HIV Prevention Through Early Detection and Treatment of Other Sexually Transmitted Diseases -- United States

In addition to practical steps that can be implemented immediately, several research issues need to be addressed to maximize the longer-term impact of early STD detection and treatment as a strategy for HIV prevention. These include:

1. Methods to better assess, at national and local levels, the attributable risks related to different STD pathogens;
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2. Methods to better assess the potential prevention impact of different approaches to enhanced STD treatment and prevention;

3. Protocols for assessing access to and quality of clinical STD services in communities and for specific populations within communities;

4. The prevalence of STDs and risk factors for STDs among asymptomatic persons currently not screened for STDs (e.g., men), so screening guidelines can be refined further;

5. The incidence of curable STDs in certain high-risk populations (e.g., HIV-infected persons), so guidelines can better specify the best frequency of screening;

6. The field performance and practical issues involved in using both new and older noninvasive tests (e.g., urine tests and self-obtained swabs) to identify STDs in nonmedical settings;

7. The precise balance of benefits and risks of presumptive or prophylactic antimicrobial therapy for persons who, based on epidemiologic data, have extremely high rates of curable STDs; and

8. The role of HSV-2 and other viral STDs in HIV transmission and the potential role of suppressive or other chemotherapy for genital herpes in reducing the risk for HIV transmission.

Similarly, new behavioral and operational research is required to complement, facilitate, and enhance overall HIV prevention efforts because of increased emphasis on early STD detection and treatment. Examples include how to best provide HIV and STD prevention counseling when asymptomatic STDs are detected and how to improve HIV prevention referral systems and processes within the full range of STD detection and treatment facilities and settings (i.e., HIV counseling and testing centers, MCOs, and street outreach settings). Operations research also is needed to better understand how to organize STD prevention services to prevent HIV transmission. Additional research issues will arise as the initial program activities described previously are implemented.