Issue: December 2019
October 07, 2019
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Q&A: The need to refocus STI research

Issue: December 2019
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Researchers at the NIH recently highlighted the need for a “refocused and enhanced research portfolio directed at the development of innovative diagnostics, therapeutics, and vaccines for STIs.”

According to WHO, in 2016, approximately 86.9 million men and women were newly infected with Neisseria gonorrhoeae, 6.3 million with Treponema pallidum, 127.2 million with Chlamydia trachomatis and 156 million with Trichomonas vaginalis, the researchers noted.

In 2017 in the United States, a record 2.3 million new STD cases were reported, according to the CDC. Since 2013, gonorrhea cases increased 67%, primary and secondary syphilis cases increased 76% and chlamydia cases increased 22%.

Infectious Disease News spoke with Emily Erbelding, MD, MPH, director of the Division of Microbiology and Infectious Diseases at the National Institute of Allergy and Infectious Diseases and co-author of the paper in The Journal of Infectious Diseases, about the need to focus research into STIs. – by Marley Ghizzone

Q: Why is it necessary to refocus STI research?

A: The rates of [STIs] in the U.S. that are reportable (gonorrhea, chlamydia and syphilis) have all increased over the past decade. All can have devastating health consequences. The bacterium that causes gonorrhea (Neisseria gonorrhoeae) is becoming increasingly resistant to the antibiotics that we use to treat this infection. Therefore, it is clear that we need to develop new therapeutics if we are to address these epidemiologic trends.

Emily Erbelding

Q: What kind of research is needed?

A: We need to develop new antibiotics that can be used to treat resistant bacteria infections, including gonorrhea. We also need to develop sensitive and specific diagnostic tests that can be implemented at the point-of-care (ie, in a doctor’s office while a patient waits) so that infections can be more readily treated. We also need to apply modern scientific tools to develop effective vaccines so that these infections can be prevented.

Q: What kind of partnerships will it take?

A: Vaccines, new drugs and new diagnostics will best be developed through public-private partnerships. Public funding agencies, such as the [NIH], can assist by supporting basic research and closing gaps in preclinical and clinical development pathways. Private industry will have a role in bringing promising new tools to the commercial market. Full implementation of any advances in this area will require engagement from public health departments along with community partnerships.

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Q: How has the STI epidemic impacted the goal to end HIV by 2030?

A: We know that the inflammation associated with untreated STIs may facilitate the sexual transmission of HIV. If there are high rates of untreated STIs in those who are also HIV-infected, especially if they are not yet treated for HIV, this could increase HIV transmission in the population.

Q: Is the WHO goal to end STI epidemics by 2030 attainable without refocusing research?

A: We believe that new biomedical tools on a number of fronts will be necessary to achieve this goal. In 1999, there was a national plan to eliminate syphilis transmission in the U.S. but this goal proved to be a tremendous challenge and was never achieved. New tools, such as a vaccine for syphilis, might put this goal within reach. Similarly, rising rates of drug-resistant gonorrhea will require new strategies — therapeutics, vaccines, as well as rapid susceptibility testing — to fully address the threat.

References:

Eisinger RW, et al. J Infect Dis. 2019;doi:10.1093/infdis/jiz442.

Disclosures: The authors report no relevant financial disclosures.