The growing threat of antibiotic-resistant Neisseria gonorrhoeae, which causes gonorrhea, presents a current public health challenge. Over the years, the pathogen has developed resistance to different antibiotics, leaving few effective treatment options. High-level resistance to key drugs, including ceftriaxone, has become a concerning reality. This article primarily focuses on the treatment of gonorrhea and the current clinical trials aimed at providing new antibiotic treatment options. We explore ongoing efforts to assess new antibiotics, including zoliflodacin, and gepotidacin. These drugs offer new effective treatment options, but their rapid availability remains uncertain. We delve into two ongoing clinical trials: one evaluating the efficacy and safety of gepotidacin compared to the standard ceftriaxone–azithromycin combination and the other assessing the non-inferiority of zoliflodacin versus the combination therapy of ceftriaxone–azithromycin. These trials represent crucial steps in the search for alternative treatments for uncomplicated gonorrhea. Notably, gonorrhea has been included in the “WHO Priority Pathogens List for Research and Development of New Antibiotics”. In conclusion, the urgent need for innovative treatment strategies is underscored by the rising threat of antibiotic resistance in N. gonorrhoeae; collaboration among researchers, industries, and healthcare authorities is therefore essential.

Data supporting the use of Tocilizumab (TCZ) in COVID-19 are contrasting and inconclusive. This meta-analysis aimed to assess TCZ effectiveness in reducing the mortality rate in COVID-19 patients. PubMed, Scopus, Embase, Cochrane, WILEY, and ClinicalTrials.gov were searched to evaluate observational studies and RCTs. The outcome was the mortality rate. Forty observational studies and seven RCTs, involving 9640 and 5556 subjects treated with Standard Therapy (ST) + TCZ or ST alone, respectively, were included. In patients treated with ST+TCZ, a higher survival (Log odds ratio = −0.41; 95% CI: −0.68 −0.14; p < 0.001) was found. Subgroups analyses were performed to better identify the possible interference of some parameters in modifying the efficacy of TCZ therapy on COVID-19 mortality. Separating observational from RCTs, no statistically significant (p = 0.70) TCZ-related reduction of mortality regarding RCTs was found, while a significant reduction (Log odds ratio = −0.52; 95% CI: −0.82 −0.22, p < 0.001) was achieved regarding the observational studies. Stratifying for the use of Invasive Mechanic Ventilation (IMV), a higher survival was found in patients treated with TCZ in the No-IMV and IMV groups (both p < 0.001), but not in the No-IMV/IMV group. Meta-regression analyses were also performed. The meta-analysis of observational studies reveals that TCZ is associated with reducing the mortality rate in both severe and critically ill patients. Although the largest RCT, RECOVERY, is in line with this result, the meta-analysis of RCTs failed to found any difference between ST + TCZ and ST. It is crucial to personalize the therapy considering the patients’ characteristics.

The rate of reported syphilis cases is increasing worldwide, particularly among men who have sex with men. In this scenario, malignant syphilis is a rare, severe form of secondary syphilis, typically observed in immunocompromised individuals and characterized by rupioid skin lesions, together with systemic symptoms that could lead to potentially life-threatening complications. We report the complex case of a 42-year-old man, previously diagnosed with HIV infection, presenting with a five-day history of fever and multiple lymphadenopathies. His immunovirological status was well controlled, and he was fully adherent to antiretroviral therapy. His clinical presentation was severe and ambiguous, with neurological involvement being progressively excluded. The diagnosis was confirmed by serological tests, while histopathological examination of an excised lymph node revealed disrupted architecture with multiple granulomas. Differential diagnosis, including lymphoma and other potential etiologies, was performed. After completion of antibiotic therapy, clinical symptoms completely resolved. No Jarisch–Herxheimer reaction occurred. We also provide an updated review of the current literature, with a focus on HIV coinfection, which is frequently associated with the development of malignant syphilis, and discuss the need for enhanced interventions to prevent sexually transmitted infections, as well as the importance of judicious use of doxycycline post-exposure prophylaxis.

Background: Dermatophytosis is an infection of the skin or adnexa, which is extremely widespread in the environment. Sexually transmitted infections (STIs) are an increasing global public health threat, especially among men who have sex with men (MSM). This study aims to describe an outbreak of sexually transmitted dermatophytosis among MSM in our cohort between April 2022 and October 2023. Methods: This is a retrospective monocentric study including outpatients who were diagnosed with at least one episode of dermatophytosis between March 2010 and October 2023 at the Infectious Diseases Unit of San Raffaele Scientific Institute, Milan, Italy. Mycosis diagnosis was mainly clinical following the medical visit and physical examination. Results: Overall, 107 people were diagnosed with dermatophytosis between March 2010 and October 2023. All 56 cases observed since April 2022 included 55 MSM and 1 female; compared to before 2022 there was a total diagnosis of 51 cases. Conclusions: These results highlight the evident increase in the incidence of mycotic infections among MSM, followed in our center. We are dealing with a new entity of sexually transmissible infections, in addition to the existing diseases that are being studied.

Genital herpes simplex virus (HSV) is associated with a reduction in quality of life and adverse outcomes. The aim of this study is to assess the interest and expectations for a therapeutic HSV vaccine among individuals diagnosed with genital herpes in Italy. A retrospective survey was conducted at the Infectious Diseases Unit of the IRCCS San Raffaele Scientific Institute, Milan, Italy. The study collected data on demographics, clinical history and interest in HSV vaccination. The results showed that 87.5% of participants were interested in a therapeutic vaccine, with interest higher among younger people and those with frequent genital herpes recurrences. Participants most expected the vaccine to reduce the pain associated with outbreaks, followed by a reduction in the frequency and duration of recurrences. These findings underscore the strong demand for a therapeutic HSV vaccine, especially among those who experience recurrent outbreaks, and highlight the importance of considering patient expectations when developing preventive and therapeutic strategies for genital herpes.