{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T12:49:49Z","timestamp":1789562989429,"version":"build-2803163510"},"reference-count":41,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T00:00:00Z","timestamp":1761091200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pathogens"],"abstract":"<jats:p>Sexually transmitted infections (STIs) remain a global health concern, but large-scale multiplex PCR surveillance data are limited. This study aimed to characterize sex- and age-specific distributions, temporal patterns, and co-infection dynamics of 12 urogenital and sexually transmitted infection (STI) pathogens in Korea. We retrospectively analyzed 1,399,431 multiplex PCR test records (902,713 females, 496,718 males) collected nationwide between 2021 and 2024. Positivity rates were stratified by sex, age, month, season, and year. Co-infection coverage and inter-pathogen correlations were assessed; \u03c6 coefficients \u22650.20 were considered relevant. Overall, 67.23% of tests were positive for at least one pathogen. Annually, positivity rates for most pathogens, including the six traditional STIs (N. gonorrhoeae, C. trachomatis, M. genitalium, T. vaginalis, T. pallidum, and HSV II), showed a significant decline over the four-year period (p &lt; 0.0001). Females had higher positivity than males (77.73% vs. 48.14%, p &lt; 0.0001), largely driven by G. vaginalis (64.70%), U. parvum (41.37%), and C. albicans (18.07%), whereas traditional STIs, except T. vaginalis and HSV II, were more frequent in males (p &lt; 0.0001). Adolescents and young adults carried the highest burden of traditional STIs such as C. trachomatis and N. gonorrhoeae (p &lt; 0.0001). In females, C. albicans decreased with age (32.17% in 10s to 6.45% in 80s) but increased annually (p = 0.0058), while HSV II positivity significantly declined in males over time (p = 0.0038). No seasonal variation was observed (p &gt; 0.90). Co-infections were predominantly commensal-driven, with U. parvum\/G. vaginalis being the most frequent pair in females, and U. urealyticum\/G. vaginalis being frequent in males (8.24% in 10s, 10.48% in 20s). Traditional STI co-infections were rare but concentrated in adolescents, with C. trachomatis\/N. gonorrhoeae reaching 4.25% in males. Correlation analysis confirmed strong associations among commensals (\u03c6 = 0.24\u20130.35) and moderate correlations involving C. trachomatis in youth (\u03c6 = 0.25\u20130.28), with G. vaginalis consistently identified as the central hub organism across all age groups. This nationwide four-year analysis highlights declining prevalence of traditional STIs, sex-specific STI patterns, distinct age-specific distributions, and commensal-driven co-infection patterns. The findings underscore the need for age- and sex-tailored screening strategies, particularly in adolescents, young adults, and women of reproductive age, and highlight the value of multiplex PCR for STI surveillance.<\/jats:p>","DOI":"10.3390\/pathogens14111073","type":"journal-article","created":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T01:14:02Z","timestamp":1761182042000},"page":"1073","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Epidemiologic Characteristics of 1.4 Million Multiplex PCR Tests for 12 Urogenital and Sexually Transmitted Infection Pathogens in Korea (2021\u20132024)"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7097-4551","authenticated-orcid":false,"given":"Soyoun","family":"Shin","sequence":"first","affiliation":[{"name":"Daejeon & Chungcheong Reference Lab, Seegene Medical Foundation, Daejeon 35203, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,22]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2023). Global Health Sector Strategies on HIV, Viral Hepatitis and Sexually Transmitted Infections, 2022\u20132030, WHO."},{"key":"ref_2","unstructured":"World Health Organization (2024). Global Research Priorities for Sexually Transmitted Infections, 2024\u20132030, WHO."},{"key":"ref_3","unstructured":"Korea Disease Control and Prevention Agency (2022). Annual Report on National Notifiable Infectious Diseases, 2021."},{"key":"ref_4","unstructured":"Korea Disease Control and Prevention Agency (2024). 2023 National Surveillance Data on Sexually Transmitted Infections."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1","DOI":"10.15585\/mmwr.rr7004a1","article-title":"Sexually Transmitted Infections Treatment Guidelines, 2021","volume":"70","author":"Workowski","year":"2021","journal-title":"MMWR Recomm. Rep."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"837","DOI":"10.4103\/ijem.IJEM_159_17","article-title":"Genital infections with sodium glucose cotransporter-2 inhibitors","volume":"22","author":"Unnikrishnan","year":"2018","journal-title":"Indian J. Endocrinol. Metab."},{"key":"ref_7","first-page":"2792","article-title":"Comparative risk of genital infections associated with sodium-glucose co-transporter-2 inhibitors vs. other antidiabetic agents","volume":"20","author":"Dave","year":"2018","journal-title":"Diabetes Obes. Metab."},{"key":"ref_8","first-page":"937","article-title":"Incidence and risk of vaginal candidiasis associated with sodium-glucose cotransporter-2 inhibitors in real-world practice for women with type 2 diabetes: A retrospective study","volume":"9","author":"Yokoyama","year":"2018","journal-title":"J. Diabetes Investig."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2458","DOI":"10.1016\/j.jacc.2024.01.040","article-title":"Genitourinary tract infections in patients taking SGLT2 inhibitors: A comprehensive review","volume":"83","author":"Kittipibul","year":"2024","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1186\/s43162-025-00500-2","article-title":"SGLT2 inhibitors and genital infections: A prospective observational study in a tertiary care hospital","volume":"37","author":"Malik","year":"2025","journal-title":"Egypt J. Intern. Med."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Gorgojo-Mart\u00ednez, J.J., G\u00f3rriz, J.L., Cebri\u00e1n-Cuenca, A., Castro Conde, A., and Velasco Arribas, M. (2024). Clinical Recommendations for Managing Genitourinary Adverse Effects in Patients Treated with SGLT-2 Inhibitors: A Multidisciplinary Expert Consensus. J. Clin. Med., 13.","DOI":"10.3390\/jcm13216509"},{"key":"ref_12","first-page":"luae010","article-title":"Sodium-glucose co-transporter-2 Inhibitors Causing Candida tropicalis Fungemia and Renal Abscess: Case reports","volume":"2","author":"Simhadri","year":"2024","journal-title":"J. Clin. Endocrinol. Metab. Case Rep."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e70183","DOI":"10.1002\/pds.70183","article-title":"Prescribing Patterns of SGLT2 Inhibitors and GLP-1 Receptor Agonists in Patients With T2DM and ASCVD in South Korea","volume":"34","author":"Eom","year":"2025","journal-title":"Pharmacoepidemiology & Drug Safety."},{"key":"ref_14","unstructured":"Korean Diabetes Association (2023). Diabetic Kidney Disease Fact Sheet in Korea 2023, KDA."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Faustino, M., Ferreira, C.M.H., Pereira, A.M., and Carvalho, A.P. (2025). Candida albicans: The current status regarding vaginal infections. Appl. Microbiol. Biotechnol., 109.","DOI":"10.1007\/s00253-025-13478-2"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Mahmodi, M.J., Shatizadeh Malekshahi, S., and Soltanghoraee, H. (2025). Seroprevalence of HSV-2 in multiple subgroups of infertile men with abnormal sperm parameters and those seeking sex selection: A case-control study. BMC Infect. Dis., 25.","DOI":"10.1186\/s12879-024-10421-0"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1086\/313647","article-title":"Herpes Simplex Virus Type 2 Shedding in Human Immunodeficiency Virus\u2014Negative Men Who Have Sex with Men: Frequency, Patterns, and Risk Factors","volume":"30","author":"Krone","year":"2000","journal-title":"Clin. Infect. Dis."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"04175","DOI":"10.7189\/jogh.15.04175","article-title":"Analysis of the trend of notifiable sexually transmitted infections in China between 2006\u20132022","volume":"15","author":"Xu","year":"2025","journal-title":"J. Glob. Health"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1186\/s41182-025-00744-2","article-title":"Trends in the incidence of common sexually transmitted infections at the global, regional and national levels, 1990\u20132021: Results of the Global Burden of Disease 2021 study","volume":"53","author":"Deng","year":"2025","journal-title":"Trop. Med. Health"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Janulaitien\u0117, M., Paliulyt\u0117, V., Grincevi\u010dien\u0117, \u0160., Marcinkut\u0117, A., Kosiakovas, R., Muralyt\u0117, J., Juchnevi\u010dien\u0117, A., and Ple\u010dkaityt\u0117, M. (2017). Prevalence and Distribution of Gardnerella vaginalis Subgroups in Women with and without Bacterial Vaginosis. BMC Infect. Dis., 17.","DOI":"10.1186\/s12879-017-2501-y"},{"key":"ref_21","first-page":"754","article-title":"Ureaplasma urealyticum and U. parvum in sexually active women attending public health clinics in Brazil","volume":"145","author":"Campos","year":"2017","journal-title":"Epidemiol. Infect."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Lyu, H., Tang, H., Feng, Y., Hu, S., Wang, Y., Zhou, L., Huang, S., Li, J., Zhu, H., and He, X. (2024). Incidence and Spontaneous Clearance of Gonorrhea and Chlamydia Infections Among Men Who Have Sex with Men: A Prospective Cohort Study in Zhuhai, China. Front. Public Health, 12.","DOI":"10.3389\/fpubh.2024.1348686"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Committee On Adolescence and Society for Adolescent Health and Medicine, Murray, P.J., Braverman, P.K., Adelman, W.P., Breuner, C.C., Levine, D.A., Marcell, A.V., Murray, P.J., O\u2019Brien, R.F., and Burstein, G.R. (2014). Screening for non-viral sexually transmitted infections in adolescents and young adults. Pediatrics, 134, e302\u2013e311.","DOI":"10.1542\/peds.2014-1024"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e296","DOI":"10.1097\/INF.0000000000004864","article-title":"Sexually Transmitted Infections in Adolescents: Age-specific Issues","volume":"44","author":"Broto","year":"2025","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1136\/sti.2010.047514","article-title":"Prevalence of sexually transmitted co-infections in people living with HIV\/AIDS: Systematic review with implications for using HIV treatments for prevention","volume":"87","author":"Kalichman","year":"2011","journal-title":"Sex. Transm. Infect."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s10096-024-04966-w","article-title":"High rates of STI co-infection in people with HIV: A systematic review and meta-analysis","volume":"44","author":"Zhang","year":"2025","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_27","unstructured":"World Health Organization (2023). The Diagnostics Landscape for Sexually Transmitted Infections, WHO."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1136\/sti.59.2.111","article-title":"Gardnerella vaginalis and anaerobic bacteria in genital disease","volume":"59","author":"Tabaqchali","year":"1993","journal-title":"Sex. Transm. Infect."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1530\/REP-21-0308","article-title":"Inflammatory response elicited by Ureaplasma parvum colonization in human cervical cells","volume":"163","author":"Tantengco","year":"2022","journal-title":"Reproduction"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"3013","DOI":"10.1007\/s43032-020-00399-w","article-title":"Associations of genital mycoplasmas with female infertility and adverse pregnancy outcomes: A meta-analysis","volume":"28","author":"Ma","year":"2021","journal-title":"Reprod. Sci."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1016\/S1473-3099(21)00448-5","article-title":"Global burden and trends of sexually transmitted infections from 1990 to 2019: An observational trend study","volume":"22","author":"Zheng","year":"2022","journal-title":"Lancet Infect. Dis."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"e9","DOI":"10.12771\/emj.2024.e52","article-title":"Update on sexually transmitted infections in Korea","volume":"47","author":"Kim","year":"2024","journal-title":"Ewha Med. J."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"S3","DOI":"10.1086\/343739","article-title":"Age-specific prevalence of HSV-2 infection: A global review","volume":"186","author":"Smith","year":"2002","journal-title":"J. Infect. Dis."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"270","DOI":"10.48022\/mbl.2204.04006","article-title":"Laboratory Investigation of Sexually Transmitted Infections in the Elderly Population of South Korea","volume":"50","author":"Oh","year":"2022","journal-title":"Microbiol. Biotechnol. Lett."},{"key":"ref_35","unstructured":"Centers for Disease Control and Prevention (2025, September 08). Bacterial Vaginosis\u2014STI Treatment Guidelines, Available online: https:\/\/www.cdc.gov\/std\/treatment-guidelines\/bv.htm."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"e011209","DOI":"10.1136\/bmjopen-2016-011209","article-title":"The impact of sexual health screening on young people: A systematic review","volume":"6","author":"Knight","year":"2016","journal-title":"BMJ Open"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Gogineni, V., Waselewski, M.E., Jamison, C.D., Bell, J.A., Hadler, N., Chaudhry, K.A., Chang, T., and Mmeje, O.O. (2021). Disparities in sexually transmitted infection screening among adolescents and young adults in the United States. BMC Public Health, 21.","DOI":"10.1186\/s12889-021-12091-y"},{"key":"ref_38","unstructured":"Labcompare (2025, September 08). Overcoming Challenges in STI Diagnostic Testing. Available online: https:\/\/www.labcompare.com."},{"key":"ref_39","first-page":"E57","article-title":"Performance of self-collected penile-meatal swabs compared to urine for detection of Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis in men using nucleic acid amplification tests","volume":"19","author":"Gaydos","year":"2013","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1411","DOI":"10.1093\/infdis\/172.5.1411","article-title":"Noninvasive Tests for Diagnosis of Chlamydia trachomatis Infection: Application of Ligase Chain Reaction to First-Catch Urine Specimens of Women","volume":"172","author":"Schachter","year":"1995","journal-title":"J. Infect. Dis."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Song, J.Y., Kim, K.S., Han, C.H., and Bae, S. (2025). Recent Changes in Sexually Transmitted Infection in Korea: A Population-Based Analysis. J. Clin. Med., 14.","DOI":"10.3390\/jcm14145145"}],"container-title":["Pathogens"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-0817\/14\/11\/1073\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T01:42:26Z","timestamp":1761183746000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-0817\/14\/11\/1073"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,22]]},"references-count":41,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2025,11]]}},"alternative-id":["pathogens14111073"],"URL":"https:\/\/doi.org\/10.3390\/pathogens14111073","relation":{},"ISSN":["2076-0817"],"issn-type":[{"value":"2076-0817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,22]]}}}