Introduction

This unit was established in January 2012. The fulltime members are Chris Kenyon (head), Kara Osbak and Ilan Schwartz (PhD Students). We collaborate extensively with the units of Prof X Van Ostade (Antwerp University), Prof Philippe Buscher (ITM), Prof Jacques van Lankveld (Open University), Prof Rebecca Brotman (University of Maryland) Prof Caroline Cameron (University of Victoria) as well as a number of other units in the ITM, UA and South African institutions.

Research in the STI Unit is focussed on:

• Preventing the emergence of antimicrobial resistance (AMR) in STIs

• Testing the pharmacoecological theory of AMR. This theory postulates that the reason why AMR in organisms such as Neisseria gonorrhoeae frequently emerges in core-groups such as sex workers and MSM is due to a combination of a dense sex network and high rates of consumption of antimicrobials. The high network connectivity generates a high prevalence of the STI and the antimicrobial consumption then places a selection pressure for the emergence of AMR. We are testing this theory through the following strategies:

• Ecological studies of the association between network conectivity + antimicrobial consumption vs. AMR
• Observational studies of changes in antimicrobial consumption in high network connectivity populations and subequent changes in AMR
• RCTs:

• 1. PReGo Study - Preventing the emergence of resistance in gonorrhoea Study. We aim to assess in this RCT if we can reduce the cumulative incidence of gonorrhoea, chlamydia and syphilis throught he use of a commercially available mouthwash product
• 2. RCT of 3 site 3monthly screening for N. gonorrhoea/C. trachomatis vs no screening in higher risk MSM

• In vitro testing of the theory in an Ngonorrhoea morbidostat
• Altering our STERGM model of N gonorrhoea transmission to include probability of the emergence of AMR depending on screening and treatment strategy

• We are evaluating alternative antibiotic combinations, screening policies on the emergence of resistance in Neisseria gonorrhoeae. 
• SeTPAT. The search for a Treponema pallidum antigen test. We are using MS/MS and MRM to detect the presence of various T pallidum antigens in the sera of 120 patients with a new diagnosis of syphilis. We aim to develop an ELISA that can detect T pallidum antigen via this approach
• Further develop and test the Sexual Network Connectivity is a fundamental determinant of STI prevalence (SeNCoSTI) theory

• Refine the SeNCoSTI Theory on the basis of empirical evidence and modelling analyses
• Map the global and within country variations in the prevalence of the major STIs over the last century and relate these changes to parameters in SeNCoSTI 

• Develop a model for transmission of genital microbiomes in general and bacterial vaginosis associated bacteria in specific
• Emergomyces africana. We aim to develop a new antigen test and serologic test for diagnosis and seroprevalence surveys.