Elizabeth A. O'Connor, PhD; Jennifer S. Lin, MD, MCR; Brittany U. Burda, MPH; Jillian T. Henderson, PhD; Emily S. Walsh, MPH; Evelyn P. Whitlock, MD, MPH
Disclaimer: The views expressed in this manuscript do not represent and should not be construed to represent a determination or policy of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.
Acknowledgment: The authors thank the following persons for their contributions to this project: AHRQ staff; the U.S. Preventive Services Task Force; Ralph J. DiClemente, PhD, for providing expert review; Peter Miele, MD, and the Centers for Disease Control and Prevention for providing federal partner review of the report; Kevin Lutz, MFA, and Smyth Lai, MLS, at the Kaiser Permanente Center for Health Research.
Financial Support: This review was conducted by the Kaiser Permanente Research Affiliates Evidence-based Practice Center under contract to AHRQ (contract HHSA-290-2012-00151-I).
Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M14-0475.
Request for Single Reprints: Reprints are available from the AHRQ Web site (www.ahrq.gov).
Current Author Addresses: Drs. O'Connor, Lin, Henderson, and Whitlock; Ms. Burda; and Ms. Walsh: Kaiser Permanente Center for Health Research, 3800 North Interstate Avenue, Portland, OR 97227.
Author Contributions: Conception and design: E.A. O'Connor, J.S. Lin, J.T. Henderson, E.P. Whitlock.
Analysis and interpretation of the data: E.A. O'Connor, J.S. Lin, B.U. Burda, J.T. Henderson, E.P. Whitlock.
Drafting of the article: E.A. O'Connor, B.U. Burda, E.S. Walsh.
Critical revision of the article for important intellectual content: J.S. Lin, B.U. Burda, J.T. Henderson, E.P. Whitlock.
Final approval of the article: E.A. O'Connor, J.S. Lin, B.U. Burda, J.T. Henderson, E.P. Whitlock.
Statistical expertise: E.A. O'Connor.
Obtaining of funding: E.P. Whitlock.
Administrative, technical, or logistic support: B.U. Burda, E.S. Walsh.
Collection and assembly of data: E.A. O'Connor, B.U. Burda, E.S. Walsh.
Sexually transmitted infections (STIs) are common and preventable.
To update a previous systematic review about the benefits and harms of sexual risk-reduction counseling to prevent STIs for the U.S. Preventive Services Task Force.
Selected databases from January 2007 through October 2013, manual searches of references lists and gray literature, and studies from the previous review.
English-language fair- or good-quality trials conducted in adolescents or adults.
One investigator abstracted data and a second checked the abstraction. Study quality was dual-reviewed.
31 trials were included: 16 (n = 56 110) were newly published and 15 (n = 14 214) were from the previous review. Most trials targeted persons at increased risk for STIs based on sociodemographic characteristics, risky sexual behavior, or history of an STI. High-intensity (>2 hours) interventions reduced STI incidence in adolescents (odds ratio, 0.38 [95% CI, 0.24 to 0.60]) and adults (odds ratio, 0.70 [CI, 0.56 to 0.87]). Lower-intensity interventions were generally not effective in adults, but some approaches were promising. Although moderate-intensity interventions may be effective in adolescents, data were very sparse. Reported behavioral outcomes were heterogeneous and most likely to show a benefit with high-intensity interventions at 6 months or less. No consistent evidence was found that sexual risk-reduction counseling was harmful.
Low-risk populations and male adolescents were underrepresented. Reliability of self-reported behavioral outcomes was unknown.
High-intensity counseling on sexual risk reduction can reduce STIs in primary care and related settings, especially in sexually active adolescents and in adults at increased risk for STIs.
Agency for Healthcare Research and Quality.
STI = sexually transmitted infection.
Appendix Table 1. Key Questions
Summary of evidence search and selection.
CE = comparative effectiveness; KQ = key question.
Appendix Table 2. Summary of Included Studies: Adolescents
Appendix Table 3. Summary of Included Studies: Adults
STI incidence in included trials targeting adolescents.
CG = control group; IG = intervention group; OR = odds ratio; STI = sexually transmitted infection.
* Pregnant adolesecent subgroup.
† Adolescent subgroup.
STI incidence in included trials targeting adults.
* Pregnant adult subgroup.
† Adult subgroup.
‡ Psychiatric patients.
Condom use in included trials targeting adults.
Table. Summary of Evidence
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O'Connor EA, Lin JS, Burda BU, et al. 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;161:874–883. doi: https://doi.org/10.7326/M14-0475
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Published: Ann Intern Med. 2014;161(12):874-883.
Infectious Disease, Sexually Transmitted Infections.
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