Current Opinion in Infectious Diseases最新文献

{"title":"Developments in genital herpes: progress in prevention and treatment.","authors":"Michelle Collins-Ogle, Betsy C Herold","doi":"10.1097/QCO.0000000000001177","DOIUrl":"10.1097/QCO.0000000000001177","url":null,"abstract":"<p><strong>Purpose of review: </strong>Genital herpes is a major worldwide public health problem with more than four billion people infected with either herpes simplex virus type 1 (HSV-1) or type 2 (HSV-2). To reduce HSV infections, which greatly impact people of all ages, a thorough understanding of the epidemiology, viral life cycle and correlates of immune protection are essential. This review highlights advances in these areas including new research in vaccine development and potential future strategies for a cure.</p><p><strong>Recent findings: </strong>Historically, HSV-2 was the predominant cause of genital infection, but HSV-1 now accounts for more than half of all new infections worldwide. HSV-1 is less likely than HSV-2 to cause clinical recurrences; however, both can be transmitted perinatally, particularly during primary infection. Neonatal infection may result in disseminated and/or neurologic disease with significant morbidity despite antiviral therapy. Resistance to current antivirals may emerge particularly among immunocompromised patients, highlighting the need for new approaches for treatment and prevention. Prior vaccine trial failures and new research indicate that neutralizing antibodies, long considered the correlate for protection, are not sufficient, and that polyfunctional antibodies with cytolytic activity as well as cellular immune responses will be needed for effective prophylactic and therapeutic vaccines.</p><p><strong>Summary: </strong>HSV infections are usually asymptomatic but the viruses uniformly establish latency with periodic reactivation and the potential for long-term neurologic sequelae. Molecular diagnostics, which has replaced viral culture, has demonstrated that reactivation is more common than previously appreciated. Thus, new approaches to treatment and prevention and ultimately cure are needed.</p>","PeriodicalId":10880,"journal":{"name":"Current Opinion in Infectious Diseases","volume":" ","pages":"61-66"},"PeriodicalIF":4.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13070350/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145676735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advances in treating bacterial vaginosis: recognizing sexual transmission and pipeline of therapies.","authors":"Eun Sol Kim, Andreea Waltmann, Joseph A Duncan, Indriati Hood-Pishchany","doi":"10.1097/QCO.0000000000001172","DOIUrl":"10.1097/QCO.0000000000001172","url":null,"abstract":"<p><strong>Purpose of review: </strong>Bacterial vaginosis (BV) is a common vaginal dysbiosis linked to increased risk of HIV, other sexually transmitted infections (STIs), and adverse obstetric outcomes. Standard antibiotic therapy often induces symptom remission, but recurrence rates exceed 50% within 6 months. The purpose of this review is to discuss recent clinical trials that demonstrate improved outcomes when compared to treatment according to current management guidelines and outline potential future therapies.</p><p><strong>Recent findings: </strong>Strong evidence supporting transmission of bacteria associated with the dysbiotic state of BV between sexual partners has accumulated over time. A recent clinical study (StepUp) demonstrated overwhelming evidence that treating male partners with combined oral and topical antibiotics significantly reduces BV recurrence in their female partners, highlighting the role of sexual transmission. Recent guideline updates reflect these advances: the American College of Obstetricians and Gynecologists now advises partner therapy for recurrent BV, signaling a shift toward partner-inclusive management strategies. In parallel, live biotherapeutic products (LBPs) and vaginal microbiota transplantation (VMT) show promise in restoring a stable, Lactobacillus crispatus-dominant microbiome. Novel approaches targeting metabolic vulnerabilities of BV-associated bacteria and L. iners, and nonantibiotic agents like metastable iron sulfides are in early development.</p><p><strong>Summary: </strong>Several advances in managing recurrent BV have shown promise in improving care of this condition. They represent a shift toward microbiome-informed, durable, and woman-controlled therapies. Strategies combining these along with continued development of promising novel approaches to treatment will be needed to optimize care of patients and reduce global BV burden.</p>","PeriodicalId":10880,"journal":{"name":"Current Opinion in Infectious Diseases","volume":"39 1","pages":"67-74"},"PeriodicalIF":4.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12839515/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145833230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post-tuberculosis lung disease in people with HIV: a scoping and narrative review.","authors":"Nicola K Wills, Nevadna Singh, Coenraad F N Koegelenberg, Brian W Allwood","doi":"10.1097/QCO.0000000000001163","DOIUrl":"10.1097/QCO.0000000000001163","url":null,"abstract":"<p><strong>Purpose of review: </strong>Tuberculosis (TB) is the leading cause of illness in people with HIV (PWH), with many survivors experiencing lasting lung damage. Post-TB lung disease (PTLD) is a challenge in this group, where additional respiratory insults, poor nutrition and healthcare access barriers may compound disability. In this scoping review, we explore the burden and patterns PTLD in PWH versus HIV-negative individuals through meta-analysis and narrative synthesis, and describe mechanisms of HIV-associated PTLD with emerging prevention, care strategies, and research priorities.</p><p><strong>Recent findings: </strong>HIV infection was associated with lower or equivalent PTLD burden across most spirometry, radiology and functional outcomes; however, despite higher rates of pulmonary TB in PWH, studies directly comparing PTLD in PWH versus HIV-negative individuals are few. Sub-analyses, including role of antiretroviral therapy, CD4 count and recurrent TB, were limited by data availability. Neutrophil-driven matrix metalloproteinase activity, cytokine dysregulation, and immune reconstitution is implicated in HIV-associated lung damage; host-directed therapies with potential for attenuating PTLD are under evaluation, though representation of PWH is limited. Gaps persist in integrating PTLD care into HIV-TB services, and longitudinal data are needed to define recovery trajectories and inform strategies for prevention and management.</p><p><strong>Summary: </strong>PTLD in PWH shows variable burden and requires multidisciplinary integrated care. Inflammatory mechanisms and care gaps underscore the need for targeted research.</p>","PeriodicalId":10880,"journal":{"name":"Current Opinion in Infectious Diseases","volume":"39 1","pages":"1-15"},"PeriodicalIF":4.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145833287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antiviral clinical trial design throughout the COVID pandemic: evolving endpoints and lessons learnt.","authors":"Beatrice Z Sim, Andre C Kalil, Cameron R Wolfe","doi":"10.1097/QCO.0000000000001165","DOIUrl":"10.1097/QCO.0000000000001165","url":null,"abstract":"<p><strong>Purpose of review: </strong>Trial design during the novel coronavirus-19 (COVID-19) pandemic was stymied by significant uncertainty about the natural history of the virus, at-risk populations, and optimal patient care by investigators and clinicians alike.</p><p><strong>Recent findings: </strong>Three main types of trial design were invoked to address both the variable clinical disease and the evolving viral landscape, and to fit the respective health systems deploying the trials. These included adaptive trial design, platform trials, and master protocols. Strengths and challenges faced with each are discussed in more detail in the main text.</p><p><strong>Summary: </strong>Future pandemics will almost certainly continue to arise. Similarly, the landscape will continue to evolve alongside our understanding of the disease. Designing trials that remain scientifically rigorous and practical while still addressing the changing natural history of the disease continues to pose a challenge.</p>","PeriodicalId":10880,"journal":{"name":"Current Opinion in Infectious Diseases","volume":" ","pages":"75-81"},"PeriodicalIF":4.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145631055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Haemophilus ducreyi in genital ulcer disease: new developments in an old disease.","authors":"Philippe Ndzomo, Sara Eyangoh","doi":"10.1097/QCO.0000000000001166","DOIUrl":"10.1097/QCO.0000000000001166","url":null,"abstract":"<p><strong>Purpose of review: </strong>Haemophilus ducreyi remains an important, though often overlooked, cause of genital ulcer disease (GUD), particularly in contexts where syndromic management limits pathogen-specific diagnosis. Although its incidence has markedly declined in high-income countries, the pathogen persists in resource-limited regions, where it is frequently co-endemic with Treponema pallidum and herpes simplex virus. A review is timely to synthesize new insights into its biology and clinical relevance.</p><p><strong>Recent findings: </strong>Over the past two decades, the recognized epidemiological spectrum of H. ducreyi has expanded to include nonsexually transmitted cutaneous ulcers in children in tropical regions. Genomic and microbiological studies have clarified its population structure, revealing two major lineages with limited divergence between genital and cutaneous isolates. Advances in the characterization of virulence determinants and host-pathogen interactions provide an integrated view of its persistence, immune evasion, and ecological adaptability.</p><p><strong>Summary: </strong>These developments have direct implications for the refinement of diagnostics, the optimization of therapeutic strategies, and the strengthening of surveillance systems in endemic areas. Revisiting the role of H. ducreyi in both genital and cutaneous ulcers is essential to anticipate its future public health impact.</p>","PeriodicalId":10880,"journal":{"name":"Current Opinion in Infectious Diseases","volume":" ","pages":"30-35"},"PeriodicalIF":4.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145631004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"HIV and menopause: current evidence, gaps, and future directions for integrated care.","authors":"Unoda A Chakalisa, Susan Cole-Haley, Chelsea Morroni, Nneka Nwokolo","doi":"10.1097/QCO.0000000000001168","DOIUrl":"10.1097/QCO.0000000000001168","url":null,"abstract":"<p><strong>Purpose of review: </strong>To synthesize current evidence on menopause in women living with HIV, highlighting the biological, psychosocial, and structural determinants of health, and to identify research and implementation gaps to inform integrated models of care.</p><p><strong>Recent findings: </strong>With increasing life expectancy, more women with HIV are transitioning through menopause. Data from international cohorts suggest that menopause may occur approximately three years earlier in women with HIV than in HIV-negative peers. Symptom burden - including vasomotor, psychological, and sexual health disturbances - appears greater and is compounded by stigma, multimorbidity, and socioeconomic disadvantage. Evidence on the safety of menopausal hormone therapy, drug-drug interactions with antiretroviral therapy, and long-term cardiometabolic and bone outcomes remains sparse, particularly in low-income and middle-income countries (LMICs). Intersectional inequities affecting racially minoritized and migrant women are increasingly recognized but under-researched.</p><p><strong>Summary: </strong>Menopause in women with HIV remains an under-prioritized aspect of care despite its significant clinical and psychosocial implications. Future efforts should focus on longitudinal and interventional studies, integration of menopause assessment within HIV services, and culturally sensitive, multidisciplinary care models that address inequities across global settings.</p>","PeriodicalId":10880,"journal":{"name":"Current Opinion in Infectious Diseases","volume":" ","pages":"16-21"},"PeriodicalIF":4.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145631053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combatting antimicrobial-resistant Neisseria gonorrhoeae: new antibiotics and the pipeline of antigonococcal therapeutics.","authors":"Sanjay Ram, Davinder Gill, Peter A Rice","doi":"10.1097/QCO.0000000000001170","DOIUrl":"10.1097/QCO.0000000000001170","url":null,"abstract":"<p><strong>Purpose of review: </strong>Gonorrhea is the second most prevalent bacterial sexually transmitted infection globally. The proliferation of antimicrobial-resistant strains has severely limited treatment options. New treatment modalities against multidrug-resistant gonococcal infections to reduce the rate of transmission and the risk of complications are urgently needed. This review summarizes ongoing efforts in the development of new antibiotics and alternative treatment approaches, including repurposing drugs, biologics, and small molecules.</p><p><strong>Recent findings: </strong>Gepotidacin and zoliflodacin are topoisomerase inhibitors that have shown promise in phase 3 clinical trials and are pending FDA approval for the treatment of uncomplicated gonorrhea. These drugs are active against currently circulating multidrug-resistant isolates and provide much-needed oral treatment options. Monoclonal antibodies have increasingly been deployed for treating infections. The identification of bactericidal human monoclonal antibodies with efficacy in preclinical animal models provides optimism for their development as passive immunoprophylactics. Several small molecules with activity against Neisseria gonorrhoeae have been identified; the identification of drugs using artificial intelligence is a particularly exciting advance.</p><p><strong>Summary: </strong>Recent advances in the development of antibiotics, biologics and small molecules against gonorrhea provide optimism against the stark background of multidrug-resistant gonorrhea. Ongoing surveillance remains critical to evaluate the efficacy of newly introduced treatments.</p>","PeriodicalId":10880,"journal":{"name":"Current Opinion in Infectious Diseases","volume":"39 1","pages":"36-50"},"PeriodicalIF":4.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145833292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is it possible to identify genotypes underlying resistant phenotypes in Gram-negative pathogens?","authors":"Almudena Burillo, Julia Serrano-Lobo, Emilio Bouza, Patricia Muñoz","doi":"10.1097/QCO.0000000000001158","DOIUrl":"10.1097/QCO.0000000000001158","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review explores the relationship between genotypes and resistant phenotypes in Gram-negative pathogens. We analyse to what extent conventional phenotypic methods predict genetic mechanisms of resistance, the reliability of genotypic approaches, and how integrated strategies may improve diagnostic accuracy and clinical utility.</p><p><strong>Recent findings: </strong>Traditional AST remains the clinical reference standard due to its correlation with therapeutic outcomes, yet it often fails to identify the molecular basis of resistance. Molecular methods such as PCR, microarrays, and targeted sequencing allow rapid detection of known genes but cannot reliably predict expression or functionality. Whole-genome sequencing provides the most comprehensive overview, capturing both known and novel resistance determinants as well as mobile genetic elements. Nevertheless, genotype-phenotype discordance persists, driven by regulatory mutations, inducible expression, or synergistic mechanisms. Emerging technologies - including real-time sequencing, metagenomics, and machine learning-based predictive models - are enhancing our ability to infer phenotypes from genomic data. Still, these approaches face challenges of standardization, validation, and integration into clinical workflows.</p><p><strong>Summary: </strong>Linking genotypes to resistant phenotypes in Gram-negative pathogens remains complex. While phenotypic AST ensures reliability for therapy, genotypic methods provide unprecedented insight into resistance mechanisms and epidemiology. Discrepancies between the two highlight the need for integrated diagnostic platforms that combine functional and genomic perspectives. Artificial intelligence-driven predictive models and curated resistance databases hold promise for improving accuracy, but widespread adoption requires robust datasets, clinical validation, and harmonized interpretative frameworks. Ultimately, integrating phenotypic and genotypic data represents the most effective strategy to provide mechanism-informed, clinically actionable diagnostics for antimicrobial resistance management.</p>","PeriodicalId":10880,"journal":{"name":"Current Opinion in Infectious Diseases","volume":" ","pages":"605-615"},"PeriodicalIF":4.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145387619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interventions for polyoma virus-associated hemorrhagic cystitis.","authors":"Claire Dendle","doi":"10.1097/QCO.0000000000001162","DOIUrl":"10.1097/QCO.0000000000001162","url":null,"abstract":"<p><strong>Purpose of review: </strong>Polyoma virus-associated haemorrhagic cystitis (PVA-HC) is a painful and high-morbidity complication after allogeneic hematopoietic stem cell transplantation (allo-HCT). It is characterized by haematuria caused by bladder inflammation and high BK-virus replication. Its incidence is changing due to expanding donor sources, including haploidentical grafts. It is difficult for clinicians to know how to treat PVA-HC, and there is limited evidence. Given evolving transplant protocols and the absence of standardized treatments, this review will examine the literature regarding interventions to treat PVA-HC.</p><p><strong>Recent findings: </strong>Supportive care remains the foundation of treatment. Interventions include urological procedures and immunomodulation. Recent literature highlights targeted approaches such as intravesical cidofovir, which delivers antiviral effects directly to the bladder mucosa, and adoptive virus-specific T-cell therapies. Hyperbaric oxygen therapy has also been explored. However, studies are generally small, retrospective, heterogeneous in design, and lack control groups.</p><p><strong>Summary: </strong>PVA-HC continues to present significant clinical challenges after allo-HCT. While novel antiviral and immunotherapy methods show promise, their effectiveness and safety need thorough evaluation. Future multicentre trials and standardized protocols are essential to guide targeted treatments, risk stratification, and potential preventive measures. A multidisciplinary management approach is highly recommended.</p>","PeriodicalId":10880,"journal":{"name":"Current Opinion in Infectious Diseases","volume":" ","pages":"544-553"},"PeriodicalIF":4.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145387629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Viral meningoencephalitis: a focus on diagnostics.","authors":"Néstor López, Genoveva Cuesta, Pedro Puerta-Alcalde","doi":"10.1097/QCO.0000000000001153","DOIUrl":"10.1097/QCO.0000000000001153","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review provides an updated overview of diagnostic strategies for viral meningoencephalitis, with a focus on molecular techniques currently used in clinical practice and the emerging role of next-generation sequencing technologies.</p><p><strong>Recent findings: </strong>The clinical and laboratory presentation of viral meningoencephalitis is often nonspecific, making timely and accurate diagnosis challenging. While PCR and multiplex RT-PCR assays have become widely used, they have notable limitations, including reduced sensitivity in low-viral-load cases and the requirement for prior pathogen suspicion. Newer platforms like QIAstat-Dx allow interpretation through cycle threshold values, but false positives and false negatives remain concerns. mNGS offers a hypothesis-free approach with improved diagnostic yield - especially in immunocompromised hosts and atypical presentations - and has proven valuable for detecting rare, emerging, or unexpected pathogens. However, practical limitations such as cost, long turnaround times, and the need for expert interpretation currently restrict its routine use.</p><p><strong>Summary: </strong>The integration of mNGS into routine diagnostic workflows could significantly improve the diagnostic yield for viral meningoencephalitis, especially in cases with negative or inconclusive results from traditional methods. However, further studies are necessary to refine its clinical application, optimize cost-effectiveness, and establish guidelines for its use in the diagnostic management of meningoencephalitis.</p>","PeriodicalId":10880,"journal":{"name":"Current Opinion in Infectious Diseases","volume":" ","pages":"560-567"},"PeriodicalIF":4.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145130114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}