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In 1970, the US Surgeon General is said to have declared that it was time to “close the book on infectious diseases, declare the war against pestilence won and shift national resources to such chronic problems as cancer and heart disease”. Though this attribution has been disputed,1 the undoubted optimism of that era over infectious disease now seems a world away, after a year in which Ebola both reached and was transmitted within the United States of America. In recent years we have been alarmed by the re-emergence of ancient diseases in newly resistant form—particularly gonorrhoea and tuberculosis. This month, Tuddenham and Ghanem's editorial introduces a mini-series on the threat of antimicrobial resistant (AMR) gonorrhoea,2 featuring expert analyses by international experts Rice,3 Lewis,4 and Giguère and Alary.5 The widespread adoption of (often unconfirmed) nucleic acid testing as reported from the UK by Toby et al6 has limited our ability to track emerging resistance in the real time allowed by culture methods, for all their limitations. Culture confirmation is reported by Mohammed et al to be lower in women and men who have sex with men than in heterosexual men in the UK.7 As we try to predict the impact of growing gonococcal resistance, it is daunting to see Trecker et al reporting the vulnerability of an AMR gonocoocal transmission model to small changes in parameters.8
Apart from the catastrophic emergence of HIV on the world stage, another discovery unforeseen in 1970 was the emergence of infectious diseases as important triggers of neoplastic disease and many chronic diseases. Human papilloma virus (HPV) is the nearest concern for the venereological community, who will be interested to read Field and Lechner's reflection on the implications of HPV infection for head and neck cancer.9 This raises new possibilities and challenges for cancer prevention through vaccines, and the major epidemiological challenges in understanding the role of co-factors in variously vulnerable populations such as MSM, smokers and those who abuse alcohol. HPV is as usual a major topic in this month's issue, with an exploration of concordance between oral and anogenital HPV by King et al,10 a clinical study of imiquimod in high-grade lesions,11 and a systematic review of the psychological effects of cervical intraepithelial neoplasia.12
This month's BASHH column addresses the challenge of identifying young people at risk of sexual exploitation,13 a topic which nicely partners an interesting study by Cho et al on the discordance between HIV and HSV biomarkers and reported behaviour in Kenyan adolescent orphans.14 Contrasting articles on HIV prevention, from different parts of the globe, remind us of its complexity. Mugo et al present an interesting study of HIV testing in Kenyan pharmacies15 while Vriend et al16 describe STI and HIV testing patterns in Dutch MSM, and others explore acceptability and preparedness for treatment as prevention in Scotland17 and microbicides in Australia.18 Noting considerable variation in this popualtion, Logie at al19 report on correlates of STI history in women who have sex with women and emphasize the need to tailor provision of services to sexual practices and history.
Last but not least, Crosby et al present condom use data from a diary study which shows that rushed application is associated with both slippage and breakage.20 A variation on the old adage, which becomes “More haste, more speed” of STI and HIV transmission.
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