Eradicating chancroid

Genital ulcers are important cofactors of HIV transmission in the countries most severely affected by HIV/AIDS. Chancroid is a common cause of genital ulcer in all 18 countries where adult HIV prevalence surpasses 8% and is r are in countries with low-level HIV epidemics. Haemophilus ducreyi, the causative organism of chancroid, is biologically v ulnerable and occupies a precarious epidemiological niche, Both simple, top ical hygiene and male circumcision greatly reduce risk of infection and sev eral classes of antibiotics - some of which can be administered in single-d ose treatment regimens - provide rapid cure. H. ducreyi depends on sexual n etworks with high rates of partner change for its survival, thriving in env ironments characterized by male mobility and intensive commercial sex activ ity. Elimination of H, ducreyi infection from vulnerable groups results in disappearance of chancroid from the larger community, Once endemic in Europe and North America, chancroid began a steady decline early in the twentieth century, well before the discovery of antibiotics. S ocial changes - resulting in changing patterns of commercial sex probably d isrupted the conditions needed to sustain chancroid as an endemic disease, Sporadic outbreaks are now easily controlled when effective curative and pr eventive services are made available to sex workers and their clients. More recently, chancroid prevalence has declined markedly in countries such as the Philippines, Senegal, and Thailand, a development that may contribute t o stabilization of the HIV epidemics in these countries. Eradication of cha ncroid is a feasible public health objective. Protecting sex workers and th eir clients from exposure to sexually transmitted diseases (STDs) and impro ving curative services for STDs are among the proven strategies that could be employed.