Learning From HIV, Building Better Infrastructure to Tackle STIs: Jeanne Marrazzo, MD, MPH

At a moment when HIV control has reshaped the prevention landscape, sexually transmitted infections are testing the limits of public health progress. During a wide-ranging presentation at the Conference on Retroviruses and Opportunistic Infections (CROI 2026), Jeanne M. Marrazzo, MD, MPH, CEO of the Infectious Diseases Society of America, described an inflection point for sexually transmitted infection (STI) prevention—one marked by innovation, uneven gains, and persistent failures.

Marrazzo framed doxycycline post-exposure prophylaxis (doxy-PEP) as one of the most consequential recent developments. Used after condomless sex to prevent bacterial STIs, doxy-PEP has demonstrated strong effectiveness among gay and bisexual men and other men who have sex with men, particularly against chlamydia and syphilis. Early implementation data from cities such as San Francisco and Seattle suggest that uptake is already bending local syphilis and chlamydia curves. Still, she cautioned that gonorrhea remains “stubbornly common,” with concerns about emerging resistance patterns, underscoring the need for vigilant genomic surveillance and responsible antibiotic stewardship.

At the same time, she highlighted promising advances in treatment and prevention. Two new single-dose antibiotics—gepotidacin and zoliflodacin—offer fresh options for gonorrhea management, and vaccine trials evaluating meningococcal group B vaccines for gonorrhea prevention are eagerly anticipated. Home-based testing for gonorrhea, chlamydia, and syphilis has also entered the US market, raising new questions about reach, equity, and linkage to care.

Yet the most sobering portion of her remarks centered on congenital syphilis. The United States recorded nearly 4000 cases last year, a stark reversal for a condition that had been close to elimination 2 decades ago. Marrazzo described each case as a “massive public health failure,” often reflecting missed prenatal care, untreated maternal infection, and broader social vulnerabilities. Provisional federal data show rates far exceeding national targets, mirroring increases in primary and secondary syphilis among women.

For Marrazzo, the path forward lies in borrowing from the HIV playbook. She pointed to the Ryan White–funded HIV care infrastructure as a global model—integrated, interdisciplinary, and attentive to social as well as medical needs. Applying that same comprehensive, equity-driven framework to STI prevention could help close gaps in screening, partner treatment, and prenatal care. Insurers, she emphasized, have a crucial role in ensuring coverage for timely testing and appropriate therapy for pregnant individuals and exposed infants.

Stepping back from the individual data points, Marrazzo’s overarching message was clear: innovation alone is not enough. Sustained investment, real-time surveillance, equitable access, and holistic care models will determine whether the next chapter in STI prevention builds on HIV-era successes—or allows preventable infections to persist.