Treating Asymptomatic Sexually Transmitted Diseases at Anonymous HIV Counseling and Testing Sites

Abstract

THE AWARENESS THAT HIV transmission is facilitated by the presence of other sexually transmitted diseases (STDs) has helped focus public HIV prevention efforts for the past several years. However, a persistent reservoir of asymptomatic STDs could stymie these efforts, and the National Institute of Medicine has reported on the dangers of the "hidden epidemics" of undiag- nosed STDs.1 A recent population-based household survey in Baltimore confirmed the seriousness of this concern when it showed that almost 1 in 12 (7.9%) young adults aged 18 to 35 had untreated genitourinary Neisseria gonorrhea (PNG), Chlamydia trachomatis (CT) infection, or both.2 Furthermore, "nearly all" these infected individuals were asymptomatic. Innovative and cost-effective strategies to diagnose and treat asymptomatic infec- tions, which would otherwise go undetected and persist, are needed. In her comprehensive review, Wasserheit reported that both gonorrhea and chlamydia significantly increase transmission of HIV.3 Among gay men, gonorrhea was associated with a 1.5-fold increase in HIV infection in 2 prospective studies reviewed in that article, and chlamydia was shown prospectively to increase HIV seroconversion among women.3 In response to a wealth of this