of engagement with online sexual health care and its potential for widening health inequalities if systems are not tailored for maximal population reach and alternatives are not provided for those who cannot or do not wish to access care online. This presentation will provide a critical assessment of potential risks in the implementation of digital technologies for sexual health in the context of digital literacy, inequality and cost-effectiveness.

IUSTI-Estonia was founded in 1999, and has been professionally active ever since. EESRH played an important role in the development and implementation by IUSTI-Estonia of the first edition of the STI Management and Treatment Guidelines in Estonia and in the organisation of bedside microscopy courses for Estonian physicians (as well as the publication of a pertinent handbook). Since then, IUSTI-Estonia has published 3 updated versions of the Guidelines, one every four years. IUSTI-Estonia has also held annual conferences for its members (20 in all so far), as well as 16 major conferences and seminars for Estonian doctors of all specialisations. Among guest speakers at the conferences there have always been numerous world-renowned specialists in the field of STIs.

What is quality? How can one explain quality? These are questions that we have to explain to our customers and partners. The best way is to say that the laboratory is accredited according to ISO 15189. But then we have the next question: what is accreditation? We tried to elucidate those issues in our EESRHR project. So many countries, so many wonderful people with whom we worked and work together!

The presentation will embrace the following topics: optimization and introduction of the quality management of the laboratory diagnosis; implementation of National Guidelines for diagnosis and treatment of STIs; international validation of the domestic diagnostic test systems for syphilis; development and implementation of a computer-based monitoring system for communicable diseases; establishment of N gonorrhoeae surveillance for antibiotic resistance; elaboration of informational materials for STI prevention in the Republic of Belarus.

During the EE SRH network project period the preparation of STI management guidelines and its adaptation to the national circumstances became an excellent example of the multiprofessional collaboration in Lithuania and other countries of Eastern Europe. The Project aimed to bring international evidence-based approaches across the professional  barriers as microbiologists, dermatovenereologists, gynaecologists, general practitioners, public health specialists and other professionals involved in STI management acted together.

Antimicrobial resistance to N.gonorrhea has changed during the last 5 years in Belarus. The important thing is to optimize the use of new drugs in treatment. This presentation will review the rationale of current treatment recommendations in Belarus.

Phylogenetic comparisons of T. pallidum genomes indicate that most contemporary strains are members of a globally dominant strain cluster, which diversified from a common ancestor in the mid-twentieth century. Based on the whole genome data, we recently proposed a new high-resolution multilocus sequence typing (MLST) scheme for Treponema pallidum subsp. pallidum strains including the analysis of the 23S rRNA gene mutations for macrolide resistance. Using the new MLST in different countries revealed a high strain variety and an overall 80-90% resistance to macrolide antibiotics.

As the rates of syphilis continue to increase in many parts of the world, some of the less common clinical manifestations such as syphilis maligna, neurosyphilis, otosyphilis, ocular syphilis, and syphilitic hepatitis are being encountered more frequently by clinicians. In addition, there are reports that recurrent syphilis may present with altered clinical manifestations. In this session, through an interactive case-based approach, we will discuss the management of some of the challenging clinical presentations of syphilis and review current and future diagnostic tests for this infection.

Rates of syphilis are on the rise in a number of high income countries posing a challenge to clinical services and control on a population level. This talk will explore a potential new framework for how we think about syphilis testing and control that includes screening for syphilis using NAAT, clinical systems changes to increase screening and real time tracking of transmission networks using genomics to target these intervention.

Children, ranging from babies after the neonatal period, to those under the age of 13 years, may present with sexually transmitted infections. Clinicians may assume this is vertical transmission, especially in younger children, but what is the evidence for this? What should you do if a child 5 years presents in your practice with genital warts? This talk will review the evidence for all STIs as markers of child sexual abuse and consider how to deal with cases in practice. The speaker led on the UK Royal College of Paediatricians Evidence Based Guidelines on this topic and will also consider how the evidence was reviewed and conclusions drawn.

Child sexual exploitation (CSE) is a form of child sexual abuse where an individual or a group of people takes advantage of an imbalance of power to coerce, manipulate or deceive a child (anyone under the age of 18) into sexual activity for which the child receives something they want or need in exchange. Exploited children (often teenagers) do not usually perceive themselves as victims and may consider the abusive relationship to be a healthy one. Spotting the Signs was developed to help sexual health and general practitioners ask the right questions of all under 18!s and vulnerable adults to detect CSE so that victims can be offered appropriate help. This is also the case with trafficked children and unaccompanied minors seeking asylum. This talk will explore whether Spotting the Signs may be useful in Europe or how it should be adapted.

Although there has been a resurgence of syphilis in Europe, syphilis in women and congenital syphilis remains uncommon. This talk will examine the impact of syphilis in pregnancy as well as the presentation and diagnosis of congenital syphilis. It will describe the current epidemiology of congenital syphilis in Europe particularly focusing on England and will discuss the responses to and challenges from the recent increase in cases of congenital syphilis. Syphilis in pregnancy remains a significant cause of adverse pregnancy outcomes and perinatal morbidity and mortality worldwide. The recent resurgence of congenital syphilis in the U.S. reminds us of the importance of continued awareness and vigilance of syphilis in pregnancy in countries where it is currently uncommon.

The Alinity m STI assay is a new highly sensitive and specific qualitative multiplex CE marked in vitro assay for the detection and differentiation of nucleic acids from Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Trichomonas vaginalis (TV), and Mycoplasma genitalium (MG) recently introduced for use with the automated Alinity m System. Alinity m is a fully automated, random and continuous access analyzer capable of performing multiple assays in parallel and providing a time-to-first-result of < 115 minutes. The reporting of the Alinity m STI assay can be customized in any combinations of one, two, three or all four analytes to allow flexibility in the management of laboratory testing.

The performance of the Alinity m STI assay and the impact of implementing the Alinity m System were evaluated in a large clinical laboratory (Ramón y Cajal University Hospital, Madrid, Spain). The Alinity m STI assay demonstrated high precision and accuracy in comparison to the currently applied molecular routine method for the detection of Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, and Mycoplasma genitalium. Consolidation of STI, HPV, HIV, HCV and HBV assays on the Alinity m system as well as random and continuous access significantly improved turnaround time of test results in comparison to the current variety of routine test methods.

The burden of STI and HPV infections has been and will be an issue that needs both routine and novel solutions. Self-sampling solutions are alternatives for people who do not have easy access to doctor, request anonymous service, have had uncomfortable experience with their physician before, etc. Based on Estonian experience, men are more active in using STI testing by self-sampling solutions compared to analysis by clinicians where women's samples are more common. HPV analysis from self-sampled material is a rising alternative to clinician-collected cervical samples. This solution, offering a convenient possibility to further improve the prevention of cervical cancer, is already being introduced in Estonia.

In early 2019 Dr Rantakokko-Jalava and her team noticed that some Chlamydia cases in the Turku region, Finland, could not be detected with the Aptima Combo 2 test used widely in diagnostics of STDs in Finland. Ever since, over 200 Chlamydia trachomatis cases testing negative by Aptima Combo 2 (AC2) but positive by Aptima CT test, run with Panther instruments, have occurred in Finland. SYNLAB-Finland and SYNLAB-Estonia have been centrally involved in showing that the cases are not limited to Turku or Helsinki regions in Finland, and that cases have been missed for more than a year. This pitfall in Chlamydia testing is most likely due to a new variant of C. trachomatis not detected with the Aptima Combo 2 test.

Many countries are facing challenges implementing and/or de-implementing chlamydia control interventions, including screening and extra-genital testing. This presentation will deal with the evolving landscape of chlamydia control, the evidence for its effectiveness, including limitations and harms. I will discuss the way forward now practice-based evidence has shown that “test and treat” programs do not seem to work as well for chlamydia infection control, as they do for hiv-control. I will reflect on implications on current testing policies and on new future avenues to pursue the goal of infectious disease control.

Given the current challenging issues we face such as XDR GC, new variant CT, MG and its increasing resistance, we rely on our diagnostic tests more than ever. There is no perfect testing system and all assays have their pros and cons. In recent years we have seen novel features of assays emerge that go beyond simply providing a positive or negative result. Desirable features of testing platforms such as the ability to test for multiple pathogens, rapid turnaround time, and the ability for in-clinic use can enable us to change clinical pathways and manage patients more effectively. In addition, diagnostics that provide information about the presence or absence of antimicrobial resistance can guide us not only when to treat but also what to use. In this talk I will elaborate on how current and future diagnostics can help improve outcomes for our patients and potentially achieve broader public health benefits.

I argue, in accordance with the 1949 UN Convention, that the sex industry is a fundamental threat to human rights and women's and girls' lives. The sex industry perpetuates inequality and shortens women's lives considerably: the mortality rate of women in prostitution is 40 times higher than for women outside prositution. The sex industry does not have positive effects for society as a whole and the Nordic Model, focusing on demand, has reduced prostitution and made men as a group aware of that bribing someone for sex is not acceptable and that sex should be mutual. The positive outcome is shown in the Honeyball report by the EU parliament; the Swedish official evaluation from 2010 among others, and should be adopted by any country which takes equality seriously.

The Nordic model of sex work regulation is centred on criminalising the purchase of commercial sex. The model was conceived and propagated by a fringe group of radical feminists who are determined to see that the concepts of sex work and trafficking are conflated. That is, that sex workers are "victims" that need to be protected from their clients. I will demonstrate that the Nordic model is ill conceived, doesn't achieve what it claims, and it causes harm. The fact that every country that has adopted the Nordic model has avoided conducting a formal scientific evaluation of the policy is clear evidence that the motives underlying the model are entirely ideological and political. The Nordic model has evolved into an international circus.

Besides the three main viruses in the world of STIs (HIV, HSV and HPV) other viruses can affect the genital tract and be considered as STIs. Molluscum Contagiosum Virus is well known as a sexually transmitted agent. The disease is benign and self healing but can cause psycho-social discomfort. Less common and less known is the role of ADENOVIRUS (AV) as a sexually transmitted agent: AV has been reported as a cause of NGU in 2-4% of cases often in association with conjunctivitis. Recently some news about AV infection have been reported Viruses can infect almost all living organisms and also sexually transmitted agents can be infected. Trichomonas vaginalis is considered the most common non viral STI pathogen. Trichomonas vaginalis virus (TVV) was first described in 1985 as a dsRNA virus infecting the protozoan. TVV was found present in about 40% of TV and can affect metronidazole susceptibility. Other small particles such as plasmids seem to play important role in the pathogenesis of chlamydial infection and in the induction of resistance in Gonorrhoea infection. A last point of discussion is related to the high infection pressure, specially of viral diseases and the suitability of MSM to blood donation.

The nine-valent vaccine has now been introduced. Incidence of high-grade cervical disease among women initially HPV-negative has been shown to be reduced by 98.2%, and the need for cervical surgery by 97.8%. The main population-level impacts and herd effects following the introduction of HPV vaccination programs have been declines in genital warts as well as in CIN 2+. Vaccination of boys has been implemented in some countries, but the vaccination uptake is often very low. Information and education seem to be very important. Development of therapeutic vaccines has been very slow. There are several explanations for these barriers. Results of a promising phase II study for cervical intraepithelial neoplasia have been presented by Harper et al. Treatment of HPV associated disease is often difficult. Imiquimod is one of the local treatment options available. In a recent review, one could see complete response in 63% of men with penile intraepithelial neoplasia (PIN). Risk factors for HPV related diseases have been discussed. Dermatological disorders of the penis and immunosuppressive drugs are examples of important risk factors for PIN. Diagnosis of this condition might be difficult; dermatoscopy might be a helpful diagnostic tool.

In Europe the impact of HSV 1 in new acquisitions of genital herpes, neonatal herpes and recurrent disease is becoming increasingly significant. This talk addresses this issue, as well as the role of stress and personality on disease progression and the problem of false negative type specific antibody testing.

The burden of psychological distress among persons attending STIs Clinics can be heavy, up to 35-40% of patients. Since the !80 a number different conditions ranging from more ordinary aspects to severe psychiatric conditions have been described among patients living with HIV, HSV and HPV. In the last years the increasing use of recreational drugs or erectile dysfunction medications, the mixing of different Culture!s environment and the advent of PrEP have widened these situations. What we can do to copy with these issues? Many Clinicians are mainly concentrated on STIs diagnosis and treatment and place STIs!s psychological distress in the background; however, the importance of a correct framing of psychological/psychiatric conditions can have an impact on the workload of STI medical personnel. In many countries the figure of health advisor are not operating; on the other hand, is this system always so effective? The “counselling” in STIs managements is not always the solution. The presentation would be a starting point for a general reflection on these issues rather than providing ready-to-use solutions.

Sexual transmission of Hepatitis A,B,C and D is well recognized as is the protective role of vaccination for Hep A and B. Changes in sexual networking have made Hepatitis A epidemics a constant threat. WHO targets for the eradication of Hep C require the rapid role out of wider testing and DAA. However reinfection with Hep C is a possibility post therapy and the tensions of unmodified risk taking and the challenges this poses post therapy particularly to public funded healthcare is unresolved. The impact of the wider availability of PREP on Hep C epidemics in urban centres has now been described in a number of epidemic case studies and the ideal intervals for testing for Hep C in those that remain at risk needs to be reviewed in the light of these reports. The presentation will also briefly touch upon the other hepatitis viruses and their links to sexual risk taking behaviors.

The specialities of Dermatology and Venereology are intrinsically tied to each other explaining the various difficulties of differentiating harmless genital inflammations from sexually transmitted diseases. Clinicians who are confronted with genital manifestations need to be familiar with clinical manifestations of STI as well as inflammatory diseases. You are cordially invited to take an active part in this quiz.

Immigration, whether the result of family reunification, economic migration, or asylum seeking, has become an increasingly visible and explosive issue in many western European nations. International migration may pose a challenge for sexual health as individuals may arrive from, or have contact with, high STI/HIV prevalence countries of origin. Moreover, refugees may be at increased risk for STIs because of many factors associated with civil disruption and displacement, resulting in vulnerability to sexual exploitation, sexual violence and abuse, and lack of access to prevention and educational efforts. The author will present some challenging clinical manifestation of STDs on dark skin compared to white.

We all make mistakes. It's inevitable. Luckily, they are usually easily resolved and no one comes to harm. A wise man said "Learn from your mistakes, but even better is to learn from someone else's"! A cacophony of errors will be presented with no harm done, other than to the ego of the speaker.

Syphilis notification rates have been increasing in the EU/EEA since 2010, with an accelerated trend observed in recent years, predominantly among MSM. Outbreaks or clusters of syphilis have also been reported among the EU/EEA heterosexual populations. The European Centre for Diseases Prevention and Control (ECDC) engaged in formulating evidence-based options for response.
A systematic literature review of several databases was conducted to identify interventions with a reported impact implemented in response to syphilis outbreaks and/or increased notifications.. A Member States survey in 2019 asked about specific response measures, if already implemented. The results will be presented in detail but show that a comprehensive approach, including a combination of enhanced screening of populations at risk, partner notification, case management and education of the general public and of the healthcare staff is advised in response to increases in syphilis in the EU/EEA. The choice of interventions should be informed by local epidemiology, address main determinants of transmission and target the populations groups affected. Please see full abstract here.

In Europe, syphilis is the third most reported STI with 33,193 cases reported in 2017 (7 per 100,000 population). Populations at-risk for bacterial STIs include young people (15-24 years old), men-who-have-sex-with-men (MSM), and pregnant women. New testing technologies, strategies and approaches may lead to increased access and coverage of STI testing in populations most at-risk for STIs in Europe. The aim of this systematic review was to assess the evidence-base for the impact of novel testing strategies and approaches on access to testing, testing coverage and linkage to care (LTC) for curable STIs (chlamydia, gonorrhoea, syphilis, trichomoniasis and Mycoplasma genitalium infections). Here we report on the review!s syphilis results.
The strongest evidence to increase syphilis testing access, coverage and LTC was for the use of rapid syphilis testing. Robust acceptability, feasibility and effectiveness studies should be carried out among at-risk groups including ANC attendees, young people, MSM, and PLWH in European settings. In addition, focused training using guidelines and screening algorithms could enable increased testing outcomes for multiple STIs. Please see full abstract here.

Gonorrhoea is a major public health problem globally. Increasing incidence in many European countries and the emergence of resistance to ceftriaxone, the last option for effective first-line monotherapy, are of serious concern. Improved understanding of the emergence and spread of antimicrobial resistant (AMR) Neisseria gonorrhoeae strains, and their associated AMR determinants, nationally and internationally is crucial. Whole genome sequencing (WGS) offers ideal resolution for describing N. gonorrhoeae population dynamics, predicting and inferring transmission of AMR from sequence data, and enhancing infection control through linkage with clinical and epidemiological data. In EU/EEA, the European gonococcal antimicrobial susceptibility programme (Euro-GASP) in collaboration with The Centre for Genomic Pathogen Surveillance (CGPS), The Wellcome Sanger Institute, Cambridge, UK utilises WGS, in conjunction with AMR, clinical and epidemiological data, to describe the N. gonorrhoeae population and its AMR across the EU/EEA and significantly enhance the understanding of distribution of AMR clones in different risk groups nationally and internationally.