HIV and sexually transmitted diseases. The physician's role in prevention.

Although vaccines for the prevention of syphilis, gonorrhea, and infection with human papillomavirus, Chlamydia, herpes simplex virus, and HIV are progressing, medical caregivers cannot wait for these vaccines to become available to prevent HIV infection and classic sexually transmitted diseases (STDs). Furthermore, it has been argued that a 90% effective HIV vaccine would not equal regular appropriate condom use in preventing the disease. Healthcare workers should include counseling on prevention of STDs and HIV infection in their routine practice. Sexual history can help to determine the degree of counseling needed. Algorithms to help identify patients at greatest risk for asymptomatic STDs (which will lead to screening) are in development. Counseling that focuses on abstinence and monogamy, recognition and eradication of classic STDs, and proper use of condoms can be expected to reduce the risk of HIV.