However, gonorrhea prevention is being threatened by the increasing prevalence of organisms with resistance to cephalosporins, the only class of first-line drugs recommended to treat gonorrhea [77] and [79]. Given that 106 million cases

of gonorrhea occur each year [9], millions could be left at risk of developing gonorrhea-associated PID, infertility, ectopic pregnancy, pregnancy-related complications, and enhancement of HIV transmission. Rapid development and evaluation of new antibiotics for the treatment of gonorrhea are critical, and two clinical trials of new regimens are ongoing [78]. However, N. gonorrhoeae has successively acquired resistance to four different classes of antibiotics since it was first treatable in the 1940s [78], and the Afatinib purchase rate of development GSK1349572 molecular weight of resistance appears to be increasing. While efforts are made to find new effective drug regimens for gonorrhea, to improve diagnostic capacity for gonorrhea in low-income settings, and to scale-up existing case management strategies, progress toward a gonorrhea vaccine is also urgently needed [103]. More cases of trichomoniasis are estimated to occur each year than gonorrhea, chlamydia, and syphilis cases combined

[9]. Genital symptoms, especially vaginal discharge and irritation, may have important adverse effects on quality of life. Trichomoniasis is also associated with more serious consequences, including preterm delivery among pregnant women and enhancement of HIV transmission. A lack of available diagnostic tests hampers control efforts globally, but especially

in low-income countries. Although not yet at the same level of urgency as for gonorrhea, reports of low-level trichomonal antimicrobial resistance are worrisome, as just one drug class treats trichomoniasis [65]. Additional drug regimens and diagnostic tests for trichomoniasis should be second pursued, while continued work is done toward developing trichomoniasis vaccines [104]. Among the curable STIs, syphilis has the lowest global incidence but accounts for the greatest number of DALYs lost [58], primarily related to the devastating consequences of mother-to-child transmission [28]. More than half a million adverse outcomes of syphilis in pregnancy are estimated to occur each year [28]. Congenital syphilis has been virtually eliminated as a public health problem in most high-income countries [69] and [70]. However, only about 30% of infected pregnant women in sub-Saharan Africa receive syphilis testing and treatment [28] and [87]. New point-of-care diagnostic tests, cheap curative treatment with one dose of penicillin, and an antenatal platform to access infected pregnant women may now make it feasible to prevent a substantial proportion of congenital syphilis outcomes [64] and [105], and WHO has launched an initiative to eliminate congenital syphilis as a global public health problem [64].