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To the Editor: The study by Dr Jemmott and colleagues¹ contributes important data to the effort to develop effective interventions that prevent sexually transmitted diseases (STDs) and human immunodeficiency virus (HIV) disease among young people. Although the authors used an ambitious study design and went to substantial lengths to document and validate the self-reported behaviors that were the principal outcome measures, we believe this and other such studies could be strengthened by the use of biomedical markers that identify STDs.

The availability of sensitive and specific urine-based testing for some of the most common bacterial STDs (ie, chlamydia and gonorrhea) makes such assessment feasible, even among subjects who do not report sexual activity. As O'Leary et al² have noted, "the real outcome of interest in intervention research is morbidity: rates of HIV, of other sexually transmitted infections [STIs] in the population or in a group of individuals and incident HIV/STD . . . [Full Text of this Article]