By Melinda Young
While the sexually transmitted infection (STI) prevention world’s research pipeline contains new vaccines to fight major STIs — a potentially exciting development — there also is concern about growing vaccine hesitancy and misinformation in the United States.
“This is a really exciting time for the STI field, overall,” says Alison Footman, PhD, MPH, senior program manager of sexually transmitted infections at AVAC, a human immunodeficiency virus advocacy organization in New York.
“With gonorrhea, we’re seeing research about a meningococcal B vaccine that might be effective at preventing some infections, and we’re waiting to see how effective it is to prevent gonorrhea,” she explains. “Some are recommending the vaccine for certain subpopulations, but we’re still waiting for the research results to understand how long it might last and how effective it is at preventing gonorrhea infection.”
With vaccines, positive study results are half the battle. The other half involves public acceptance.
Vaccine hesitancy is a barrier to vaccination efforts and may have affected uptake of human papillomavirus (HPV) vaccination, a new paper suggests.1
While 89% of adolescents have received at least one dose of the tetanus, diphtheria, and acellular pertussis vaccine and 91.3% received two doses or more of the measles, mumps, and rubella vaccine, only 76.8% of adolescents, ages 13 to 17 years, received at least one dose of the HPV vaccine.1
Public health challenges related to vaccine acceptance could be on the rise as the COVID-19 vaccine backlash continues and anti-vaccination voices have found champions among people in the Trump administration’s orbit.2
For instance, data show that routine vaccination rates for kindergarten children has continued to decline in the United States, a trend that began with the COVID-19 pandemic and appears to be the result of vaccine hesitancy and vaccine misinformation. The new presidential administration appears poised to support anti-vaccination attitudes and opposes vaccination mandates.2
On the positive side, there are clinical trials underway for vaccines that could reduce rates of chlamydia, gonorrhea, and syphilis. The National Institutes of Health (NIH) dedicated more than $41 million to the development of these vaccines.1 “Those NIH awards stirred the development of these vaccines to protect against STIs,” Footman says.
Private companies have investigated a herpes vaccine and gonorrhea vaccine development.
“My research has focused on STI vaccine acceptance,” she says. “Currently, there are several vaccines for chlamydia, gonorrhea, and syphilis that are under development. But if we build it, will they come?”
Footman has studied barriers that discourage people from vaccination, and the biggest one is vaccine hesitancy.
“Maybe someone thinks they don’t need the vaccine or has concerns about vaccine safety or has seen misinformation online,” she says. “We like to think about vaccine hesitancy as an evil phenomenon with all these evil people in the world telling you not to get vaccinated, but maybe it’s just people being concerned about the impact of vaccines on their health.”
When the STI vaccines make it to market in coming years, they may be seen as a game changer — a solution that has the potential to decimate rates of the most common STIs. But this will only happen if sexually active people trust the vaccines and use them.
“We currently have the HPV vaccine and it was made available in 2006, and in the United States, a lot of people are not using it,” Footman says. “For 9 years to 17 years, 38% of people have been vaccinated for HPV, and the numbers are still low for those who are 13 to 17 years.”
Nations that have a high — about 90% — uptake of the HPV vaccine are not seeing any new cases of cervical cancer among women who are vaccinated, she says. “In the U.S., cervical cancer rates have dropped among women, but we could be doing so much better in the U.S.”
Vaccine hesitancy is the reason a lot of people are not being vaccinated and are not feeling safe and comfortable with the vaccine, she adds. “We don’t want people to feel forced; we want them to know this is their choice, and we want them to be comfortable when they get their vaccine,” Footman says.
The HPV vaccine is a good indicator of STI vaccine acceptance because it has several positives regarding access. For example, it is recommended by the Advisory Committee on Immunization Practices (ACIP), and that makes it easier for the vaccine to be covered by insurance companies for use with adolescents, she says.
The remaining gaps to the HPV vaccine include geographical barriers. There are rural areas and limited resource areas where there are no healthcare clinics nearby, and so people would need to travel out of their community to get vaccinated. Also, not all insurers will cover the vaccine for adults, even though the vaccine is recommended for people up to age 45 years, Footman notes.
“U.S. insurance has a big influence on healthcare decision-making,” she adds. “If you don’t have health insurance, or if it doesn’t cover the vaccine, that could influence your decision to get or not get vaccinated.”
When a broader range of STI vaccines are available, another potential barrier is privacy. For adolescents and other young people living at home or who are covered by their parents’ health insurance, there is the risk that their family will know they got the vaccine because of an insurance billing statement.
It may be too early to say how the new administration will affect both STI vaccine research and public rollout of any successful vaccines. “They made a lot of claims of what they want to do and have made a lot of statements about their opinions on vaccines and sexual health, overall, but their making statements is very different from policy making,” Footman says. “My role is to provide information about why these vaccines are important because there is a lot of misinformation out there, and we have to make sure we’re on top of this and combat misinformation with accurate, easily digestible information.”
Combating anti-vaccine misinformation is important for healthcare clinicians to do in their public-facing roles and also among their network of family and friends, she says. “When you talk with your family and friends about vaccines and why they’re important to you, when you’re having conversations at the dinner table, it’s important to normalize this information so people are not getting all their information from some tweet that has 2 million views,” she explains. “Hopefully, we’re better at addressing the stigma around these issues.”
Melinda Young has been a healthcare and medical writer for 30 years. She currently writes about contraceptive technology.
References
1. Footman A, Griner SB. Vaccine hesitancy and other challenges to sexually transmitted infection vaccine acceptance. Curr Opin Infect Dis. 2025;38(1):60-64.
2. Williams E, Kates J. Childhood vaccination rates continue to decline as Trump heads for a second term. KFF. Nov. 18, 2024. https://www.kff.org/policy-watch/childhood-vaccination-rates-continue-to-decline-as-trump-heads-for-a-second-term/
While the sexually transmitted infection (STI) prevention world’s research pipeline contains new vaccines to fight major STIs — a potentially exciting development — there also is concern about growing vaccine hesitancy and misinformation in the United States.
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