Monitoring Multiple Sexually Transmitted Pathogens Through Wastewater Surveillance

Abstract

Wastewater-based epidemiology (WBE) offers a promising tool for sexually transmitted infection (STI) surveillance, especially in settings where underdiagnosis or social stigma complicates conventional reporting. To assess its utility, we conducted a year-long study examining six STIs, Chlamydia trachomatis, Treponema pallidum, Neisseria gonorrhoeae, human immunodeficiency virus (HIV), hepatitis C virus (HCV), and herpes simplex virus (HSV), in weekly composite samples from the primary influent of a small-sized Midwestern wastewater treatment plant. Pathogen detection and quantification were performed via digital PCR. Among the tested targets, Gonorrhea, HIV, HCV, and HSV were detected at the highest frequencies, often in 40-50% of the samples, while Chlamydia and Syphilis appeared less frequently. Despite the variability in detection patterns, this study demonstrates that even infrequent signals can reveal community-level shedding of poorly reported or asymptomatic infections. Although month-to-month wastewater data were not strongly correlated with corresponding clinical records, which could potentially reflect delayed healthcare seeking and pathogen-specific shedding dynamics, the overall findings underscore WBE's ability to complement existing surveillance by capturing infections outside traditional healthcare channels. These results not only advance our understanding of STI prevalence and population shedding but also highlight the practical benefits of WBE as an early warning and targeted intervention tool.

Keywords: HIV; STD/STI; chlamydia; gonorrhea; hepatitis C virus; herpes; syphilis; wastewater-based epidemiology.

Figure 1

Monthly average concentrations of crAssphage in Bloomington wastewater over a year. The bars are standard deviation for four samples collected each month (n = 4).

Figure 2

Number of new-case counts by month for Gonorrhea, Chlamydia, and HCV in the county for the year 2023.

Figure 3

Wastewater concentrations of Chlamydia, Syphilis, Gonorrhea, HIV, Hepatitis C virus, and HSV nucleic acids. The black line represents the 5-sample smoothed and trimmed average.