Summary of Recommendation

The USPSTF recommends behavioral counseling for all sexually active adolescents and for adults who are at increased risk for sexually transmitted infections (STIs) (Table 1). B recommendation.

See the Practice Considerations section for more information on populations at increased risk for acquiring STIs.

Importance

Bacterial and viral STIs are common in the United States. Approximately 20 million new cases of bacterial or viral STIs occur each year in the United States, 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 STIs 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 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 2 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

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

STIs are transmitted through sexual activity and intimate physical contact. In the United States, common STIs with significant clinical and public health effects include HIV, herpes simplex virus, human papillomavirus, hepatitis B virus, Chlamydia trachomatis, Neisseria gonorrhoeae, 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.