Why the SAFE- S Strategy for Trachoma? Are Musca sorbens or Scatophaga stercoraria Really the Culprit?-A Brief Historical Review from an Italian Point of View

Abstract

The biological history of Chlamydia trachomatis is intertwined with the evolution of the man. Infecting Elemental Bodies (EBs), having penetrated mucosal epithelial cells, wrap themselves in a cloak (ĸλαμις) of glycogen that ensures their obligatory intracellular survival and protects this differentiation into Reticulate Bodies (RBs) that feed on cellular ATP. Multiple chemokines and cytokines are involved under the direction of IL-6 in the florid phase and IL-17A in the scar phase. The WHO has successfully identified the SAFE strategy against trachoma (Surgery, Antibiotics, Facial cleansing, Environment) as the blueprint to eliminate the disease by 2020. Recently, interest has been increasingly focused on changing sexual attitudes in different areas of the world, leaving Musca sorbens, Scatophaga stercoraria, and stepsisters fairly blameless, but extolling the role of Chlamydia trachomatis in apparently "sterile" chronic prostatitis or conjunctivitis or, less frequently, in oropharyngitis and proctitis. The addition of an S (SAFE-S) standing for "sexual behavior" was then proposed to also attract the interest and attention not only of Ophthalmologists and Obstetricians/Gynecologists, Urologists/Andrologists, and the School Authorities for information on the prevention of sexually transmitted diseases, but also of Social Physicians and Pediatricians. This means that sexually transmitted infections should be screened in asymptomatic patients with risky sexual behavior or sexual contact with people diagnosed with a transmitted infection.

Keywords: Musca sorbens; RT-PCR; WHO SAFE strategy; chlamydia; conjunctivitis; neglected transmitted diseases; sexually transmitted diseases; trachoma; vaccines.

Figure 1

Eber papyrus, approximately 1550 BC, Egypt, New Kingdom, XVIII dynasty. Medical papyrus on diseases and herbal knowledge, written in hieratic as a summa of older texts. Line 350. “nekha.t” = this can be interpreted as ‘trachome’, conjunctivitic granulosis; ripple of water = “n” as a phoneme; clumps of papyrus = “kh” as a phoneme, sounds like “ch” in German; vulture bird = “a” as a phoneme (it is generally transliterated with sign “3” to indicate an open “A”); bread loaf = “t” as a phoneme; pustule is a determinative for blister, wound or phlogosis; three vertical lines = indicate a plural form (maybe a number of blisters or tearing). The word “nekha.t” is translated as “an eye disease” [belegt Med. eineAugenkrankheit] in Woerterbuch [the Dictionary]. (Cristiano Daglio. Le Malattie. S. Malgora: Ur Sunu, pp 65–81. Saviolo ed. Vercelli, Italy, 2008. Courtesy Dr. F. Buttiglione PhD and Serena Salmé).

Figure 2

(a) Tarsal conjunctiva. Florid trachoma. (TF, according to WHO classification). Papillary infiltration, forming nodules. Van Gieson ferric hematoxylin. 75×. (b) Tarsal conjunctiva. Scarring trachoma. From TI (T. Inflammation Intense: fibroblastic proliferation of the chorion, still site of histiolymphocytic infiltration) to TS (T. Scarring): conjunctival scars with fibrous white bands (arrow). Absence of infiltrate and Ct in the scar area. Giemsa 120× [16], (Courtesy Prof. Nicola Delle Noci). (c) Tarsal conjunctiva. (MacCallan T4); TS: Arlt’s line. (Reproduced with permission—reference number 230716-012078. From Weisenthal RW. External Disease and Cornea. Basic and Clinical Science Course, Section 8, American Academy of Ophthalmology, 2013–2014).

Figure 3

Knapp forceps for expression of the follicles of granular conjunctivitis. From Axenfeld [9], 1914. (Note: It is suggested to use gloves!).

Figure 4

Everting sutures for entropion. George Bartisch: Ophthalmodouleia, 1583. Courtesy Prof. Nicola Delle Noci [40].

Figure 5

A Sri Lankan child with eyes infested with flies (M. sorbens). Courtesy Imperial College London. Institute of Global Health Innovation. The impact of Neglected Tropical Diseases on Universal eye health, 2016.

Figure 6

Unprotected sex is guilty. Improved control of sexual behavior is needed: SAFE-S strategy. Courtesy ihy-ihealthealthyou.com and digitaldictionary.it.