Letter to the Editor: “Testing for Sexually Transmitted Infections in Symptomatic Male Military Trainees” by Malone et al.

Sir, We read with great interest the article entitled “Testing for Sexually Transmitted Infections in Symptomatic Male Military Trainees” by Malone et al.1 This study provides valuable insights into diagnostic testing and treatment practices in young men presenting with symptoms of urethritis. We fully agree with the authors, who appropriately avoid interpreting their results as prevalence estimates of gonococcal or chlamydial urethritis [GCU] within this U.S. military population. Because the study focused exclusively on symptomatic men, it did not systematically assess asymptomatic infections or extra-urethral sites (pharyngeal or anorectal). For context, according to French Armed Forces data (COSEMIL study), overall STI prevalence was 4.7% [3.8-5.9] (4.1% in men and 10.4% in women), with associations including low educational level, birthplace, religiosity, and anal sex.2 Behavioral risks (multiple partners, sex work contacts, risky drinking) were frequent.2 This aligns with prior estimates of STI prevalence in the same population and with the authors’ concern that closed or insular sexual networks may amplify transmission, underscoring the need for standardized testing among trainee.3