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To the Editor: Dr Kaul and colleagues¹ again confirm that sexually transmitted infections (STIs) are important human immunodeficiency virus (HIV) cofactors and, with new insights on potential pathways, reinforce the importance of STI control at the population level. Notably, the study may say more about the impact of cumulative public health efforts on local STI/HIV transmission than about the effectiveness of any specific intervention.

The rationale for treating sex workers presumptively for STIs is based on 2 assumptions. First, sex workers are frequently exposed to STIs and can transmit infection to many partners, particularly when condom use is low. Second, STIs in women are difficult to identify without sensitive laboratory tests.

These factors are dynamic and the potential benefit of presumptive treatment is setting-specific. The greatest effect can be expected where STI transmission is intense and access to services poor. Sexually transmitted infections, particularly genital ulcers, spread easily under such . . . [Full Text of this Article]

Richard Steen, PA, MPH
steenr@who.int
Department of HIV/AIDS
World Health Organization
Geneva, Switzerland

Gina Dallabetta, MD
HIV/AIDS Institute
Prevention and Mitigation Division

Graham Neilsen, MD
STIs & Care
Asia Pacific Field Programs Division
Family Health International
Arlington, Va

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