USPSTF finalizes recommendation for STI behavioral counseling

The U.S. Preventive Service Task Force recommends that physicians provide behavioral counseling to all sexually active adolescents and adults who are at an increased risk for contracting an STI.

The task force’s final recommendation comes after the draft recommendation was released in December 2019.

“Approximately 20 million new cases of bacterial or viral STIs occur each year in the US, and about one-half of these cases occur in persons aged 15 to 24 years,” the task force said in the full recommendation published in JAMA. “Rates of chlamydial, gonococcal, and syphilis infection continue to increase in all regions.”

Sexually active adolescents are at an increased risk for STIs due to high rates of these infections among this age group, and therefore should receive behavioral counseling interventions, the task force said.

According to the USPSTF, adults are considered at an increased risk for STIs if they already have an STI, if they do not use condoms consistently, have multiple sex partners or have sex with partners in populations that have a high prevalence of STIs.

The task force recommends that physicians routinely ask patients for relevant information about their sexual history to determine if they should receive behavioral interventions, including in-person counseling, video, written materials, phone support and text messages.

They said the most successful intervention approaches provide information about common STIs and transmission, assess patients’ risk for STIs, aim to motivate or get patients to commit to safer sex, train patients to discuss safe sex practices, use condoms and problem solve.

The recommendation is consistent with the task force’s previous statement in 2014, but permits a broader range of counseling approaches, including some that involve less than the 30 minutes of contact time suggested in the previous recommendation.

“Primary care clinicians can deliver in-person behavioral counseling interventions, refer patients to behavioral counseling interventions in other settings, or inform patients about media-based interventions,” they wrote.

The USPSTF recommendation comes at a “crucial moment,” Jeanne Marrazzo, MD, MPH, director of the division of infectious diseases at University of Alabama at Birmingham School of Medicine and Infectious Diseases News editorial board member, and Ina Park, MD, MS, associate professor of family community medicine in the School of Medicine at the University of California, San Francisco, wrote in an accompanying editorial.

They said the ongoing COVID-19 pandemic has “overshadowed” the focus on STIs, and difficulty accessing sexual health services during the pandemic could potentially worsen the current STI crisis.

Marrazzo and Park noted that USPSTF’s focus on shorter interventions is key to implementing the recommendations.

“If time during the clinical encounter is lacking, even a few minutes of meaningful, caring conversation with a patient may be as effective as a longer formal counseling session, particularly around intimate sexual health issues,” they wrote. “At a minimum, a brief conversation can facilitate future discussion and engagement in behavioral counseling.”

References:

Kristi AH, et al. JAMA. 2020;doi:10.1001/jama.2020.13095.

Marrazzo J, et al. JAMA. 2020;doi:10.1001/jama.2020.12324.