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August 25, 2004

Antibiotic Chemoprophylaxis and HIV Infection in Kenyan Sex Workers—Reply

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2004;292(8):921. doi:10.1001/jama.292.8.921-b

In Reply: Mr Steen and colleagues make some very important observations, with which we largely agree. It is true that at the time our study was conducted in Nairobi the population incidence of bacterial genital ulcer disease due to chancroid and syphilis had declined considerably, probably related to the impact of effective treatment and prevention programs.1 However, despite the low incidence of bacterial genital ulcer disease, the incidence of the nonulcerative bacterial STIs gonorrhea and chlamydia was still relatively high in our cohort of female sex workers and was markedly reduced by monthly antibiotic treatment and prophylaxis with azithromycin. The presence of these STIs is believed to represent an important risk for HIV-1 acquisition in female sex workers, and so the fact that their treatment, reduction, or prevention did not reduce HIV incidence requires explanation.