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Professor Cathy Ison will retire from her position as Director of the Sexually Transmitted Bacterial Reference Unit (STBRU) within Public Health England (PHE) during December 2013. As many of our readers will know, Cathy has devoted her working life to the science and practice of sexually transmitted infection (STI) control. It is therefore highly appropriate for our journal to honour and celebrate Cathy's many and varied contributions to our field in this issue (figure 1).
Cathy began her working life as a junior medical laboratory scientific officer (MLSO) at Central Middlesex Hospital in north-west London in 1965. In 1967, Cathy took up a position as an MLSO in Clinical Microbiology at St. Mary's Hospital Medical School, London, and contributed to the scientific endeavours of St. Mary's campus for 37 years. In doing so, Cathy witnessed a number of organisational name changes until she took up her current position to establish STBRU at the former Health Protection Agency, which became part of PHE. After obtaining her Higher National Certificate in Medical Microbiology, Cathy successfully obtained a number of qualifications including Fellowship of the Institute of Medical Laboratory Sciences, a PhD from the University of London and, somewhat unusual for a non-medical graduate, both Membership and subsequent Fellowship of the Royal College of Pathologists. More recently, Cathy obtained membership of the Institute for Learning and Teaching (2002) and an honorary Fellowship of the Royal College of Physicians (2010) in recognition of her many achievements in the field of STIs. After being promoted to the position of Reader in Clinical Microbiology at Imperial College School of Medicine (ICSM) in 1999, Cathy was appointed as Professor in Medical Microbiology at the same institution in 2003. Following her move to PHE in 2004, Cathy was appointed as Visiting Professor of Investigative Science and Infectious Disease Epidemiology at ICSM. Cathy has an impressive publication record, with approximately 250 peer-reviewed publications and over 25 book chapters. Cathy is a member of several relevant learned societies and continues to serve on the Editorial Boards of three international specialist journals, including our own where she currently serves as an Associate Editor.
Cathy's passion has been the study and surveillance of antimicrobial resistance (AMR) in her favourite pathogen, Neisseria gonorrhoeae. Cathy has been at the forefront of research into gonococcal AMR from the basic science perspective, where her work contributed to improved understanding of the genetic mechanisms responsible for AMR, to the public health perspective, where Cathy has been a leader in the field in national and regional AMR surveillance. Cathy has substantial experience of the use of both phenotypic and molecular typing methods to track the spread of antimicrobial resistant gonococci and she was intricately involved in the development of the highly discriminatory molecular-based opa typing and N gonorrhoeae multiantigen sequence typing (NG-MAST) methods. The NG-MAST approach was novel as it employed hyper-variable genes and it allowed in-depth analysis of gonorrhoea transmission chains and the identification of large clusters of individuals that were not evident on clinico-epidemiological grounds. The NG-MAST method is now internationally employed as the N gonorrhoeae typing method of choice. Cathy set up the London-based pre-cursor of the national Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP) in England and Wales and, with European collaborators, the European Centre for Disease Prevention and Control-funded Gonococcal Antimicrobial Surveillance Programme in Europe (Euro-GASP). Both these programmes have been critical to generate the data required to heighten awareness and improve our understanding of the spread of gonococcal AMR within the UK and across Europe. These UK-based and European data have informed the WHO's public health efforts to prepare for the further spread of multi- and extensively-drug resistant N gonorrhoeae at the global level.
Still within the genus Neisseria, Cathy forged a productive collaboration to study N meningitidis with Professor Mike Levin's research group at the St. Mary's campus. A whole-blood assay for studying antigen expression of meningococci was developed in Cathy's laboratory. Cathy was also a key member of the St. Mary's scientific team that evaluated the Cuban group B meningococcal vaccine.
Cathy has also made significant contributions to the field of bacterial vaginosis, lymphogranuloma venereum (LGV), chancroid and medico-legal work. With Dr Phillip Hay, Cathy developed the Ison-Hay criteria for the diagnosis of bacterial vaginosis and classification of vaginal bacterial flora patterns. When LGV emerged as significant public health concern among men who have sex with men in Western industrialised countries in the early 2000s, Cathy established the first diagnostic reference service for LGV in the UK at the STBRU, thereby enabling the systematic surveillance of the UK outbreak. Cathy developed an interest in improving diagnosis of Haemophilus ducreyi infection in the early 1990s and raised monoclonal antibodies against the organism's heat shock proteins. The work of Cathy and the STBRU team was recognised through the award of a police commendation for improving the quality of STI-associated medico-legal work in the UK.
Cathy has always recognised the importance and value of collaborative working between microbiologists and epidemiologists to improve understanding of STI epidemics, and has pioneered this approach for STI surveillance in the UK. At PHE, Cathy has been able to work closely with epidemiologists to develop ‘state of the art’ surveillance systems which integrate microbiological, epidemiological and behavioural data, thus strengthening interpretation of national and local data on STI outbreaks and epidemics, and leading to improved interventions for infection control. The linking of AMR, NG-MAST and behavioural data in GRASP and Euro-GASP has been used to identify rapid clonal spread of gonococcal resistance across Europe and the UK in defined behavioural sub-populations. This intelligence has helped elucidate the impact of prescribing practice on patterns of susceptibility in ‘at-risk’ populations and will continue to inform treatment guidelines. As part of the UK LGV Incident Group, Cathy was instrumental in helping develop enhanced surveillance of LGV in the UK which combined microbiological data from the STBRU with detailed clinical and behavioural data collected from clinics. The combined high coverage and quality of these data enabled not only the rapid detection of changes in the epidemic, but also the risks and behaviours associated with these changes, which together were used to develop local infection control plans and interventions.
In 1997, Cathy co-developed a successful microscopy course with colleagues at the St. Mary's campus. This popular course is now run by the Bacterial Special Interest Group of the British Association for Sexual Health and HIV (BASHH), of which Cathy was a founding member and the first chairperson. In recent years, Cathy has also organised annual basic science academic meetings for the BASHH membership. Cathy's teaching activities extend to various university courses as well as supervision of several MSc and PhD students. Most recently, Cathy co-edited and wrote several chapters for inclusion in the WHO manual entitled ‘Laboratory diagnosis of STIs, including HIV’ (http://www.who.int/reproductivehealth/publications/rtis/9789241505840/en/). Most notably, throughout her career Cathy has given generously of her time to train and mentor young scientists, including both microbiologists and epidemiologists, supporting their career development by encouraging them to critically examine their work and to publish it promptly.
In conclusion, Cathy has made an enormous contribution to the science and practice of STI control both within the UK and internationally. Cathy leaves her present post in the sure knowledge that a strong team of hand-picked younger scientists will continue and develop the work she has started. We would like to thank Cathy for her many contributions to the specialty, as well as our journal, and wish her a long, happy and well-deserved retirement.
Contributors This editorial was co-written and all drafts reviewed by both authors.
Competing interests None.
Provenance and peer review Commissioned; internally peer reviewed.