Behavioral Counseling Interventions to Prevent Sexually Transmitted Infections: U.S. Preventive Services Task Force Recommendation Statement

Who developed these recommendations? The U.S. Preventive Services Task Force (USPSTF) developed these recommendations. The USPSTF is a group of health experts that reviews published research and makes recommendations about preventive health care. What is the problem and what is known about it so far? Sexually transmitted infections (STIs), also known as sexually transmitted diseases or venereal diseases, are spread through sexual contact. Common STIs include syphilis, gonorrhea, chlamydia, herpes, hepatitis B, human papillomavirus, and HIV. Although great advances have been made in the prevention, detection, and treatment of STIs, these infections remain a common problem in the United States. The Centers for Disease Control and Prevention estimates that about 20 million new cases of STIs occur each year in the United States. Safe sex practices, such as using condoms, avoiding sexual contact when using alcohol or drugs, and limiting the number of sexual partners, can prevent STIs. In 2008, the USPSTF recommended high-intensity behavioral counseling for all sexually active adolescents and for adults at increased risk for STIs. Because of the lack of evidence, the USPSTF could not make a recommendation for nonsexually active adolescents or adults who are not at increased risk. The USPSTF is now updating these recommendations. How did the USPSTF develop these recommendations? The USPSTF reviewed published research on the benefits and harms of behavioral counseling to prevent STIs. What did the authors find? As in the previous review, the USPSTF found that high-intensity counseling reduced the number of new STIs in sexually active adolescents and adults. In this update, the USPSTF also identified some effective interventions of lesser intensity. It also found adequate evidence that intensive counseling reduced risky sexual behaviors and increased the use of condoms and other protective practices. The USPSTF found adequate evidence that the potential harms of counseling to the patient are low. What does the USPSTF recommend that patients and doctors do? All sexually active adolescents and adults at increased risk for STIs should receive intensive counseling about ways to reduce their risk for STIs. Adults at risk include those who have a current STI or had one in the past year, who have multiple sexual partners, or who do not consistently use condoms. Intensive counseling includes sessions that last from 30 minutes to 2 or more hours. Counseling could occur in primary care settings or through referral to other parts of the health care system. It can also be provided by community organizations, schools, and health departments or their STI clinics. What are the cautions related to these recommendations? There is not enough published research on counseling for STI prevention in some important populations, such as people at low risk, adolescent boys, men who have sex with men, and American Indians or Alaska Natives. Also, the USPSTF reviewed many studies that used self-reported behavioral outcomes (which may be unreliable) excluded certain types of studies.