Public health is facing growing challenges due to the expansion of sexually transmitted infections (STIs), especially the Human Papilloma Virus (HPV), whose prevalence disproportionately affects vulnerable populations. Against this backdrop, timely and complete diagnosis, supported by clinical practice guidelines (CPG), becomes a tool of strategic impact not only for individual health, but also for collective health. Molecular tests, especially polymerase chain reaction (PCR), have transformed the health system’s capacity to detect, treat and prevent diseases with a high social burden, such as HPV, HIV, syphilis, genital herpes, gonorrhea, chlamydiosis and other STIs. Its implementation improves the relevance of clinical decisions, strengthens epidemiological surveillance and ensures evidence-based care for historically marginalized groups such as sex workers, transgender people, men who have sex with men (MSM) and the prison population.

Early diagnosis: a bridge between the clinic and prevention:

Detecting an STI at an early stage means interrupting chains of transmission, avoiding chronic complications and reducing costs for the health system. In the case of HPV, persistent infection by high-risk genotypes is the main etiological factor in cervical cancer, the second leading cause of cancer deaths in women in Latin America (WHO, 2022).

The conventional diagnosis of STIs faces different challenges that limit its clinical efficacy, this is because many STIs are asymptomatic, which hinders their early detection by conventional tests such as culture, microscopy or serological tests. These tests present some difficulties such as low sensitivity, which can delay the initiation of timely treatment, favoring the progression of the infection and the spread of the disease, so these limitations make a call to adopt more sensitive, specific and rapid diagnostic technologies such as molecular tests to optimize the management of STIs.

PCR tests can identify the presence of the virus even in asymptomatic stages, with a sensitivity of more than 90% compared to conventional cytology. The use of tools such as PCR also makes it possible to discriminate between the different genotypes of the virus, differentiating between those at low risk (such as types 6 and 11) and those at high risk (16, 18, among others), which significantly improves clinical management and decision-making in screening and follow-up programs.

Molecular diagnosis of other STIs could make a difference in early detection of endometritis, salpingitis and pelvic inflammation, secondary tubal infertility, mother-to-child transmission infections, miscarriage, fetal death and premature delivery, among others.

GPC and diagnostics in high-risk populations: relevance and inclusion

The purpose of Clinical Practice Guidelines (CPG) is to provide systematized recommendations to improve health care. In the case of HPV and other STIs, the CPGs in Colombia and in several countries in the region recommend the use of molecular testing in populations with greater vulnerability, given that they have high prevalences, multiple co-infections and less access to health services (Ministry of Health and Social Protection, 2013).

Applying PCR tests in these groups allows for timely medical intervention with a differential approach. For example, in trans women or MSM with receptive anal sex practices, anorectal sampling is recommended for the detection of HPV and other STIs such as gonorrhea or chlamydiosis, which is rarely done with traditional methods. These strategies help overcome structural barriers, provide risk-based care and ensure that prevention is not a privilege, but a right.

The implementation of this type of CPG optimizes diagnosis, making it timely and accessible, improving treatment initiation times, reducing transmission, STI complications such as infertility, pelvic inflammatory disease, neurological damage and the risk of co-infection with HIV. In addition, it improves clinical outcomes, avoids empirical treatments and contributes to epidemiological control in the population.

PCR and public health: a tool for equity and sustainability

The ability of PCR to detect multiple agents in a single sample has proven to be fundamental not only in clinical practice, but also in the efficient management of healthcare resources. In high STI prevalence settings, traditional syndromic diagnoses (based on signs and symptoms) have high error rates, leading to inadequate treatment, increased antimicrobial resistance and increased risk of sequelae.

Studies such as that of Gómez-Ramírez et al. (2022) have shown that a diagnostic strategy based on molecular tests reduces hospitalizations, reduces readmissions and shortens hospital stay, which translates into sustainability for the system. Thus, PCR not only has clinical value, but also has a direct impact on institutional efficiency indicators.

Integration with sexual and reproductive health programs

One of the most strategic benefits of molecular diagnostics, particularly of technologies such as PCR, is its ability to integrate in a cross-cutting manner with public health programs, especially those focused on sexual and reproductive health. This integration not only improves the efficiency of the system, but also enhances the clinical and social impact of interventions. Currently, numerous health institutions in Latin America and other regions prioritize the use of molecular testing as part of expanded screening in high-risk populations, such as women living with HIV, pregnant adolescents or people with multiple sexual partners. These populations have an increased susceptibility to persistent HPV infection and progression to high-grade intraepithelial lesions and cancer.

 

The inclusion of PCR as a routine component of screening makes it possible to detect asymptomatic and multi-causal infections, which are often invisible to traditional methods, making it possible to provide more timely and accurate care adapted to the risk profile of each patient. In addition, it strengthens the articulation with complementary public health strategies such as HPV vaccination, the offer of contraceptive methods, the promotion of self-care, counseling on safe sexual practices and community education with a gender and sexual and reproductive rights approach.

In this context, molecular diagnostics is not limited to the clinical setting, but acts as a catalyst for comprehensive interventions that promote equity, prevent serious outcomes and consolidate more proactive, coordinated and person-centered health systems.

Conclusion

Molecular testing, in particular polymerase chain reaction (PCR), is emerging as a highly valuable diagnostic tool to address the clinical and epidemiological challenges of sexually transmitted infections (STIs), such as human papillomavirus (HPV). In high-risk populations, where early detection and early intervention can make the difference between timely treatment and progression to severe disease, the ability of PCR to identify viral genetic material with high sensitivity and specificity represents an unquestionable advance.

From a health management perspective, the implementation of these technologies not only responds to clinical relevance criteria, but also optimizes operational efficiency. It reduces the burden of disease resulting from diagnostic errors or inadequate treatment, and reduces the costs associated with non-quality, such as avoidable complications, unnecessary hospitalizations or prolonged clinical follow-up.

In addition, molecular diagnostics enables the integration of essential attributes such as equitable access, timeliness of clinical response and patient safety. This is particularly relevant in risk-centered models of care, such as sexual and reproductive health programs or secondary prevention strategies in cervical cancer.

In contexts where health systems face increasing pressures for their sustainability, evidence-based and cost-effectiveness decisions become crucial. In this sense, molecular tests are not only a diagnostic solution, but a true enabler to achieve health outcomes with a population-based approach, favoring equity, and guaranteeing continuous improvement processes, epidemiological impact and rational use of available resources.

References

-Gómez-Ramírez, O., Arbeláez, M. P., & Hernández, D. C. (2022). Impact of bacterial resistance on clinical and economic outcomes in high complexity hospitals in Colombia. Revista Colombiana de Infectología, 26(3), 123-131. https://doi.org/10.22354/in.v26i3.1348

-Kumar, A., Roberts, D., Wood, K. E., Light, B., Parrillo, J. E., Sharma, S., … & Cheang, M. (2006). Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Critical Care Medicine, 34(6), 1589-1596. https://doi.org/10.1097/01.CCM.0000217961.75225.E9

-Ministry of Health and Social Protection. (2013). Clinical Practice Guideline for the prevention, diagnosis and treatment of sexually transmitted infections. https://www.minsalud.gov.co

-Rodríguez-Baño, J., Paño-Pardo, J. R., Alvarez-Rocha, L., Asensio, Á., Calbo, E., Cercenado, E., … & Garnacho-Montero, J. (2020). Antimicrobial use optimization programs (PROA) in Spanish hospitals: GEIH-SEIMC, SEFH and SEMPSPH consensus document. Spanish Journal of Chemotherapy, 33(2), 102-119 . https://doi.org/10.37201/req/019.2020.

-World Health Organization. (2022). Human papillomavirus (HPV) and cervical cancer. https://www.who.int/news-room/fact-sheets/detail/human-papillomavirus-(hpv)-and-cervical-cancer

-Lam Díaz, R. M., & Hernández Ramírez, P. (2008). Are the terms efficiency, efficacy and effectiveness synonymous in healthcare? Revista Cubana de Hematología, Inmunología y Hemoterapia, 24(2), May-August. http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0864-02892008000200002