Two for the price of one: should donovanosis and chancroid be targeted for eradication?

Half a century after smallpox eradication, this feat has not been repeated, although there is hope for the Guinea worm. This article examines whether two uncommon genital ulcerative diseases, donovanosis and chancroid, should be targeted for eradication. Many think that their decline has been such that they might be heading towards spontaneous eradication, following more effective treatments, integration of sexually transmitted infection management in primary healthcare, enhanced condom use by sex workers and promotion of male circumcision. However, examples of syphilis and mpox suggest spontaneous eradication may be a fallacy. Donovanosis occurs sporadically in several countries, especially India. In other formerly endemic nations (eg, Papua New Guinea and the Papua region of Indonesia), the current epidemiological situation is unclear. Worldwide incidence might be a few hundred cases annually, perhaps a thousand. The availability of effective interventions, relatively easy clinical diagnosis, adequate laboratory tests and the absence of animal reservoirs suggest that eradication could be achieved through enhanced surveillance and a stronger contact tracing system with presumptive treatment of all sexual contacts, including sex workers. Chancroid’s current annual caseload is unknown but likely in the hundreds of thousands of cases globally. Prior to eradication activities, a first phase should document its status in all previously endemic countries using molecular tests on patients presenting with genital ulcers in sentinel clinics. Additional research should investigate whether Haemophilus ducreyi in skin ulcers can cause genital infections. Chancroid is strongly associated with sex work: this is the tap that must be turned off. Where it remains endemic, sex workers’ services should be supported to treat symptomatic cases, enhance condom use and deliver periodic presumptive treatment with azithromycin. Given their overlapping geographic distribution and the preponderant role of sex workers in transmission dynamics, an eradication programme could address both diseases simultaneously, with the same personnel.