Sexually Transmitted Infections: Behavioral Counseling--Sexually active adolescents and adults at increased risk
General
Grade: B The USPSTF recommends the service. There is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial. Offer or provide this service.
Specific Recommendations
The USPSTF recommends behavioral counseling for all sexually active adolescents and for adults who are at increased risk for sexually transmitted infections (STIs). See the Practice Considerations section for more information on populations at increased risk for acquiring STIs.
Frequency of Service
No information available.
Risk Factor Information
All sexually active adolescents are at increased risk for STIs because of the high rates of STIs in this age group and should receive behavioral counseling interventions. Adults at increased risk for STIs include those who currently have an STI or were diagnosed with one within the past year, do not consistently use condoms, have multiple sex partners, or have sex partners within populations with a high prevalence of STIs. Populations with a high prevalence of STIs include persons who seek STI testing or attend STI clinics; sexual and gender minorities; persons who are living with HIV, inject drugs, have exchanged sex for money or drugs, or have entered correctional facilities; and some racial/ethnic minority groups.1-4
Clinical
Practice
Practice Considerations
Patient Population Under Consideration
This recommendation applies to all sexually active adolescents and to adults at increased risk for STIs.
Definition of STIs
Sexually transmitted infections are transmitted through sexual activity and intimate physical contact. In the US, common STIs with significant clinical and public health effects include HIV, herpes simplex virus, human papillomavirus (HPV), hepatitis B virus (HBV), Chlamydia trachomatis, Neisseria gonorrhea, Treponema pallidum (syphilis), and Trichomonas vaginalis.1-4
Assessment of Risk
All sexually active adolescents are at increased risk for STIs because of the high rates of STIs in this age group and should receive behavioral counseling interventions. Adults at increased risk for STIs include those who currently have an STI or were diagnosed with one within the past year, do not consistently use condoms, have multiple sex partners, or have sex partners within populations with a high prevalence of STIs. Populations with a high prevalence of STIs include persons who seek STI testing or attend STI clinics; sexual and gender minorities; persons who are living with HIV, inject drugs, have exchanged sex for money or drugs, or have entered correctional facilities; and some racial/ethnic minority groups.1-4 Difference in STI rates among racial/ethnic groups may reflect differences in social determinants of health.2 To determine which adolescents are sexually active, and which adults might engage in activities that may increase their risk for STIs, clinicians should routinely ask their patients for pertinent information about their sexual history.
Behavioral Counseling Interventions
Intervention approaches include in-person counseling, videos, websites, written materials, telephone support, and text messages. Most successful approaches provide information on common STIs and STI transmission; assess the person’s risk for acquiring STIs; aim to increase motivation or commitment to safer sex practices; and provide training in condom use, communication about safer sex, problem solving, and other pertinent skills. Interventions that include group counseling and involve high total contact times (defined in the evidence review as more than 120 minutes), often delivered over multiple sessions, are associated with larger STI prevention effects. However, some less intensive interventions have been shown to reduce STI acquisition, increase condom use, or decrease number of sex partners. Interventions shorter than 30 minutes tended to be delivered in a single session. There is not enough evidence to determine whether several intervention characteristics were independently related to effectiveness, including degree of cultural tailoring, counselor characteristics, or setting.
Implementation
Primary care clinicians can deliver in-person behavioral counseling interventions, refer patients to behavioral counseling interventions in other settings, or inform patients about media-based interventions. For more information about risk assessment methods and behavioral counseling interventions, see the Additional Tools and Resources section and Table 2.
Additional Tools and Resources
The following resources may help clinicians implement this recommendation.
- The Centers for Disease Control and Prevention (CDC) provides a tool for STI risk assessment suitable for primary care settings (https://www.cdc.gov/std/products/provider-pocket-guides.htm); provides information about behavioral counseling and other STI prevention strategies (https://www.cdc.gov/std/prevention); and maintains a compendium of evidence-based behavioral counseling interventions that have been shown to reduce STI acquisition or increase safer sexual behaviors (https://www.cdc.gov/hiv/research/interventionresearch/compendium/rr/complete.html).
- The Community Preventive Services Task Force has issued recommendations on preventing HIV, other STIs, and teen pregnancy and has described effective individual- and group-level community interventions for school-aged youth (https://www.thecommunityguide.org/findings/hiv-other-stis-and-teen-pregnancy-group-based-comprehensive-risk-reduction-interventions) and for men who have sex with men (https://www.thecommunityguide.org/findings/hiv-interventions-reduce-sexual-risk-behaviors-or-increase-protective-behaviors-prevent).
- The National Coalition of Sexually Transmitted Disease Directors and the National Alliance of State and Territorial AIDS Directors have developed optimal care checklists for clinicians serving male patients who have sex with men (https://www.ncsddc.org/wp-content/uploads/2017/08/provider_brochure2.pdf).
Additionally, the CDC provides the following resources on how to help persons experiencing sexual violence or sex trafficking:
- https://www.cdc.gov/violenceprevention/sexualviolence/index.html
- https://www.cdc.gov/violenceprevention/sexualviolence/resources.html
Other Related USPSTF Recommendations
The USPSTF has issued several recommendations about screening for STIs (chlamydia,27 gonorrhea,27 syphilis,28 HIV,29 HBV,30 and HPV31) and cervical cancer31 and offering preexposure prophylaxis to prevent HIV acquisition.32 The USPSTF has also issued a recommendation on screening for intimate partner violence and elder abuse.33
Update of Previous USPSTF Recommendation
In 2014, the USPSTF recommended intensive behavioral counseling (defined as total contact time of 30 minutes or more) to prevent STIs for all sexually active adolescents and for adults at increased risk for STIs (B recommendation).33 This updated recommendation statement is consistent with the 2014 USPSTF statement but slightly differs by recommending a broader range of effective counseling approaches, including those involving less than 30 minutes of total contact time. The USPSTF continues to conclude that the current evidence is lacking on the benefits and harms of behavioral counseling to prevent STIs in nonsexually active adolescents and in adults not at increased risk for STIs.
Rationale
Assessment
Importance
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
Magnitude of Net Benefits
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 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
Others
No information available.
