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J. Dennis Fortenberry, MD,MS

JAMA. 2002;287:768-769.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

In 2000, a total of 702 093 genital infections due to Chlamydia trachomatis and 358 995 due to Neisseria gonorrhoeae were reported to the Centers for Disease Control and Prevention.¹ These reported cases represent an extraordinary number of curable infections. One explanation for the persistence of high levels of disease may lie in a gross underestimation of the burden of disease in the population. Both C trachomatis and N gonorrhoeae have poorly understood capacities for production of asymptomatic infections. A pool of untreated persons sustains high levels of disease, even for individuals not otherwise characterized by patterns of high-risk sexual behaviors.²

The number of persons with asymptomatic sexually transmitted diseases (STDs) is unknown but many studies suggest it is large, likely exceeding the number of symptomatic infections.^3-5 In 1997, the Institute of Medicine described the state of STDs in the United States as a "hidden" epidemic.⁶ This dramatic . . . [Full Text of this Article]

Author Affiliation: Section of Adolescent Medicine, Indiana University School of Medicine, Indianapolis.

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