Sexually Transmitted Infections: Recommendations from the U.S. Preventive Services Task Force

 

Am Fam Physician. 2016 Dec 1;94(11):907-915.

  Patient information: A handout on this topic is available at http://familydoctor.org/familydoctor/en/diseases-conditions/sexually-transmitted-infections.html.

Author disclosure: No relevant financial affiliations

The U.S. Preventive Services Task Force (USPSTF) has issued recommendations on behavioral counseling to prevent sexually transmitted infections (STIs) and recommendations about screening for individual STIs. Clinicians should obtain a sexual history to assess for behaviors that increase a patient's risk. Community and population risk factors should also be considered. The USPSTF recommends intensive behavioral counseling for all sexually active adolescents and for adults whose history indicates an increased risk of STIs. These interventions can reduce STI acquisition and risky sexual behaviors, and increase condom use and other protective behaviors. The USPSTF recommends screening for chlamydia and gonorrhea in all sexually active women 24 years and younger, and in older women at increased risk. It recommends screening for human immunodeficiency virus (HIV) infection in all patients 15 to 65 years of age regardless of risk, as well as in younger and older patients at increased risk of HIV infection. The USPSTF also recommends screening for hepatitis B virus infection and syphilis in persons at increased risk. All pregnant women should be tested for hepatitis B virus infection, HIV infection, and syphilis. Pregnant women 24 years and younger, and older women with risk factors should be tested for gonorrhea and chlamydia. The USPSTF recommends against screening for asymptomatic herpes simplex virus infection. There is inadequate evidence to determine the optimal interval for repeat screening; clinicians should rescreen patients when their sexual history reveals new or persistent risk factors.

The Centers for Disease Control and Prevention estimates that 20 million new cases of sexually transmitted infections (STIs) occur each year in the United States.1 STIs are often asymptomatic, which can lead to inadvertent transmission of these infections.2 Undiagnosed and untreated STIs can cause serious complications and adverse health outcomes, including death.

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SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

Provide or refer for intensive behavioral counseling in all sexually active adolescents (regardless of risk) and in adults who are at increased risk of sexually transmitted infection.

B

8

Screen for chlamydia and gonorrhea in sexually active nonpregnant female adolescents and adults 24 years and younger, and in older women who are at increased risk.

B

3

Screen for HIV infection in adolescents and adults 15 to 65 years of age. Younger adolescents and older adults who are at increased risk should also be screened.

A

6

Screen all pregnant women for syphilis, hepatitis B virus, and HIV infections.

A

6, 9, 10

Screen for chlamydia and gonorrhea in all pregnant women 24 years and younger, and in older women who are at increased risk.

B

3

Screen for syphilis, HIV infection, and hepatitis B in men and women at increased risk.

A

57


HIV = human immunodeficiency virus.

A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

Provide or refer for intensive behavioral counseling in all sexually active adolescents (regardless of risk) and in adults who are at increased risk of sexually transmitted infection.

B

8

Screen for chlamydia and gonorrhea in sexually active nonpregnant female adolescents and adults 24 years and younger, and in older women who are at increased risk.

B

3

Screen for HIV infection in adolescents and adults 15 to 65 years of age. Younger adolescents and older adults who are at increased risk should also be screened.

A

6

Screen all pregnant women for syphilis, hepatitis B virus, and HIV infections.

A

6, 9, 10

Screen for chlamydia and gonorrhea in all pregnant women 24 years and younger, and in older women who are at increased risk.

B

3

Screen for syphilis, HIV infection, and hepatitis B in men and women at increased risk.

A

57


HIV = human immunodeficiency virus.

A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.

This article provides an overview of current recommendations from the U.S. Preventive Services Task Force (USPSTF) on behavioral counseling and screening for STIs. In addition to its general recommendations on counseling about prevention, the USPSTF has issued recommendations on screening for individual STIs, including chlamydia, gonorrhea, herpes, hepatitis B virus (HBV) infection, human immunodeficiency virus (HIV) infection, and syphilis.37  These recommendations, which pertain to adult men and women, adolescents, and

The Authors

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KAREN C. LEE, MD, MPH, was a medical officer for the Task Force Program at the Agency for Healthcare Research and Quality, Rockville, Md., at the time this article was written. She is currently affiliated with the National Institutes of Health, which was not involved with this effort....

QUYEN NGO-METZGER, MD, MPH, is scientific director for the Task Force Program at the Agency for Healthcare Research and Quality.

TRACY WOLFF, MD, MPH, is associate scientific director for the Task Force Program at the Agency for Healthcare Research and Quality.

JOYA CHOWDHURY, MPH, is senior coordinator for the Task Force Program at the Agency for Healthcare Research and Quality.

MICHAEL L. LEFEVRE, MD, MSPH, is immediate past chair of the U.S. Preventive Services Task Force and is a Future of Family Medicine professor at the University of Missouri School of Medicine, Columbia.

DAVID S. MEYERS, MD, is chief medical officer at the Agency for Healthcare Research and Quality.

Author disclosure: No relevant financial affiliations

Address correspondence to Quyen Ngo-Metzger, MD, MPH, AHRQ, 5600 Fishers Ln., Rockville, MD 20857 (e-mail: quyen.ngo-metzger@ahrq.hhs.gov). Reprints are not available from the authors.

REFERENCES

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