Beyond behavioural change: prioritising structural solutions to control bacterial sexually transmitted infections.

With over 374 million new curable bacterial STI cases annually, we are far from meeting global health targets. Despite their serious consequences for sexual, reproductive, and mental health, control efforts often focus on individual-level interventions like condom promotion and behavior change, which are insufficient. A scientific framework for STI control emphasizes reducing infectiousness, decreasing the number of susceptible individuals, and lowering transmission probability. Effective strategies should focus on environmental modifications, including expanding access to quality sexual health care, rapid testing with same-visit treatment, and AI-enhanced diagnostics. Equally critical are protecting susceptible communities through vaccination and chemoprophylaxis (e.g., doxycycline post-exposure prophylaxis). While individual behavioural interventions like condom promotion remain relevant, declining usage trends challenge their impact. Surveillance of STIs and antimicrobial resistance is essential, influencing all key drivers of transmission. To control STIs more effectively, we must shift from individual behaviour change to systems-level public health strategies. Prioritising accessible, stigma-free health services, leveraging technological advances, and investing in comprehensive public health policies will improve STI prevention and help meet global health goals. Funding: JJO, CKF and KS are funded by the Australian National Health and Medical Research Council (GNT1193955, GNT1172900 and GNT2017383, respectively).