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Clinical Guidelines |

Behavioral Counseling Interventions to Prevent Sexually Transmitted Infections: U.S. Preventive Services Task Force Recommendation StatementBehavioral Counseling Interventions to Prevent STIs FREE

Michael L. LeFevre, MD, MSPH, on behalf of the U.S. Preventive Services Task Force*
[+] Article, Author, and Disclosure Information

* For a list of USPSTF members, see the Appendix.

This article was published online first at www.annals.org on 23 September 2014.


From the U.S. Preventive Services Task Force, Rockville, Maryland.

Disclaimer: Recommendations made by the USPSTF are independent of the U.S. government. They should not be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.

Financial Support: The USPSTF is an independent, voluntary body. The U.S. Congress mandates that the Agency for Healthcare Research and Quality support the operations of the USPSTF.

Disclosures: Dr. Owens reports nonfinancial support for travel during the conduct of the study. Authors not named here have disclosed no conflicts of interest. Authors followed the policy regarding conflicts of interest described at www.uspreventiveservicestaskforce.org/methods.htm. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M14-1965.

Requests for Single Reprints: Reprints are available from the USPSTF Web site (www.uspreventiveservicestaskforce.org).


Ann Intern Med. 2014;161(12):894-901. doi:10.7326/M14-1965
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Description: Update of the U.S. Preventive Services Task Force (USPSTF) 2008 recommendation on behavioral counseling interventions to prevent sexually transmitted infections (STIs).

Methods: The USPSTF reviewed the evidence on behavioral counseling for sexual risk reduction in primary care, including interventions targeting risky sexual behaviors to prevent STIs (alone or in combination with other behaviors) in persons of any sexual orientation or level of reported sexual activity.

Population: This recommendation applies to all sexually active adolescents and to adults who are at increased risk for acquiring or transmitting STIs.

Recommendation: The USPSTF recommends intensive behavioral counseling for all sexually active adolescents and for adults who are at increased risk for STIs. (B recommendation)


The U.S. Preventive Services Task Force (USPSTF) makes recommendations about the effectiveness of specific preventive care services for patients without related signs or symptoms.

It bases its recommendations on the evidence of both the benefits and harms of the service and an assessment of the balance. The USPSTF does not consider the costs of providing a service in this assessment.

The USPSTF recognizes that clinical decisions involve more considerations than evidence alone. Clinicians should understand the evidence but individualize decision making to the specific patient or situation. Similarly, the USPSTF notes that policy and coverage decisions involve considerations in addition to the evidence of clinical benefits and harms.

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

See the Clinical Considerations section for a description of high-risk populations.

See the Figure for a summary of the recommendation and suggestions for clinical practice.

Grahic Jump Location
Figure.

Behavioral counseling interventions to prevent sexually transmitted infections: clinical summary of U.S. Preventive Services Task Force recommendation.

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Appendix Table 1 describes the USPSTF grades, and Appendix Table 2 describes the USPSTF classification of levels of certainty about net benefit.

Table Jump PlaceholderAppendix Table 1. What the USPSTF Grades Mean and Suggestions for Practice 
Table Jump PlaceholderAppendix Table 2. USPSTF Levels of Certainty Regarding Net Benefit 
Importance

The Centers for Disease Control and Prevention (CDC) estimate that approximately 20 million new cases of STIs occur each year in the United States. Half of these cases occur in persons aged 15 to 24 years. Sexually transmitted infections are frequently asymptomatic, which leads persons to unknowingly transmit STIs to others. Serious sequelae of STIs include pelvic inflammatory disease, infertility, and cancer. Untreated STIs present during pregnancy or birth may cause harms to the infant, including perinatal infection, death, and serious physical and mental disabilities.

Recognition of Behavior

Primary care clinicians can identify adolescents and adults who are at increased risk for STIs. See the Clinical Considerations section for more information.

Benefits of Behavioral Counseling Interventions

The USPSTF found adequate evidence that intensive behavioral counseling interventions reduce the likelihood of STIs in sexually active adolescents and in adults who are at increased risk. The USPSTF determined that this benefit is of moderate magnitude. The USPSTF also found adequate evidence that intensive interventions reduce risky sexual behaviors and increase the likelihood of condom use and other protective sexual practices.

Harms of Behavioral Counseling Interventions

The USPSTF found adequate evidence that the harms of behavioral interventions to reduce the likelihood of STIs are small at most. The primary harm is the opportunity cost associated with intensive behavioral counseling interventions.

USPSTF Assessment

The USPSTF concludes with moderate certainty that intensive behavioral counseling interventions reduce the likelihood of STIs in sexually active adolescents and in adults who are at increased risk, resulting in a moderate net benefit.

Patient Population Under Consideration

This recommendation applies to all sexually active adolescents and to adults who are at increased risk for acquiring or transmitting STIs.

Assessment of Risk

All sexually active adolescents are at increased risk for STIs and should be counseled. Other risk groups that have been included in counseling studies are adults with current STIs or other infections within the past year, adults who have multiple sex partners, and adults who do not consistently use condoms.

Clinicians should be aware of populations with a particularly high prevalence of STIs. African Americans have the highest STI prevalence of any racial/ethnic group, and prevalence is higher in American Indians, Alaska Natives, and Latinos than in white persons. Increased STI prevalence rates are also found in men who have sex with men (MSM), persons with low incomes living in urban settings, current or former inmates, military recruits, persons who exchange sex for money or drugs, persons with mental illness or a disability, current or former intravenous drug users, persons with a history of sexual abuse, and patients at public STI clinics.

Behavioral Counseling Interventions

Behavioral counseling interventions can reduce a person's likelihood of acquiring an STI. Interventions ranging in intensity from 30 minutes to 2 or more hours of contact time are beneficial. Evidence of benefit increases with intervention intensity. High-intensity counseling interventions (defined in the review as contact time of ≥2 hours) were the most effective, moderate-intensity interventions (defined as 30 to 120 minutes) were less consistently beneficial, and low-intensity interventions (defined as <30 minutes) were the least effective. Interventions can be delivered by primary care clinicians or through referral to trained behavioral counselors.

Most successful approaches provided basic information about STIs and STI transmission; assessed the person's risk for transmission; and provided training in pertinent skills, such as condom use, communication about safe sex, problem solving, and goal setting. Many successful interventions used a targeted approach to the age, sex, and ethnicity of the participants and also aimed to increase motivation or commitment to safe sex practices. Intervention methods included face-to-face counseling, videos, written materials, and telephone support. The USPSTF did not find enough evidence to determine whether the following intervention characteristics were related independently to effectiveness: degree of cultural tailoring, group versus individual format, condom negotiation or other communication as an intervention component, counselor characteristics, setting, or type of control group.

Additional Approaches to Prevention

The CDC provides information about STI prevention, testing, and resources at www.cdc.gov/std/prevention/default.htm. It recommends that health care providers inform patients on how to reduce their risk for STI transmission, including abstinence, correct and consistent condom use, and limiting the number of sex partners. The CDC also maintains an inventory of efficacious interventions in the “Compendium of Evidence-Based HIV Behavioral Interventions” (available at www.cdc.gov/hiv/prevention/research/compendium).

The Community Preventive Services Task Force has issued several recommendations on the prevention of HIV/AIDS, other STIs, and teen pregnancy. The Community Guide discusses interventions that have been effective in school settings and for MSM (available at www.thecommunityguide.org/hiv/index.html).

The CDC Advisory Committee on Immunization Practices has issued recommendations on the control of vaccine-preventable diseases, including hepatitis B and human papillomavirus (available at www.cdc.gov/vaccines/hcp/acip-recs/index.html).

The National Coalition of Sexually Transmitted Disease Directors and the National Alliance of State and Territorial AIDS Directors developed optimal care checklists for health providers of MSM (available at www.ncsddc.org/publications/optimal-care-checklists-providers-msm-patients).

Useful Resources

The USPSTF has issued several recommendations related to screening for STIs, including chlamydia and gonorrhea, hepatitis B, genital herpes, HIV, and syphilis. These recommendations can be found at www.uspreventiveservicestaskforce.org.

Implementation

Intensive behavioral counseling may be delivered in primary care settings or other sectors of the health care system. This may require referral from the primary care clinician or system. In addition, risk-reduction counseling may be offered by community organizations, schools, and health departments or their affiliated STI clinics. Despite the seriousness and prevalence of STIs, primary care clinicians often do not provide counseling about sexual activity, contraception, or STIs during routine periodic health examinations or other health care visits, and many believe that counseling is ineffective. Surveys examining STI counseling by primary care clinicians have found wide variations in practice (1). Stronger linkages between the primary care setting and the community may greatly improve the delivery of this service.

Providers should select behavioral counseling interventions on the basis of their effectiveness, appropriateness to the patient population, and feasibility of implementation. Examples of effective behavioral counseling interventions are described in the Table.

Table Jump PlaceholderTable. Examples of Behavioral Counseling Interventions for STIs 
Research Needs and Gaps

Most of the studies identified by the USPSTF were in high-risk populations of adults or sexually active girls. Research on interventions that reduce risk for STIs in sexually active boys, prevent STIs in younger adolescents who are not yet sexually active, and reduce risk for STIs in older adults are needed. More data are needed from trials including both sexes and other broad-based interventions that could be implemented in or linked to primary care. The effectiveness of low-intensity interventions that are more practical in the typical primary care setting is another research gap. Promising approaches have been identified that need replication.

Burden of Disease

According to the CDC, approximately 20 million new cases of STIs occur each year in the United States, and half of these cases occur in persons aged 15 to 24 years (8). A 2009 nationally representative survey found that STI prevalence (not including HIV) was 24.1% among female adolescents aged 14 to 19 years and 37.7% in those who were sexually active (9). In 2010, the inflation-adjusted annual direct medical costs of STIs (including HIV) were an estimated $16.9 billion in the United States (10). According to the CDC, STI incidence rates are consistently 8 or more times higher in African Americans than white persons (11), and African American youth accounted for 57% of all new HIV infections among persons aged 13 to 24 years in 2009 (12).

Scope of Review

To update its 2008 recommendation, the USPSTF commissioned a systematic review (1, 13) of the benefits and harms of behavioral counseling for sexual risk reduction in primary care to prevent STIs in adolescents and adults. The review included randomized, controlled trials and nonrandomized, controlled clinical trials of interventions targeting risky sexual behaviors to prevent STIs (alone or in combination with other behaviors) in adults and adolescents (including pregnant women) of any sexual orientation or level of reported sexual activity.

The review included studies that were conducted in, or recruited participants from, primary care settings, mental health clinics, reproductive health clinics (including STI clinics), or broader health care systems in developed countries. Included studies reported health outcomes (STI incidence or related illness), behavioral outcomes (changes in sexual behavior), or adverse effects of sexual risk-reduction counseling (for example, care avoidance, shame, guilt, or stigma). Included studies had to have at least 3 months of postbaseline follow-up for all outcomes except harms. High-, moderate-, and low-intensity interventions were defined as having contact time of more than 2 hours, 30 minutes up to 2 hours, and less than 30 minutes, respectively.

Effectiveness of Counseling to Change Outcomes and Behavior

In adolescents, 7 trials (23, 1418) with 8 treatment groups (n = 3407) reported STI outcomes. Incidence of STIs decreased in all 8 comparisons, although results were not statistically significant in 2 trials. Pooled results showed a 62% reduction in the odds of acquiring an STI after 12 months with high-intensity counseling (odds ratio [OR], 0.38 [95% CI, 0.24 to 0.60]; I2 = 65%; k = 5) and a 43% reduction with the 2 moderate-intensity interventions (OR, 0.57 [CI, 0.37 to 0.86]; I2 = 0%). In all trials, most participants were not white, and most trials were limited to female participants.

In adolescents, 6 trials (2, 14, 16, 1820) (n = 3030) reported sexual behavioral outcomes. Interventions yielded benefit in 3 of 5 trials reporting effects on condom use or unprotected sex and 4 of 5 trials reporting other sexual behavior outcomes (for example, number of sex partners or use of birth control).

In adults, 19 trials (35, 15, 18, 2134) (n = 61 909) reported STI outcomes, 4 of which had multiple treatment groups with varying intervention intensity. High-intensity interventions resulted in a 30% reduction in the odds of acquiring an STI (OR, 0.70 [CI, 0.56 to 0.87]; I2 = 23%; k = 9). The pooled effects from trials of low- and moderate-intensity interventions did not show a reduction in the odds of acquiring an STI. However, 2 low- and 2 moderate-intensity interventions proved effective in preventing STIs (4, 24). For example, 1 large (n = 40 282), good-quality randomized, controlled trial (24) created a 23-minute video, “Safe in the City,” that participants watched in the waiting rooms of STI clinics. The video covered basic information on HIV and STI risk and prevention and attempted to build condom use skills along with self-efficacy and positive attitudes for condom use. Vignettes of young couples of various races, ethnicities, and sexual orientations demonstrated communication about partner notification and the acquisition, negotiation, and use of condoms. This trial found a small but statistically significant reduction in the proportion of participants with an STI. After an average of almost 15 months, 4.9% of intervention participants had an STI compared with 5.7% of control group participants (adjusted hazard ratio, 0.91 [CI, 0.84 to 0.99]; unadjusted OR, 0.85 [CI, 0.73 to 0.99]), which represents a number needed to treat of 123 (CI, 68 to 1859). Planned subgroup analyses revealed that the effect was statistically significant for men (adjusted hazard ratio, 0.88 [CI, 0.80 to 0.98]) but not for women (adjusted hazard ratio, 1.02 [CI, 0.86 to 1.21]).

In adults, 21 trials reporting sexual behavioral outcomes yielded mixed results, but high-intensity interventions were fairly consistent in reporting beneficial results. In a meta-analysis of 9 trials (with 11 comparisons) (3, 21, 23, 2829, 3437) reporting condom use or related outcomes, the odds of condom use increased by 29% with high-intensity interventions (OR, 1.29 [CI, 1.13 to 1.48]; I2 = 0%; k = 4) and by 21% with moderate-intensity interventions (OR, 1.21 [CI, 1.00 to 1.46]; I2 = 28%; k = 4).

The USPSTF evaluated variations in treatment effect for different population characteristics. Trials and subgroup analyses targeting adolescents were highly likely to be effective, with most showing at least a 50% decrease in the odds of acquiring an STI after behavioral counseling. The USPSTF found no consistent evidence of differential effectiveness by sex or race/ethnicity. The USPSTF also found no evidence of differential effectiveness associated with low-income setting; mental illness; or history of sexual, physical, or intimate partner abuse. However, these groups were poorly represented in available studies. Some subpopulations were also poorly represented, such as low-risk populations, adolescent boys, MSM, and American Indians or Alaska Natives. Aside from the underrepresentation of important subpopulations, other limitations of the evidence review include reliance on self-reported behavioral outcomes and exclusion of comparative effectiveness studies.

The USPSTF also evaluated the effects of different intervention characteristics. Intensity was the most important factor; high-intensity interventions were most likely to be effective, moderate-intensity interventions were less consistently beneficial, and low-intensity interventions were least likely to be effective. Pooled effect estimates were similar for trials with a single session and those with more than 1 session. The USPSTF found no clear relationship between the effect size and degree of cultural tailoring, group versus individual format, condom negotiation or other communication as an intervention component, counselor characteristics, setting, or type of control group based on qualitative synthesis. The USPSTF could not isolate the importance of these features because they were not evenly distributed across the spectrum of intervention intensity or population risk.

Although most trials of low-intensity interventions did not show treatment benefit, 2 such trials effectively demonstrated reduced odds of acquiring an STI: 1 very large trial of a video-based intervention that was powered to detect a small effect (24) and the low-intensity group of a trial of African American women (4). In the latter trial, the intervention included a 20-minute individualized and culturally sensitive counseling session with trained African American nurse educators. Incidence of STIs was lower in both of the skill-based intervention groups at 12 months (14% [high-intensity] and 15% [low-intensity]) than in the control group (27%). The 2 skill-based intervention groups were not statistically different from the 2 information-based intervention groups (19% [high-intensity] and 22% [low-intensity]). Two (34) of the 4 trials that included high-intensity treatment counseling groups with low- or moderate-intensity groups were successful in reducing STI incidence in both groups and seemed to use the same interventionists for both treatment groups.

Potential Harms of Counseling

Two fair-quality studies (22, 32) and 1 good-quality trial (27) explicitly reported no adverse effects (n = 6837). No studies reported an overall paradoxical effect on the incidence of STIs. However, 1 study of risk-reduction counseling with rapid HIV testing showed a paradoxical, statistically significant increase in the incidence of STIs in MSM (18.7% in men who received behavioral counseling vs. 12.5% in men who received only HIV test results; adjusted risk ratio, 1.41 [98.3% CI, 1.05 to 1.90]) (27). The USPSTF found no consistent evidence that interventions increased sexual activity in adolescents.

Estimate of Magnitude of Net Benefit

The USPSTF concludes with moderate certainty that intensive behavioral counseling interventions reduce the likelihood of STIs in sexually active adolescents and in adults who are at increased risk, resulting in a moderate net benefit.

Response to Public Comments

A draft version of this recommendation statement was posted for public comment on the USPSTF Web site from 29 April to 26 May 2014. In response to public comments, the USPSTF clarified that the recommendation applies to all sexually active adolescents and to adults who are at increased risk for STIs. The USPSTF further clarified that persons diagnosed with an STI should be considered at increased risk for subsequent STIs. The revised recommendation provides more information about treatment factors other than intensity and expanded discussion of the limitations of the available evidence. In addition, the USPSTF offered more guidance for providers on implementation of this recommendation. The USPSTF also noted the need for more information from trials in both sexes and other broad-based interventions that could be implemented in or linked to primary care, as well as interventions to reduce risk for STIs in older Americans.

In 2008, the USPSTF recommended high-intensity behavioral counseling to prevent STIs for all sexually active adolescents and for adults who were at increased risk for STIs (B recommendation). At that time, the USPSTF also found that the evidence was insufficient to assess the balance of benefits and harms of behavioral counseling to prevent STIs in non–sexually active adolescents and in adults who were not at increased risk for STIs (I statement). This updated recommendation reaffirms that the evidence is adequate to recommend high-intensity behavioral counseling for persons who are at increased risk (including all sexually active adolescents) and recognizes that some interventions of lesser intensity are also effective.

The CDC recommends that all providers routinely obtain a sexual history from their patients and encourage risk reduction using various strategies (for example, prevention counseling) (38). It also recommends that HIV prevention counseling be offered and encouraged in all health care facilities that serve patients who are at high risk (for example, STI clinics) and persons living with HIV (39).

The American Congress of Obstetricians and Gynecologists recommends discussing contraception and STIs during the initial reproductive health visit for adolescent patients (40). It also recognizes that the annual well-woman visit provides an excellent opportunity to counsel patients about maintaining a healthy lifestyle and minimizing health risks. The visit should include screening, evaluation and counseling, and immunizations based on the patient's age and risk factors (41). In addition, applying principles of motivational interviewing (for example, prompting patients to use safe sex practices and more consistent contraception) to daily patient practices has proved effective in eliciting behavior change that contributes to positive health outcomes and improved patient–clinician communication (42). Comprehensive care, including prevention of STIs, is recommended for lesbian and bisexual patients (43); education about the risks for STIs and dispelling the perception that STI transmission between women is negligible will help these patients make informed decisions. All patients should be encouraged to use safe sex practices to reduce the risk for transmitting or acquiring STIs and HIV, such as using condoms on sex toys, gloves, and dental dams and avoiding sharing other sex paraphernalia (43). Several approaches (for example, gender-tailored and culturally appropriate interventions to reduce risk-taking behavior) can reduce the rate of HIV infection and optimize health in women of color (44). Practitioners should provide risk-reduction counseling to prevent STIs in women participating in noncoital activities (for example, mutual masturbation or anal sex) (45).

The Institute for Clinical Systems Improvement states that counseling on sexual behaviors to prevent STIs could be recommended beginning at age 12 years (46) and for higher-risk adults (47). The National Institute for Health and Care Excellence recommends one-on-one structured discussions with patients who are identified as high risk for STIs (if the health professional is trained in sexual health) or arranging these discussions with a trained practitioner (48). When appropriate, practitioners should provide one-on-one sexual advice about STI prevention and information on testing to persons younger than 18 years, including pregnant women and mothers. The American Academy of Family Physicians recommends intensive behavioral counseling for all sexually active adolescents and for adults who are at increased risk for STIs (49).

Appendix: U.S. Preventive Services Task Force

Members of the U.S. Preventive Services Task Force at the time this recommendation was finalized† are Michael L. LeFevre, MD, MSPH, Chair (University of Missouri School of Medicine, Columbia, Missouri); Albert L. Siu, MD, MSPH, Co-Vice Chair (Mount Sinai School of Medicine, New York, and James J. Peters Veterans Affairs Medical Center, Bronx, New York); Kirsten Bibbins-Domingo, PhD, MD, Co-Vice Chair (University of California, San Francisco, San Francisco, California); Linda Ciofu Baumann, PhD, RN (University of Wisconsin, Madison, Wisconsin); Susan J. Curry, PhD (University of Iowa College of Public Health, Iowa City, Iowa); Karina W. Davidson, PhD, MASc (Columbia University, New York, New York); Mark Ebell, MD, MS (University of Georgia, Athens, Georgia); Francisco A.R. García, MD, MPH (Pima County Department of Health, Tucson, Arizona); Matthew Gillman, MD, SM (Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts); Jessica Herzstein, MD, MPH (Air Products, Allentown, Pennsylvania); Alex R. Kemper, MD, MPH, MS (Duke University, Durham, North Carolina); Ann E. Kurth, PhD, RN, MSN, MPH (New York University, New York, New York); Douglas K. Owens, MD, MS (Veterans Affairs Palo Alto Health Care System, Palo Alto, and Stanford University, Stanford, California); William R. Phillips, MD, MPH (University of Washington, Seattle, Washington); Maureen G. Phipps, MD, MPH (Brown University, Providence, Rhode Island); and Michael P. Pignone, MD, MPH (University of North Carolina, Chapel Hill, North Carolina).

† For a list of current Task Force members, go to www.uspreventiveservicestaskforce.org/members.htm.

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Wingood GM, Diclemente RJ, Robinson-Simpson L, Lang DL, Caliendo A, Hardin JW. Efficacy of an HIV intervention in reducing high-risk human papillomavirus, nonviral sexually transmitted infections, and concurrency among African American women: a randomized-controlled trial. J Acquir Immune Defic Syndr. 2013; 63 Suppl 1:S36-43.
PubMed
CrossRef
 
Carey MP, Carey KB, Maisto SA, Gordon CM, Schroder KE, Vanable PA. Reducing HIV-risk behavior among adults receiving outpatient psychiatric treatment: results from a randomized controlled trial. J Consult Clin Psychol. 2004; 72:252-68.
PubMed
CrossRef
 
Marion LN, Finnegan L, Campbell RT, Szalacha LA. The Well Woman Program: a community-based randomized trial to prevent sexually transmitted infections in low-income African American women. Res Nurs Health. 2009; 32:274-85.
PubMed
CrossRef
 
Shain RN, Piper JM, Holden AE, Champion JD, Perdue ST, Korte JE, et al. Prevention of gonorrhea and chlamydia through behavioral intervention: results of a two-year controlled randomized trial in minority women. Sex Transm Dis. 2004; 31:401-8.
PubMed
CrossRef
 
Boyer CB, Barrett DC, Peterman TA, Bolan G. Sexually transmitted disease (STD) and HIV risk in heterosexual adults attending a public STD clinic: evaluation of a randomized controlled behavioral risk-reduction intervention trial. AIDS. 1997; 11:359-67.
PubMed
CrossRef
 
Proude EM, D'Este C, Ward JE. Randomized trial in family practice of a brief intervention to reduce STI risk in young adults. Fam Pract. 2004; 21:537-44.
PubMed
CrossRef
 
Wenger NS, Greenberg JM, Hilborne LH, Kusseling F, Mangotich M, Shapiro MF. Effect of HIV antibody testing and AIDS education on communication about HIV risk and sexual behavior. A randomized, controlled trial in college students. Ann Intern Med. 1992; 117:905-11.
CrossRef
 
Cianelli R, Ferrer L, Norr KF, Miner S, Irarrazabal L, Bernales M, et al. Mano a Mano-Mujer: an effective HIV prevention intervention for Chilean women. Health Care Women Int. 2012; 33:321-41.
PubMed
CrossRef
 
Workowski KA, Berman S, Centers for Disease Control and Prevention (CDC). Sexually transmitted diseases treatment guidelines, 2010. MMWR Recomm Rep. 2010; 59:1-110.
PubMed
 
Centers for Disease Control and Prevention (CDC). HIV infection among heterosexuals at increased risk—United States, 2010. MMWR Morb Mortal Wkly Rep. 2013; 62:183-8.
PubMed
 
Committee Opinion No. 460: the initial reproductive health visit. Obstet Gynecol. 2010; 116:240-3.
PubMed
CrossRef
 
Committee on Gynecologic Practice. Committee Opinion No. 534: well-woman visit. Obstet Gynecol. 2012; 120:421-4.
PubMed
CrossRef
 
ACOG Committee Opinion No. 423: motivational interviewing: a tool for behavioral change. Obstet Gynecol. 2009; 113:243-6.
PubMed
CrossRef
 
ACOG Committee on Health Care for Underserved Women. ACOG Committee Opinion No. 525: health care for lesbians and bisexual women. Obstet Gynecol. 2012; 119:1077-80.
PubMed
CrossRef
 
Committee on Health Care for Underserved Women, The American College of Obstetricians and Gynecologists. ACOG Committee Opinion No. 536: human immunodeficiency virus and acquired immunodeficiency syndrome and women of color. Obstet Gynecol. 2012; 120:735-9.
PubMed
CrossRef
 
Committee on Adolescent Health Care. Committee Opinion No. 582: addressing health risks of noncoital sexual activity. Obstet Gynecol. 2013; 122:1378-82.
PubMed
CrossRef
 
Wilkinson J, Bass C, Diem S, Gravley A, Harvey L, Maciosek M, et al, Institute for Clinical Systems Improvement. Preventive services for children and adolescents. Bloomington, MN: Institute for Clinical Systems Improvement; 2013.
 
Wilkinson J, Bass C, Diem S, Gravley A, Harvey L, Maciosek M, et al, Institute for Clinical Systems Improvement. Preventive services for adults. Bloomington, MN: Institute for Clinical Systems Improvement; 2013.
 
National Institute for Health and Clinical Excellence. One to one interventions to reduce the transmission of sexually transmitted infections (STIs) including HIV, and to reduce the rate of under 18 conceptions, especially among vulnerable and at risk groups. London: National Institute for Health and Clinical Excellence; 2007.
 
American Academy of Family Physicians.  Recommendations by type: clinical preventive services. Leawood, KS: American Academy of Family Physicians; 2014. Accessed at www.aafp.org/patient-care/clinical-recommendations/cps.html on 14 August 2014.
 

Figures

Grahic Jump Location
Figure.

Behavioral counseling interventions to prevent sexually transmitted infections: clinical summary of U.S. Preventive Services Task Force recommendation.

Grahic Jump Location

Tables

Table Jump PlaceholderAppendix Table 1. What the USPSTF Grades Mean and Suggestions for Practice 
Table Jump PlaceholderAppendix Table 2. USPSTF Levels of Certainty Regarding Net Benefit 
Table Jump PlaceholderTable. Examples of Behavioral Counseling Interventions for STIs 

References

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DiClemente RJ, Wingood GM, Harrington KF, Lang DL, Davies SL, Hook EW 3rd, et al. Efficacy of an HIV prevention intervention for African American adolescent girls: a randomized controlled trial. JAMA. 2004; 292:171-9.
PubMed
CrossRef
 
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O'Donnell CR, O'Donnell L, San Doval A, Duran R, Labes K. Reductions in STD infections subsequent to an STD clinic visit. Using video-based patient education to supplement provider interactions. Sex Transm Dis. 1998; 25:161-8.
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Centers for Disease Control and Prevention.  CDC fact sheet: incidence, prevalence, and cost of sexually transmitted infections in the United States. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2013. Accessed at www.cdc.gov/std/stats/sti-estimates-fact-sheet-feb-2013.pdf on 4 September 2014.
 
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Chesson HW, Gift TL, Owusu-Edusei K Jr, Tao G, Johnson AP, Kent CK. A brief review of the estimated economic burden of sexually transmitted diseases in the United States: inflation-adjusted updates of previously published cost studies. Sex Transm Dis. 2011; 38:889-91.
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Centers for Disease Control and Prevention.  Sexually transmitted disease surveillance 2010. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2011. Accessed at www.cdc.gov/STD/stats10/default.htm on 4 September 2014.
 
Centers for Disease Control and Prevention (CDC). Vital signs: HIV infection, testing, and risk behaviors among youths - United States. MMWR Morb Mortal Wkly Rep. 2012; 61:971-6.
PubMed
 
O'Connor E, Lin JS, Burda BU, Henderson JT, Walsh ES, Whitlock EP. Behavioral sexual risk-reduction counseling in primary care to prevent sexually transmitted infections: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med. 2014; 161:874-83.
 
Boekeloo BO, Schamus LA, Simmens SJ, Cheng TL, O'Connor K, D'Angelo LJ. A STD/HIV prevention trial among adolescents in managed care. Pediatrics. 1999; 103:107-15.
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Kershaw TS, Magriples U, Westdahl C, Rising SS, Ickovics J. Pregnancy as a window of opportunity for HIV prevention: effects of an HIV intervention delivered within prenatal care. Am J Public Health. 2009; 99:2079-86.
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Jemmott JB 3rd, Jemmott LS, Braverman PK, Fong GT. HIV/STD risk reduction interventions for African American and Latino adolescent girls at an adolescent medicine clinic: a randomized controlled trial. Arch Pediatr Adolesc Med. 2005; 159:440-9.
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Champion JD, Collins JL. Comparison of a theory-based (AIDS Risk Reduction Model) cognitive behavioral intervention versus enhanced counseling for abused ethnic minority adolescent women on infection with sexually transmitted infection: results of a randomized controlled trial. Int J Nurs Stud. 2012; 49:138-50.
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Shain RN, Piper JM, Newton ER, Perdue ST, Ramos R, Champion JD, et al. A randomized, controlled trial of a behavioral intervention to prevent sexually transmitted disease among minority women. N Engl J Med. 1999; 340:93-100.
PubMed
CrossRef
 
Guilamo-Ramos V, Bouris A, Jaccard J, Gonzalez B, McCoy W, Aranda D. A parent-based intervention to reduce sexual risk behavior in early adolescence: building alliances between physicians, social workers, and parents. J Adolesc Health. 2011; 48:159-63.
PubMed
CrossRef
 
Danielson R, Marcy S, Plunkett A, Wiest W, Greenlick MR. Reproductive health counseling for young men: what does it do? Fam Plann Perspect. 1990; 22:115-21.
PubMed
CrossRef
 
Scholes D, McBride CM, Grothaus L, Civic D, Ichikawa LE, Fish LJ, et al. A tailored minimal self-help intervention to promote condom use in young women: results from a randomized trial. AIDS. 2003; 17:1547-56.
PubMed
CrossRef
 
Carey MP, Senn TE, Vanable PA, Coury-Doniger P, Urban MA. Brief and intensive behavioral interventions to promote sexual risk reduction among STD clinic patients: results from a randomized controlled trial. AIDS Behav. 2010; 14:504-17.
PubMed
CrossRef
 
Peipert JF, Redding CA, Blume JD, Allsworth JE, Matteson KA, Lozowski F, et al. Tailored intervention to increase dual-contraceptive method use: a randomized trial to reduce unintended pregnancies and sexually transmitted infections. Am J Obstet Gynecol. 2008; 198:630.
PubMed
CrossRef
 
Warner L, Klausner JD, Rietmeijer CA, Malotte CK, O'Donnell L, Margolis AD, et al, Safe in the City Study Group. Effect of a brief video intervention on incident infection among patients attending sexually transmitted disease clinics. PLoS Med. 2008; 5:e135.
PubMed
CrossRef
 
Marrazzo JM, Thomas KK, Ringwood K. A behavioural intervention to reduce persistence of bacterial vaginosis among women who report sex with women: results of a randomised trial. Sex Transm Infect. 2011; 87:399-405.
PubMed
CrossRef
 
Petersen R, Albright J, Garrett JM, Curtis KM. Pregnancy and STD prevention counseling using an adaptation of motivational interviewing: a randomized controlled trial. Perspect Sex Reprod Health. 2007; 39:21-8.
PubMed
CrossRef
 
Metsch LR, Feaster DJ, Gooden L, Schackman BR, Matheson T, Das M, et al. Effect of risk-reduction counseling with rapid HIV testing on risk of acquiring sexually transmitted infections: the AWARE randomized clinical trial. JAMA. 2013; 310:1701-10.
PubMed
CrossRef
 
Berenson AB, Rahman M. A randomized controlled study of two educational interventions on adherence with oral contraceptives and condoms. Contraception. 2012; 86:716-24.
PubMed
CrossRef
 
Crosby R, DiClemente RJ, Charnigo R, Snow G, Troutman A. A brief, clinic-based, safer sex intervention for heterosexual African American men newly diagnosed with an STD: a randomized controlled trial. Am J Public Health. 2009; 99 Suppl 1:S96-103.
PubMed
CrossRef
 
Wingood GM, Diclemente RJ, Robinson-Simpson L, Lang DL, Caliendo A, Hardin JW. Efficacy of an HIV intervention in reducing high-risk human papillomavirus, nonviral sexually transmitted infections, and concurrency among African American women: a randomized-controlled trial. J Acquir Immune Defic Syndr. 2013; 63 Suppl 1:S36-43.
PubMed
CrossRef
 
Carey MP, Carey KB, Maisto SA, Gordon CM, Schroder KE, Vanable PA. Reducing HIV-risk behavior among adults receiving outpatient psychiatric treatment: results from a randomized controlled trial. J Consult Clin Psychol. 2004; 72:252-68.
PubMed
CrossRef
 
Marion LN, Finnegan L, Campbell RT, Szalacha LA. The Well Woman Program: a community-based randomized trial to prevent sexually transmitted infections in low-income African American women. Res Nurs Health. 2009; 32:274-85.
PubMed
CrossRef
 
Shain RN, Piper JM, Holden AE, Champion JD, Perdue ST, Korte JE, et al. Prevention of gonorrhea and chlamydia through behavioral intervention: results of a two-year controlled randomized trial in minority women. Sex Transm Dis. 2004; 31:401-8.
PubMed
CrossRef
 
Boyer CB, Barrett DC, Peterman TA, Bolan G. Sexually transmitted disease (STD) and HIV risk in heterosexual adults attending a public STD clinic: evaluation of a randomized controlled behavioral risk-reduction intervention trial. AIDS. 1997; 11:359-67.
PubMed
CrossRef
 
Proude EM, D'Este C, Ward JE. Randomized trial in family practice of a brief intervention to reduce STI risk in young adults. Fam Pract. 2004; 21:537-44.
PubMed
CrossRef
 
Wenger NS, Greenberg JM, Hilborne LH, Kusseling F, Mangotich M, Shapiro MF. Effect of HIV antibody testing and AIDS education on communication about HIV risk and sexual behavior. A randomized, controlled trial in college students. Ann Intern Med. 1992; 117:905-11.
CrossRef
 
Cianelli R, Ferrer L, Norr KF, Miner S, Irarrazabal L, Bernales M, et al. Mano a Mano-Mujer: an effective HIV prevention intervention for Chilean women. Health Care Women Int. 2012; 33:321-41.
PubMed
CrossRef
 
Workowski KA, Berman S, Centers for Disease Control and Prevention (CDC). Sexually transmitted diseases treatment guidelines, 2010. MMWR Recomm Rep. 2010; 59:1-110.
PubMed
 
Centers for Disease Control and Prevention (CDC). HIV infection among heterosexuals at increased risk—United States, 2010. MMWR Morb Mortal Wkly Rep. 2013; 62:183-8.
PubMed
 
Committee Opinion No. 460: the initial reproductive health visit. Obstet Gynecol. 2010; 116:240-3.
PubMed
CrossRef
 
Committee on Gynecologic Practice. Committee Opinion No. 534: well-woman visit. Obstet Gynecol. 2012; 120:421-4.
PubMed
CrossRef
 
ACOG Committee Opinion No. 423: motivational interviewing: a tool for behavioral change. Obstet Gynecol. 2009; 113:243-6.
PubMed
CrossRef
 
ACOG Committee on Health Care for Underserved Women. ACOG Committee Opinion No. 525: health care for lesbians and bisexual women. Obstet Gynecol. 2012; 119:1077-80.
PubMed
CrossRef
 
Committee on Health Care for Underserved Women, The American College of Obstetricians and Gynecologists. ACOG Committee Opinion No. 536: human immunodeficiency virus and acquired immunodeficiency syndrome and women of color. Obstet Gynecol. 2012; 120:735-9.
PubMed
CrossRef
 
Committee on Adolescent Health Care. Committee Opinion No. 582: addressing health risks of noncoital sexual activity. Obstet Gynecol. 2013; 122:1378-82.
PubMed
CrossRef
 
Wilkinson J, Bass C, Diem S, Gravley A, Harvey L, Maciosek M, et al, Institute for Clinical Systems Improvement. Preventive services for children and adolescents. Bloomington, MN: Institute for Clinical Systems Improvement; 2013.
 
Wilkinson J, Bass C, Diem S, Gravley A, Harvey L, Maciosek M, et al, Institute for Clinical Systems Improvement. Preventive services for adults. Bloomington, MN: Institute for Clinical Systems Improvement; 2013.
 
National Institute for Health and Clinical Excellence. One to one interventions to reduce the transmission of sexually transmitted infections (STIs) including HIV, and to reduce the rate of under 18 conceptions, especially among vulnerable and at risk groups. London: National Institute for Health and Clinical Excellence; 2007.
 
American Academy of Family Physicians.  Recommendations by type: clinical preventive services. Leawood, KS: American Academy of Family Physicians; 2014. Accessed at www.aafp.org/patient-care/clinical-recommendations/cps.html on 14 August 2014.
 

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Behavioral Counseling Interventions to Prevent Sexually Transmitted Infections: U.S. Preventive Services Task Force Recommendation Statement

The full report is titled “Behavioral Counseling Interventions to Prevent Sexually Transmitted Infections: U.S. Preventive Services Task Force Recommendation Statement.” It is in the 16 December 2014 issue of Annals of Internal Medicine (volume 161, pages 894-901). The author is M.L. LeFevre, on behalf of the U.S. Preventive Services Task Force.

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