• Service delivery
• control programs
• genitourinary medicine services
• public health
• Chlamydia trachomatis
• HIV testing
• M Genitalium

Reforms in the National Health Service (NHS) in England have given those of us working in the national network of genitourinary medicine (GUM) clinics reason to reflect on their role. The conclusion that the UK national specialty society (BASHH, British Association for Sexual Health and HIV) has come to is that GUM clinics are important because their core functions of testing for, and managing cases of, sexually transmitted infections (STI) including HIV, make an important contribution to the public health.

Professor Sir Donald Acheson, the UK's Chief Medical Officer between 1983 and 1991, defined public health as: ‘The science and art of preventing disease, prolonging life and promoting health through the organised efforts of society’. In this editorial I shall summarise the ways in which GUM clinics contribute to these goals.

First, through prevention of HIV infection. This is of major importance both because delayed diagnosis is a cause of morbidity and mortality which is avoidable with antiretroviral therapy but also because of the enormous costs to the NHS and other pubic services. Each case will cost the NHS approximately £12 000 a year for treatment indefinitely given the long life expectancy of HIV-infected persons. It has been projected that by 2013 the annual cost will be £1 billion.1 GUM clinics contribute to reducing transmission of HIV in several ways: first by diagnosing people as HIV-infected which has been shown in two meta-analyses to result in a very significant reduction in unsafe sexual behaviour.2 …