Putting Prevention into Practice

An Evidence-Based Approach

Behavioral Counseling to Prevent Sexually Transmitted Infections

Am Fam Physician. 2010 Mar 15;81(6):765-766.

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This clinical content conforms to AAFP criteria for evidence-based continuing medical education (EB CME). See CME Quiz on page 709.

Case Study

A.B. is a 16-year-old girl who comes to your office for a sports physical examination. She tells you that since seeing you last year, she has become sexually active with a boy at her school.

Case Study Questions

  1. What additional information is needed to classify A.B. as at increased risk of sexually transmitted infections (STIs)?

    • A. None. A.B.'s age and sexual activity put her at increased risk.

    • B. Whether A.B. and her sex partner are using barrier contraceptives to avoid STIs.

    • C. Whether A.B. has more than one sex partner.

    • D. The rate of STIs in A.B.'s community.

    • E. The age at which A.B. first became sexually active.

  2. You determine that A.B. is at increased risk of STIs and offer the appropriate screening tests. Which one of the following is consistent with the U.S. Preventive Services Task Force (USPSTF) recommendation on behavioral counseling to prevent STIs?

    • A. Giving A.B. a brochure and brief advice about the proper use of barrier contraceptives.

    • B. Providing abstinence-only counseling.

    • C. Scheduling two or more follow-up appointments with a social worker so A.B. may receive intensive behavioral counseling on STI prevention.

    • D. Providing A.B. with a prescription for birth control.

    • E. Providing a follow-up telephone counseling session.

  3. A.B.'s 50-year-old mother, who is also your patient, comes to your office for a routine visit. Which of the following would classify her as being at increased risk of STIs?

    • A. She was treated for a chlamydial infection three years ago.

    • B. She has had six sex partners in her lifetime.

    • C. She has had vaginal intercourse with two men in the past month.

    • D. She lives in a community with a high rate of STIs and is in a nonmonogamous relationship.

Answers

  1. The correct answer is A. The USPSTF states that all sexually active adolescents are at increased risk of STIs and should be offered behavioral counseling to prevent STIs.

  2. The correct answer is C. The USPSTF recommends high-intensity behavioral counseling for adolescents at increased risk of STIs. High-intensity behavioral counseling includes multiple sessions in primary care settings or group settings in the community. Strong links between the primary care setting and the community may improve the delivery of counseling services.

    The USPSTF found no studies of abstinence-only counseling programs for the prevention of STIs.

  3. The correct answers are C and D. The USPSTF recommends offering high-intensity behavioral counseling to prevent STIs in adults at increased risk of infection. Those adults at increased risk are:

    • Adults with current STIs or who have had STIs in the past year

    • Adults who have multiple current sex partners

    • All sexually active patients in nonmonogamous relationships, if the practice's population has a high rate of STIs.

The USPSTF also recommends screening for STIs in patients at increased risk. Recommendations for screening for STIs can be found at http://www.preventiveservices.ahrq.gov.

SOURCES

U.S. Preventive Services Task Force. Behavioral counseling to prevent sexually transmitted infections: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2008;149(7):491–496,W95.

Lin JS, Whitlock E, O'Connor E, Bauer V. Behavioral counseling to prevent sexually transmitted infections: a systematic review for the U. S. Preventive Services Task Force. Ann Intern Med. 2008;149(7):497–508,W96–W99.

The case study and answers to the questions on behavioral counseling to prevent sexually transmitted infections are based on the recommendations of the U.S. Preventive Services Task Force (USPSTF), an independent panel of experts in primary care and prevention that systematically reviews the evidence of effectiveness and develops recommendations for clinical preventive services. More detailed information on this subject is available in the USPSTF Recommendation Statement and the evidence synthesis on the USPSTF Web site (http://www.ahrq.gov/clinic/uspstfix.htm). The practice recommendations in this activity are available at http://www.ahrq.gov/clinic/uspstf/uspsstds.htm.


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