Surveillance and sexually transmitted infections: a story of chemsex, tropical leg ulcers, gonococcal resistance and child abuse.
DOI:10.1097/QCO.0000000000000231 Surveillance and its importance is a central theme in this edition of Current Opinion in Infectious Diseases, as is the role of nucleic acid amplification testing (NAAT) methodology in sexually transmitted infection (STI) surveillance, control and management. New diagnostic testing methods and surveillance come together in an article by Lewis and Mitja (pp. 52 57) on the remarkable data from the past 18 months regarding Haemophilus ducreyi, a significant cause of sexually transmitted genital ulcer disease chancroid in the past. Lewis and Mitja describe how just over 25 years ago a single case report identified H. ducreyi, a STI, in a leg ulcer in a young man returning from Fiji [1] but that it is only in the last 2 years that the results of five community surveys have been presented and dramatically shown that this organism is an important previously unrecognized cause of chronic leg ulcers in the Pacific region and in Africa. At a time when genital infections with H. ducreyi have almost disappeared because of syndromic management and behavioural change, it is fascinating that this pathogen should reemerge as a global health problem. It is the development of new testing methodology in the form of nucleic acid amplification tests that has allowed identification of the organism in leg ulcers and thus its role to be determined, as it is fastidious to grow in culture. NAATs have also shown that although it is very closely linked to the genital type H. ducreyi I, it is actually a different strain [2] although divergence only occurred relatively recently approximately 1.93 million years ago [3] The article by Lewis and Mitja also describes how these data, showing many leg ulcers previously thought due to Treponema pallidum subsp. pertenue are due to H. ducreyi, throw into doubt the whole Yaws eradication programme which uses community reporting of leg ulcers as a surveillance method to determine its effectiveness. Surveillance of risk behaviour is a key part of STI control and the recent changes in nonprescription illicit drug use and their effects is an area identified by Melendez Torres and Bourne (pp. 58 63) as an
Current opinion in infectious diseases