Counseling during Primary Care Visits to Prevent Sexually Transmitted Infections: U.S. Preventive Services Task Force Recommendations

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The summary below is from the full reports titled "Behavioral Counseling to Prevent Sexually Transmitted Infections: U.S. Preventive Services Task Force Recommendation Statement" and "Behavioral Counseling to Prevent Sexually Transmitted Infections: A Systematic Review for the U.S. Preventive Services Task Force." They are in the 7 October 2008 issue of Annals of Internal Medicine (volume 149, pages 491-496 and pages 497-508). The first report was written by the U.S. Preventive Services Task Force; the second report was written by J.S. Lin, E. Whitlock, E. O'Connor, and V. Bauer.

Who developed these guidelines?

The U.S. Preventive Services Task Force (USPSTF) is a group of health experts that makes recommendations about preventive health care.

What is the problem and what is known about it so far?

Sexually transmitted infections (STIs), also known as sexually transmitted diseases (STDs) or venereal diseases, are infections transmitted through sexual contact. Common STIs include syphilis, gonorrhea, chlamydia, herpes, hepatitis C and hepatitis B, human papillomavirus, and HIV. Although great advances have been made in the prevention, detection, and treatment of STIs, these infections remain a common problem in the United States. "Safe sex" practices, such as using condoms, avoiding sexual contact while using alcohol or drugs, and limiting the number of sexual partners, can prevent STIs. The USPSTF wanted to determine whether counseling about safe sex during primary care doctor visits would be an effective way to decrease STIs in the United States.

How did the USPSTF develop these recommendations?

The USPSTF reviewed published research on counseling in primary care settings to prevent STIs to look at the benefits and harms of screening.

What did the authors find?

Good-quality studies showed that high-intensity counseling for sexually active adolescents and adults at high risk for STIs reduced the number of STIs at both 6 months and 1 year after counseling. The authors found no studies of STI counseling for adults not at high risk or for non–sexually active adolescents. The potential harms of counseling to the patient are low.

What does the USPSTF recommend that doctors and patients do?

The USPSTF recommends that doctors counsel people at high risk for STIs. People at high risk include all sexually active adolescents, adults with a history of STIs within the past year, and adults with multiple sexual partners.

Because of the lack of evidence, the USPSTF does not recommend for or against STI counseling for non–sexually active adolescents or adults who are not at high risk. However, the USPSTF noted that although the potential harms of counseling are low, the cost of intensive counseling in time and resources is high and these resources might be better spent on types of preventive care that are known to improve health.

What are the cautions related to these recommendations?

The recommendations may change as new studies become available. However, the USPSTF has judged that it would take large, high-quality studies to overturn the recommendation supporting counseling for people at high risk.