USPSTF issues recommendations on preventing STIs

The U.S. Preventive Services Task Force (USPSTF) issued a new recommendation this week on reducing risky sexual behavior in teens and adults at risk for sexually transmitted infections (STIs), as well as updated screening recommendations for chlamydia and gonorrhea in young, sexually active women.

Both recommendation statements and the supporting evidence reviews were published online Sept. 22 by Annals of Internal Medicine and are available free of charge online.

The recommendation on reducing risky sexual behavior were based on a systematic review of the benefits and harms of behavioral counseling in primary care for reducing STIs in adolescents and adults. Seven trials and 19 trials reported STI outcomes in adolescents and adults, respectively, and 6 trials and 21 trials reported sexual behavioral outcomes, respectively. The review found that intensity of counseling was the most important factor in predicting effect and that high-intensity interventions, defined as those involving contact time of at least 2 hours, yielded the most benefit.

The Task Force recommended intensive behavioral counseling for all sexually active adolescents and for adults who are at increased risk for STIs, such as those who have multiple sex partners and those who do not use condoms consistently. This is a grade B recommendation, meaning that there is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial.

The recommendations on screening for chlamydia and gonorrhea were based on an updated review of the literature that included trials published since the Task Force's previous recommendations in 2005 and 2007. The review examined accuracy of screening tests, as well as effectiveness of early detection and treatment. One good-quality trial examined screening for chlamydia in a subset of asymptomatic young women, one observational study evaluated a risk prediction tool for identifying high-risk patients with chlamydia, and 10 fair-quality studies examined diagnostic accuracy of screening tests.

The review concluded that screening for chlamydia in young women may reduce the incidence of pelvic inflammatory disease and that nucleic acid amplification tests accurately diagnose gonorrhea and chlamydia in asymptomatic people. On the basis of these findings, the Task Force recommended screening for chlamydia and gonorrhea in sexually active women 24 years of age or younger and in older women who are at increased risk for infection. These are grade B recommendations. The USPSTF also stated that current evidence is insufficient to assess the balance of benefits and harms of screening for chlamydia and gonorrhea in men.