• HIV testing
• heterosexual men

Editor,—The long awaited strategy for sexual health¹ promulgates some shibboleths and proposes some targets, which may increase sexually transmitted diseases and associated suffering.

A statement such as: “Some genital wart infections are associated with cancer, as is Chlamydia” may contribute to the anxiety that constitutes much of the burden of morbidity which such mostly innocuous conditions often engender.^2,3 The proposed target to increase uptake of HIV testing in GUM clinics may increase HIV neurosis. Offering an HIV test on first screening may lead to false reassurance and increase the chance of undiagnosed HIV infection, since many patients attend within three months of sexual exposure. The unlinked anonymous HIV prevalence survey⁴ has shown little change in the rate of undiagnosed HIV infection in heterosexuals attending GUM clinics between 1990 and 1999. The most recent (1999) rate in heterosexual men outside London is 0.09 %. Increasing the uptake of HIV tests to 60% by the end of 2007 may miss this tiny fraction; the total number of undiagnosed samples from heterosexual men outside London in 1999 was only 14. Efforts by increasingly stretched professionals in sexual health services to meet targets set by the strategy will result in less energy and time available for more appropriate approaches to the burden of sexually related morbidity.