Heterosexual Transmission of Acquired Immunodeficiency Syndrome

To the Editor.— Fischl and colleagues 1 are to be commended for their study, which provides compelling evidence that use of condoms protects against the transmission of human immunodeficiency virus (HIV) in sexually active heterosexual couples. However, the authors' data suggest an additional conclusion that is of major potential significance to heterosexual couples but that is not clearly delineated in their report or given the emphasis I believe it deserves. It can be inferred from the authors' discussion that the seven male spouses who had a history of other heterosexual partners were all seropositive for HIV at entry into the study. It is also stated that after elimination of these seven subjects from the analyses, gonorrhea and syphilis were no longer significantly associated with seropositivity in men. Thus, it can be suspected that the presence of gonorrhea or syphilis in male spouses was probably a marker for having other heterosexual