Behavioral Counseling Interventions to Prevent Sexually Transmitted Infections

Abstract

Bacterial and viral sexually transmitted infections (STIs) are common in the US. Approximately 20 million new cases of bacterial or viral STIs occur each year in the US, and about one-half of these cases occur in persons aged 15 to 24 years. 1,2 Rates of chlamydial, gonococcal, and syphilis infection continue to increase in all regions. 2 Sexually transmitted infections are frequently asymptomatic, which may delay diagnosis and treatment and lead persons to unknowingly transmit STIs to others. Serious consequences of STIs include pelvic inflammatory disease, infertility, cancer, and AIDS. Untreated STIs that present during pregnancy or birth may cause harms to the mother and infant, including perinatal infection, serious physical and developmental disabilities, and death. 3,4 USPSTF Assessment of Magnitude of Net Benefit The US Preventive Services Task Force (USPSTF) concludes with moderate certainty that behavioral counseling interventions reduce the likelihood of acquiring STIs in sexually active adolescents and in adults at increased risk, resulting in a moderate net benefit. See the Figure and Table 1 for more information on the USPSTF recommendation rationale and assessment. For more details on the methods the USPSTF uses to determine the net benefit, see the USPSTF Procedure Manual. 5 IMPORTANCE Approximately 20 million new cases of bacterial or viral sexually transmitted infections (STIs) occur each year in the US, and about one-half of these cases occur in persons aged 15 to 24 years. Rates of chlamydial, gonococcal, and syphilis infection continue to increase in all regions. Sexually transmitted infections are frequently asymptomatic, which may delay diagnosis and treatment and lead persons to unknowingly transmit STIs to others. Serious consequences of STIs include pelvic inflammatory disease, infertility, cancer, and AIDS. OBJECTIVE To update its 2014 recommendation, the US Preventive Services Task Force (USPSTF) commissioned a review of the evidence on the benefits and harms of behavioral counseling interventions for preventing STI acquisition. POPULATION This recommendation statement applies to all sexually active adolescents and to adults at increased risk for STIs. EVIDENCE ASSESSMENT The USPSTF concludes with moderate certainty that behavioral counseling interventions reduce the likelihood of acquiring STIs in sexually active adolescents and in adults at increased risk, including for example, those who have a current STI, do not use condoms, or have multiple partners, resulting in a moderate net benefit. RECOMMENDATION The USPSTF recommends behavioral counseling for all sexually active adolescents and for adults at increased risk for STIs. (B recommendation)

Dyadic Intervention for Sexually Transmitted Infection Prevention in Urban Adolescents and Young Adults (The SEXPERIENCE Study): Protocol for a Randomized Controlled Trial

“…The results from this critical inquiry will further clarify the potential role for a joint health educator–administered sexual education and counseling intervention in enhancing AYA access to sexual and reproductive health services in primary care settings and will determine the feasibility, acceptability, and effectiveness of using the sexually involved dyad as a vehicle for behavioral change. It will also give us an insight into the role of actively engaging sexual partners in joint communications for promoting healthier sexual behaviors on STI prevention compared to the general practice of individualized risk reduction counseling, partner notification, and expedited therapy without mutual engagement [ 14 , 17 , 34 ]. Dyadic interventions have been used in many medical conditions including parent-adolescent dyads for improving HIV prevention and self-efficacy [ 35 ], obesity prevention, and smoking and sedentary lifestyle cessation and were influential for sparking behavior changes [ 36 ] and preventing HIV transmission between serodiscordant same-sex male couples.…”

“…In response to this public health failure, many states are establishing regulations to implement expedited partner therapy [ 14 - 16 ]. In addition, the US Preventive Task Force recently recommended the integration of behavioral counseling as part of STI management, especially for adolescents at higher risk for new or recurrent disease [ 17 ]. This clinical change is estimated to have a moderate benefit and will reduce the probability of acquiring new STIs.…”

Screening for Syphilis Infection in Nonpregnant Adolescents and Adults

“…The USPSTF has issued a separate recommendation for screening for syphilis infection in pregnant persons as well as screening recommendations for other STIs, including hepatitis B, hepatitis C, genital herpes, HIV, and chlamydia and gonorrhea . The USPSTF has also issued a recommendation on behavioral counseling for all sexually active adolescents and for adults who are at increased risk for STIs …”

An Advanced, Risk-Driven Sexual Health Curriculum for First-Year Internal Medicine Residents

“…Sexual histories during primary care visits provide important details to help guide testing, diagnosis, and treatment of STIs as well as an opportunity to offer prevention-focused behavioral counseling in accordance with the United State Preventive Services Task Force (USPSTF) guidelines. 5 , 6 A survey of 3,300 adults found that only one-quarter of patients reported being asked about sexual health or STIs by their primary care physicians during their last visit. 7 One unique issue in primary care STI screening is that patients with varying levels of STI risk are seen.…”