STD treatment: how can it improve HIV prevention in the South?

Rates of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) and sexually transmitted diseases (STDs) are disproportionately high in the Southern United States. A high percentage of the population is black, and STD/HIV rates are particularly high among this group. Control and treatment of STDs offers promise as an HIV prevention strategy, and nowhere more than in the South.

Identify those specific recommendations for control and treatment of STDs that available evidence indicates can reduce HIV transmission.

Review of published literature.

Community trials produced inconsistent results but still suggest that STD treatment can reduce HIV transmission in the United States. Treatment of symptomatic STDs among those with HIV-infection should reduce HIV infectivity. There is as yet only limited evidence that STD treatment can reduce HIV susceptibility, although promising studies addressing herpes simplex virus are under way.

The unacceptably large racial disparities in STD rates must be addressed, symptomatic STDs among HIV-infected individuals treated, and syphilis prevention activities continued. Detection of unrecognized HIV infections among those seeking STD services should be a priority; identification of those with STDs and acute HIV infection may provide unique HIV prevention opportunities.