By Rebecca Bowers

EXECUTIVE SUMMARY

According to a new report, serious gaps exist in the research pipeline regarding the development of prevention and treatment options for sexually transmitted infections such as gonorrhea, chlamydia, and syphilis.

  • In 2018, the National Institutes of Health made a significant new investment in gonorrhea, chlamydia, and syphilis vaccine research. The funding opportunity, which will invest $9 million in FY 2019, is scheduled to endow three to five awards. Although the sum is significant, vaccine development will require even more funding, the report states.
  • Infrastructure for the delivery of sexual health services remains highly underfunded in the United States, the report notes. Declining funding for sexual health clinics must be addressed.

Serious gaps exist in the research pipeline regarding the development of prevention and treatment options for sexually transmitted infections (STIs) such as gonorrhea, chlamydia, and syphilis, according to a new report.1

“Despite a few promising advancements, STI research is nowhere near where it needs to be,” says Jeremiah Johnson, MPH, HIV project director with Treatment Action Group and lead author of the current paper. “I hope this report is an eye-opener for people working not just on STI prevention, but also other areas of sexual health.”

In 2017, a total of 30,644 cases of primary and secondary syphilis were reported in the United States, a 10.5% jump from 2016 figures. A total of 555,608 cases of gonorrhea were reported in 2017, representing an increase of 18.6% since 2016. More than 1.7 million cases of chlamydia were diagnosed in 2017, with 45% of cases found among young females 15 to 24 years of age.2

The new report highlights the need for increased STI prevention, treatment, and diagnostics, says Barbara Van Der Pol, PhD, MPH, president of the American Sexually Transmitted Diseases Association, and associate professor in the Department of Infectious Diseases at the University of Alabama at Birmingham.

“We have made important strides in the STI research field, but nowhere near enough to keep up with the scope of the STI crisis here and around the globe,” said Van der Pol in a press statement.

Could Vaccines Offer an Answer?

In 2018, the National Institutes of Health made a significant new investment in gonorrhea, chlamydia, and syphilis vaccine research. The funding opportunity, which will invest $9 million in FY 2019, is scheduled to endow three to five awards. Although the sum is significant, vaccine development will require even more funding, the report states. Commercial vaccine producers will be unlikely to commit to funding such products unless there is some certainty of vaccine safety, as well as the potential of an established market, according to the report.1

In the case of gonorrhea, Oregon State University researchers have made progress in narrowing down targets for a potential vaccine. Scientists recently completed proteomic profiling on all the proteins produced by 15 gonorrhea strains. Among the isolates were World Health Organization-maintained reference strains that show all known profiles of gonococcal antimicrobial resistance.3 Nine new potential vaccine candidates were identified as a result of the research.

Investigators are looking at multiple paths for a potential chlamydia vaccine. McMaster University scientists in Ontario recently published research indicating that a novel chlamydial antigen known as BD584 may serve as a potential candidate. Data indicate that administering BD584 through the nose reduced chlamydial shedding by 95%.4

Recent efforts to map all proteins produced by syphilis and identify vaccine targets have brightened the outlook for vaccine development.
According to research published by University of Connecticut scientists, outer membrane proteins have been identified. Collaboration with researchers at the University of North Carolina is underway to determine whether the identified strains are similar to strains in Malawi and China.5

Time to Rework the Infrastructure

Infrastructure for the delivery of sexual health services remains highly underfunded in the United States, the report states. Declining funding for sexual health clinics must be addressed.

Most local health departments participating in a 2017 survey reported stagnant or declining funds for HIV, STI, and viral hepatitis services. Local departments that reported funding cuts indicated that subsequent reduced services were most likely to affect disease surveillance and STI partner services, as well as HIV testing and hepatitis B vaccination. Almost half (43%) reported reductions in HIV, STI, and/or viral hepatitis program staffing levels. The greatest loss in staffing was in public health nurses.6

“Now is the time to increase funding at the National Institutes of Health for major new STI research initiatives,” states David Harvey, MSW, executive director for the National Coalition of STD Directors.

REFERENCES

  1. Treatment Action Group. Gonorrhea, Chlamydia and Syphilis: Pipeline Report 2019. New York; 2019.
  2. Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2017. Atlanta: U.S. Department of Health and Human Services; 2018.
  3. El-Rami FE, Zielke RA, Wi T, et al. Quantitative proteomics of the 2016 WHO Neisseria gonorrhoeae reference strains surveys vaccine candidates and antimicrobial resistance determinants. Mol Cell Proteomics 2019;18:127-150.
  4. Bulir DC, Liang S, Lee A, et al. Immunization with chlamydial type III secretion antigens reduces vaginal shedding and prevents fallopian tube pathology following live C. muridarum challenge. Vaccine 2016;34:3979-3985.
  5. Kumar S, Caimano MJ, Anand A, et al. Sequence variation of rare outer membrane protein β-barrel domains in clinical strains provides insights into the evolution of Treponema pallidum subsp.pallidum, the syphilis spirochete. MBio 2018;9. doi:10.1128/mBio.01006-18.
  6. National Academy of Public Administration. The Impact of Sexually Transmitted Diseases on the United States: Still Hidden, Getting Worse, Can Be Controlled. December 2018. Available at: https://bit.ly/2GYvGV5. Accessed April 19, 2019.