• trachoma
• chlamydia
• azithromycin

A few minutes spent searching Medline reveals some interesting trends: while the total number of scientific publications has exploded over the past 35 years, the number of papers incorporating the keyword “trachoma” has actually decreased (Fig 1A). The number of reviews of trachoma, however, has increased (Fig 1B). Is this a sign that the study of trachoma has matured—that effective treatments are well known and that the only challenge left is to implement them? Many recent editorials have indeed suggested that a wide variety of treatments are effective.^1–6 In fact, studies suggest that trachoma is disappearing even in the absence of a programme specifically targeting the disease.^7–10 Is the war against trachoma, or at least the scientific part, finally over?

The past decade has witnessed numerous advances in chlamydia research: the chlamydial genome has been sequenced,¹¹ diagnosis with sensitive nucleic acid amplification tests has become routine,^12–14 and randomised clinical trials have purported to demonstrate the efficacy of behavioural,¹⁵ pharmacological,¹⁶ and even entymological¹⁷ control measures in reducing the prevalence of trachoma. A course of three doses of oral azithromycin administered to all members of a community was shown to be as effective as a 6 week course of topical tetracycline.¹⁸ This is important because compliance with oral azithromycin is clearly far superior. Another trial suggested that an …