The military “don’t ask, don’t tell” policy for gay, lesbian, and bisexual service members is not only a constitutional and legal issue — it also has serious health implications, an epidemiologist claims.

The policy often means that sexually transmitted infections go undiagnosed and service members and their partners are untreated, Kenneth Katz, MD, of San Diego State University, wrote in a Perspective piece published online by the New England Journal of Medicine.

And messages aimed at preventing HIV and other sexually transmitted diseases — and tailored for gay, lesbian, and bisexual service members — are not transmitted, Katz argued.

“In very real ways,” Katz wrote, the policy threatens the health of service members as well as the community at large, and may even have an impact on the ability of the service as a whole to respond to combat missions.

Katz cited the case of a gay serviceman who came to his municipal STD clinic in San Diego County complaining of rectal pain and discharge. The diagnosis was rectal gonorrhea, which was treated according to CDC guidelines with an intramuscular injection of 125 mg of ceftriaxone (Rocephin) along with one gram of oral azithromycin (Zithromax) for empirical treatment of chlamydia.

But, Katz noted, the man had had ready access — for free — to military clinics. He said he chose the municipal clinic because he would have felt uncomfortable discussing his sexual behavior with a military doctor.

Katz reported that, in 2002, nearly one in 10 clients of a gay men’s health clinic in San Diego were sailors on active duty, which is consistent with his own experience.

But there are an estimated 66,000 gays, lesbians, and bisexuals in the military, or about 2.2% of the total, he noted. “How many of them have no access to nonmilitary medical care?” Katz wrote. “How many simply don’t seek it?”

The policy also may have effects on the use of public health resources, he argued.

Katz cited the case of gay man diagnosed with an STD at a service clinic. Rather than providing the name of his actual sexual partners for follow-up, he gave the name of a female friend who in due time got a phone call advising her she had been exposed to an STD. Meanwhile, the man notified his partners on his own.

The policy also may have adverse effects on the military as a whole, Katz argued. The illnesses caused by STDs can compromise troop readiness and increase the chance of acquiring HIV, which in most cases bars a service member from combat missions.

And the substantial costs of treating HIV are borne by the military.

“We can do better for our service members, our military, and our country,” Katz concluded.