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We aimed to assess the burden of a diverse range of sexually transmitted infections in a high HIV burden setting in Eswatini and associated risk factors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This cross\u2010sectional study enrolled adults accessing routine outpatient care at six sites in Shiselweni, from July 2022 to April 2023. Laboratory investigations included antibody\u2010based tests for HIV, <jats:styled-content style=\"fixed-case\">\n<jats:italic>Treponema pallidum<\/jats:italic>\n<\/jats:styled-content>, hepatitis B, hepatitis C, and herpes simplex 2 viruses. The molecular\u2010based Xpert platform tested urine samples for <jats:styled-content style=\"fixed-case\">\n<jats:italic>Chlamydia trachomatis<\/jats:italic>\n<\/jats:styled-content>, <jats:italic>Neisseria gonorrhoea<\/jats:italic>, <jats:italic>Trichomonas vaginalis<\/jats:italic>, self\u2010collected vaginal\/anal swabs for Human papillomavirus, and plasma for HIV viremia. We calculated the proportion of laboratory\u2010confirmed sexually transmitted infections among available test results and identified predictors of combined <jats:styled-content style=\"fixed-case\">\n<jats:italic>Chlamydia trachomatis<\/jats:italic>\n<\/jats:styled-content>\/<jats:italic>Neisseria gonorrhoea<\/jats:italic>\/<jats:italic>Trichomonas vaginalis<\/jats:italic> infection.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 1396 study participants, 65.4% were women, the median age was 29 (IQR 23\u201336) years, and 19.6% were known HIV\u2010positive. Overall, 68.6% had symptoms suggestive of <jats:styled-content style=\"fixed-case\">\n<jats:italic>Chlamydia trachomatis<\/jats:italic>\n<\/jats:styled-content>\/<jats:italic>Neisseria gonorrhoea<\/jats:italic>\/<jats:italic>Trichomonas vaginalis<\/jats:italic> infections. Laboratory\u2010confirmed <jats:styled-content style=\"fixed-case\">\n<jats:italic>Chlamydia trachomatis<\/jats:italic>\n<\/jats:styled-content>\/<jats:italic>Neisseria gonorrhoea<\/jats:italic>\/<jats:italic>Trichomonas vaginalis<\/jats:italic> infection was found in 31.7% (<jats:italic>n<\/jats:italic>\u2009=\u2009443\/1396), of whom 20.8% were asymptomatic. Combined <jats:styled-content style=\"fixed-case\">\n<jats:italic>Chlamydia trachomatis<\/jats:italic>\n<\/jats:styled-content>\/<jats:italic>Neisseria gonorrhoea<\/jats:italic>\/<jats:italic>Trichomonas vaginalis<\/jats:italic> infections were common even among individuals with low risk of infection (e.g., no sexual intercourse: 20.7%) and were associated with young age, factory employment, and transactional sex. Prevalences for individual sexually transmitted infections were 16.9% (<jats:italic>n<\/jats:italic>\u2009=\u2009236\/1394) for <jats:styled-content style=\"fixed-case\">\n<jats:italic>Chlamydia trachomatis<\/jats:italic>\n<\/jats:styled-content>, 12.4% (<jats:italic>n<\/jats:italic>\u2009=\u2009173\/1394) for <jats:italic>Neisseria gonorrhoea<\/jats:italic>, 10.6% (<jats:italic>n<\/jats:italic>\u2009=\u2009148\/1390) for <jats:italic>Trichomonas vaginalis<\/jats:italic>, and 9.7% (<jats:italic>n<\/jats:italic>\u2009=\u2009135) for <jats:styled-content style=\"fixed-case\">\n<jats:italic>Treponema pallidum<\/jats:italic>\n<\/jats:styled-content>. Viral infections were high for herpes simplex 2 viruses (<jats:italic>n<\/jats:italic>\u2009=\u2009792\/1279, 61.9%) and human papillomavirus (<jats:italic>n<\/jats:italic>\u2009=\u2009166\/324, 51.2%) and lower for hepatitis B virus (<jats:italic>n<\/jats:italic>\u2009=\u200955\/1396, 3.9%) and hepatitis C virus (<jats:italic>n<\/jats:italic>\u2009=\u20093\/1396, 0.2%). Of 1122 clients undergoing HIV testing, 4.1% (<jats:italic>n<\/jats:italic>\u2009=\u200946\/1122) tested positive, with 21.7% (<jats:italic>n<\/jats:italic>\u2009=\u200910\/46) being acute\/early HIV infection.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The substantial sexually transmitted infections burden highlights the urgent need to strengthen sexually transmitted infections service integration, expand access to affordable diagnostics, and target prevention in decentralised care. These findings support the development of context\u2010adapted strategies to improve detection, treatment, and partner services in high\u2010burden settings.<\/jats:p><\/jats:sec>","DOI":"10.1111\/tmi.70011","type":"journal-article","created":{"date-parts":[[2025,7,23]],"date-time":"2025-07-23T02:04:16Z","timestamp":1753236256000},"page":"987-1005","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["High Burden of Symptomatic and Asymptomatic Sexually Transmitted Infections in a Routine Decentralised <scp>HIV<\/scp> Care Setting in Eswatini: A Cross\u2010Sectional Study"],"prefix":"10.1111","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0525-7262","authenticated-orcid":false,"given":"Bernhard","family":"Kerschberger","sequence":"first","affiliation":[{"name":"M\u00e9decins Sans Fronti\u00e8res (MSF)  Mbabane 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