Abstract: To the Editor: In their editorial published in the April issue of Sexually Transmitted Diseases, Golden and Kerndt present data from a sample of US Sexually Transmitted Disease (STD) clinics, including ours, that suggest that these clinics may be more important in the control of sexually transmitted infections, particularly syphilis and gonorrhea, than is generally thought.1 To further inform the discussion on why we should save our STD clinics, we submit here some findings of additional analyses of the Denver STD data that we provided for the editorial. The most striking point from these analyses is the discrepancy found when stratifying by gender. First, of all reported chlamydia cases in the City and County of Denver in 2009, 69% were among women, compared to 44% for gonorrhea, and 7% for syphilis. This makes sense since, as a result of practice guidelines women are more likely to be screened for chlamydia. However, it also indicates that trends in reported chlamydia cases disproportionally reflect the testing experiences among women. Indeed, when investigating the origin of case reports, we found that for men, 46% of chlamydia cases, 54% of gonorrhea cases, and 24% of syphilis cases were reported from the Denver STD clinic, compared to only 13%, 20%, and 12% for women, respectively. These data have an important corollary in the fact that men consistently comprise over 60% of the visits at the Denver clinic. Thus it appears that, at least in the Denver area, men are much more dependent on the STD clinic for STD services than women, and it is probable that the situation will be similar in other jurisdictions. Men do not only use STD clinics in higher number than women, they are also more likely to profit from primary prevention interventions in the STD clinic setting, as was recently demonstrated in the Safe in the City project.2 There appears to be a growing sentiment that under health care reform, the primary care setting can easily take over the provision of STD services, especially since evolving STD testing technologies including NAAT and rapid testing, make the provision of such services much easier than in the past. However, it is an open question if the increasing demand for primary health care services will be paralleled by an increase in capacity and which services will be prioritized. Furthermore, men are historically less likely to access the general health care system; although health care reform will improve their access, it is by no means certain that even with better access men will change their health seeking behaviors. As Golden and Kerndt mention, despite years of universal access insurance systems, many countries abroad have elected to maintain their publicly-funded STD clinic safety net. They may be on to something. However, in the debate on health care reform, we in the United States have been particularly reluctant to heed the lessons learned by other countries, often times citing the unique nature of our society. One has to hope that in this instance, the experience by other countries will guide us in saving our STD clinics. We should, and yes, we can. Cornelis A. Rietmeijer, MD, PHD Christie Mettenbrink, MPH Denver Public Health Department Denver, CO