Based on the current evidence, the task force recommended behavioral counseling for all adolescents who are sexually active and for adults who are at increased risk for STIs. This is a "B" recommendation.
"By providing behavioral counseling interventions to those at risk for STIs, clinicians can make a real difference for their patients," said USPSTF Chair Alex Krist, M.D., M.P.H., in a news release. "If these interventions are provided widely, this counseling has the potential to reduce STI rates by approximately a third."
The CDC estimates that 20 million new STIs occur in the United States each year, with half of these infections occurring in adolescents and young adults ages 15-24. Family physicians and other clinicians are often the first point of contact for patients when discussing STIs; the Jan. 3, 2020, CDC Morbidity and Mortality Weekly Report cited previous research indicating that up to half of all primary care clinicians routinely screen patients for these types of infections.
The final recommendation statement aligns with the task force's December 2019 draft recommendation statement, but differs slightly from its September 2014 recommendation on the topic, which the AAFP supported at the time.
In the 2014 recommendation, the agency recommended intensive behavioral counseling, defined as total contact time of at least 30 minutes, to prevent STIs.
To update the previous recommendation, the USPSTF commissioned a systematic literature review that examined the effectiveness of behavioral counseling interventions in reducing STIs, related morbidity and mortality, or other health outcomes; the effectiveness of such interventions in decreasing risky sexual behaviors or increasing protective behaviors; and potential harms associated with these interventions. The review included studies from the task force's previous review, along with additional studies published between January 2013 and June 2018.
The task force concluded that there are effective behavioral counseling interventions to prevent STIs by helping individuals increase condom use and reduce sexual risk behaviors.
While intensive group counseling and individual counseling interventions were found to be effective in some patient populations (such as young women at increased risk for STIs based on socioeconomic or racial/ethnic characteristics), the review also found modest benefits for less intensive approaches, especially when they were tested among individuals who presented to STI clinics or had a recent history of STI.
The task force noted that the review did not include behavioral counseling interventions that could not be provided in or referred from primary care, meaning that certain types of interventions (such as community-level interventions, school-based interventions and others that took place within established social networks) were not included. Nevertheless, the task force concluded that for some populations at increased risk for STIs, there is clear evidence that behavioral counseling in primary care settings can improve sexual health.
The draft recommendation statement was posted for public comment on the USPSTF website from Dec. 17, 2019, through Jan. 21, 2020.
Several comments requested clarification about taking a sexual history and identifying which adults are considered at increased risk. In response, the task force added clarifying language to the Assessment of Risk section.
The task force also received comments that sought additional clarification on recommended interventions. Where appropriate, the USPSTF provided more details in the Behavioral Counseling Interventions section.
Finally, some commenters sought clearer guidance on how to provide counseling in situations in which sexual activity was not within the patient's control, such as cases involving sexual trafficking or abuse. In response, the task force added links to CDC resources that discuss how to help individuals who experience sexual violence or sex trafficking.
The AAFP's Commission on Health of the Public and Science plans to review the USPSTF's final recommendation statement and evidence summary and will then determine the Academy's stance on the recommendation.