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.

Trachoma and the Importance of Sexual Infective Route in Developed Countries. Comment on Gallenga et al. 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. Pathogens 2023, 12, 1419

“…The incidence of visual impairment due to Trachoma is lower in European and Latin American countries in comparison to African countries [2,3], due to Trachoma's association with rural and lower-income areas [1], as has been clearly pointed out in the discussed review article. As stated by the authors, Trachoma's global elimination has been proposed for 2030 [3].…”

“…Are Musca sorbens or Scatophaga stercoraria Really the Culprit?-A Brief Historical Review from an Italian Point of View." [1], We want to point out an aspect that may have been forgotten regarding the investigation of Trachoma vectors, which could be a key factor when it comes to understanding Gallenga's conclusion regarding Trachoma and Chlamydia trachomatis's epidemiology in higher-income countries and the need for sexual behavior control.…”

“…Despite the previously shared information, when we think of higher-income countries' levels of sanitization, it is difficult to imagine eye-seeking flies being attracted to human feces and therefore being the main vector for the infection. Yet, ocular infections caused by Chlamydia trachomatis (Ct), apart from Trachoma, are still persistent in these countries [1]. Indeed, as Gallenga et al remark, Ct has not been fully eradicated, probably due to the sexual infective route [1].…”

About Chlamydia trachomatis. Reply to Garcia-Teillard et al. Trachoma and the Importance of Sexual Infective Route in Developed Countries. Comment on “Gallenga et al. 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. Pathogens 2023, 12, 1419”

“…It is also mandatory to evaluate the interference of the order Diptera with the rural anthropized environment, as in Figure 5 of the reference paper [2].…”

“…The comment by Damian Garcia-Teillard et al [1] regarding the suggestion about the need to increase awareness of Chlamydia trachomatis (Ct) infection due to the sexual infectious route [2] helps to pave the way for more articulated answers and considerations.…”