This Special Issue aims to collate the latest evidence-base focused on optimising sexual health services in the 2020s. We discuss why we need specialist sexual health services, how to get the right people to attend, how to strengthen current services, and smarter use of technologies to enhance sexual health services.

Attendance at sexual health clinics can help reduce STI transmission, yet many individuals at risk of STIs do not attend the sexual health appointments they have booked. Delivering an intervention with reliable sources, SMS appointment reminders, and information regarding relevant health consequences was found to increase attendance at sexual health appointments. Future research is needed to explore how successful different combinations of techniques are at increasing attendance.

Mycoplasma genitalium is an emerging sexually transmitted bacterium that is becoming increasingly resistant to antimicrobial treatment, creating a range of challenges for successful patient management. Within this review, we discuss the emergence of antimicrobial resistance and their implications for successful treatment practices; we also provide recommendations for testing but not screening for M. genitalium and highlight the importance of expanding individualised treatment strategies.

This paper reviews the evidence for the effect that different measures have on the incidence of sexually transmitted infections (STIs). Access to health care is by far the most powerful tool governments have to control STIs and although other measures such as encouraging condom use can work, their effect is weak and hard to sustain at a population level.

Identifying groups most at risk of sexually transmissible infections (STIs) is important for prioritising screening and targeting prevention strategies; however, this is complicated by the diversification of STI epidemics beyond traditional risk groups characterised by demographics. In this review, we describe the epidemiology of STIs among traditional and emerging risk groups, explore contemporary approaches to risk determination, and review the evidence on the benefits and harms of risk-guided versus population-based screening for STIs among key populations.

This narrative review examines digital sexual health services for clinical settings. The manuscript summarises evidence, guidelines, and practical resources.

Rates of sexually transmitted infections (STI) are higher among American Indian/Alaska Native (AI/AN) populations as compared to non-Hispanic Whites in the United States. Colonisation, historical trauma and ongoing social and behavioural risk, alongside clinical service challenges, contribute to disease burden. Community-grown innovations and public health interventions have been implemented to increase sexual health and STI prevention and services; all of which warrant broader implementation and evaluation.

Although sexual health programming and clinical sexually transmitted infections (STIs) services delivery have traditionally been developed through ‘top-down’ approaches, there is emerging evidence that participatory approaches, characterised by deeper levels of engagement and shared leadership with communities, provide benefits for the development and implementation of such services. This narrative review provides an overview of how participatory approaches have been utilised, the methods of participation, as well as gaps and challenges faced in implementing such approaches in clinical STIs services delivery.

Partner notification, the process of notifying, testing and sometimes treating sex partners of people with STIs, is a key element of infection control in the population. Current approaches to partner notification struggle to deliver good outcomes at scale. Here, we summarise evidence related to different approaches to partner notification for STIs in high-income nations, make recommendations for best practice and identify priority research questions.

Prevention of sexually transmitted infections (STIs) is central to achieving good sexual health and to reducing the cost burden of treatment and management on healthcare services. Specialist sexual health services (SHS) are ideally placed to deliver primary prevention interventions for STIs; however, quantifying their impact remains a challenge. This review summarises the role of specialist SHS in the delivery of primary prevention and considers the barriers and opportunities presented by emerging technologies for STI prevention and changing SHS delivery models.

Sexual health care has been transformed by a range of innovations, many of which take delivery of key services out of the clinic and into the community. This review examines the role of the sexual health clinic in this new service landscape. We conclude that sexual health clinics offer many services essential to patient health and activities essential to the health system that are best delivered in physical locations with a concentration of funding, infrastructure and expertise.

With the rapid expansion of digital health within sexual health services, rigorous measurement and evaluation of sexual health outcomes is critical. We describe the opportunities, challenges, and potential of effective measurement and evaluation in the era of digital health, providing recommendations for policy and practice. Only by addressing current inequity through a social justice lens, and the gaps in access and provision through robust measurement and evaluation, will we fulfil the true potential of digital health.

Specialised sexual health clinics (SHCs) play an important role in addressing the staggering rates of STIs seen in many high-income nations. This review discusses the rationale for sustaining and expanding the network of SHCs, their future role in the community, the need for a strong infrastructure to support SHCs and describes some innovative programs developed in US, Australia, and the Netherlands to serve priority populations.

Men who have sex with men in China have disproportionately high HIV prevalence while facing barriers (e.g. stigma) to facility-based testing. This quasi-experimental study revealed that secondary distribution of blood-based HIV/syphilis dual self-testing kits engaged more Chinese MSM to distribute and receive HIV tests compared to testing card referral. The findings would be of use in increasing HIV testing uptake among MSM in China.

Indigenous Papuans are racially and culturally different from most Indonesians, and HIV prevalence in this area is approximately 24-fold higher than in other regions. HIV awareness programs have been promoted to the general population in this area, but the programs have been conducted specifically for key populations. However, the programs have been unsuccessful because sensitive issues related to ‘Keep being a good Papuan’ as the way for Papuans to overcome HIV problems were missing from the programs.

With STIs on the rise in Australia, demand for sexual health services is growing. This study describes the range of sexual health services in Australia, focusing on current and future strategies to improve testing among priority populations, and highlighting the need for different service configurations and multiple access points. Through summarising the experiences and views of Australian key informants, this article will assist services in optimising service delivery.

The Hunter New England (HNE) endocrinology and sexual health service commenced a co-located gender community clinic with aim of increasing access to gender affirming hormone treatment (GAHT) for trans and gender diverse adults (TGD). This paper describes this novel model of service delivery, and found that co-located clinics provide care for a similar patient population and facilitated access to both GAHT and sexual health services such as STI screening.