In a statement released Sept. 23, the U.S. Preventive Services Task Force recommended intensive behavioral counseling for all sexually active adolescents and for adults who are at increased risk for sexually transmitted infections.
The Centers for Disease Control and Prevention estimates that about 20 million new cases of STIs occur each year in the U.S. and half of these cases occur in people ages 15 to 24 years old, according to a news release. Sexually transmitted infections are frequently asymptomatic, which leads people to unknowingly transmit STIs to others.
According to the statement, a 2009 nationally representative survey found that STI prevalence (not including HIV) was 24.1% among female adolescents ages 14 to 19 years old and 37.7% in those who were sexually active. In 2010, the direct medical costs of STIs (including HIV) were estimated at $16.9 billion in the U.S.
The USPSTF commissioned a systematic review of the benefits and harms of behavioral counseling for sexual risk reduction in primary care to prevent STIs in adolescents and adults. The review included clinical trials of interventions targeting risky sexual behaviors to prevent STIs alone or in combination with other behaviors in adults and adolescents of any sexual orientation or level of reported sexual activity.
The USPSTF found evidence that intensive behavioral counseling interventions can reduce the likelihood of STIs in sexually active adolescents and in adults who are at increased risk. It also found these interventions reduce risky sexual behaviors and increase the likelihood of condom use and other protective sexual practices.
According to the recommendation statement, clinicians should be aware of populations with a particularly high prevalence of STIs. Those populations include African Americans, American Indians, Alaska Natives and Latinos. Increased STI prevalence rates also are found in men who have sex with men, people with low incomes living in urban settings, current or former inmates, military recruits, people who exchange sex for money or drugs, people with mental illness or a disability, current or former intravenous drug users, people with a history of sexual abuse and patients at public STI clinics, according to the statement.
Behavioral counseling interventions ranging in intensity from 30 minutes to two or more hours of contact time are beneficial. Evidence of benefit increases with intervention intensity. High-intensity counseling interventions, defined in the review as contact time of two hours or more, were the most effective. Moderate-intensity interventions of 30 to 120 minutes were less consistently beneficial and low-intensity interventions of less than 30 minutes were the least effective, according to the statement. Interventions can be delivered by primary care clinicians or through referral to trained behavioral counselors.
The most successful approaches provide basic information about STIs and STI transmission; assess the persons risk for transmission; and provided training in pertinent skills, such as condom use, communication about safe sex, problem solving and goal setting, according to the statement. Many successful interventions use a targeted approach to the age, sex and ethnicity of the participants and also aim to increase motivation or commitment to safe sex practices. Intervention methods included face-to-face counseling, videos, written materials, and telephone support.
Intensive behavioral counseling may be delivered in primary care settings or other sectors of the healthcare system. In addition, risk-reduction counseling may be offered by community organizations, schools and health departments. Despite the seriousness and prevalence of STIs, primary care clinicians often do not provide counseling about sexual activity, contraception or STIs during routine periodic health examinations or other healthcare visits and many believe that counseling is ineffective, the task force stated. Surveys examining STI counseling by primary care clinicians have found wide variations in practice. Stronger linkages between the primary care setting and the community may greatly improve the delivery of this service.
For more information: http://www.uspreventiveservicestaskforce.org/uspstf13/sti12/stifinalrs.htm