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See the Figure for a more detailed summary of the recommendations for clinicians. See the Practice Considerations section for more information on populations at increased risk for acquiring STIs. USPSTF indicates US Preventive Services Task Force.

Figure.  Clinician Summary: Behavioral Counseling Interventions to Prevent Sexually Transmitted Infections
Clinician Summary: Behavioral Counseling Interventions to Prevent Sexually Transmitted Infections

USPSTF indicates US Preventive Services Task Force.

Table 1.  Summary of USPSTF Rationalea
Summary of USPSTF Rationalea
Table 2.  Behavioral Counseling Interventions to Reduce Risk for STI Acquisition in Persons at Increased Risk for STIsa
Behavioral Counseling Interventions to Reduce Risk for STI Acquisition in Persons at Increased Risk for STIsa
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Metsch  LR, Feaster  DJ, Gooden  L,  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(16):1701-1710. doi:10.1001/jama.2013.280034PubMedGoogle ScholarCrossref
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Peipert  JF, Redding  CA, Blume  JD,  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(6):630.e1-630.e8. doi:10.1016/j.ajog.2008.01.038PubMedGoogle ScholarCrossref
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Warner  L, Klausner  JD, Rietmeijer  CA,  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(6):e135. doi:10.1371/journal.pmed.0050135PubMedGoogle Scholar
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Carey  MP, Senn  TE, Walsh  JL,  et al.  Evaluating a brief, video-based sexual risk reduction intervention and assessment reactivity with STI clinic patients: results from a randomized controlled trial.   AIDS Behav. 2015;19(7):1228-1246. doi:10.1007/s10461-014-0960-3PubMedGoogle ScholarCrossref
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Bailey  JV, Webster  R, Hunter  R,  et al.  The Men’s Safer Sex project: intervention development and feasibility randomised controlled trial of an interactive digital intervention to increase condom use in men.   Health Technol Assess. 2016;20(91):1-124. doi:10.3310/hta20910PubMedGoogle ScholarCrossref
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Free  C, McCarthy  O, French  RS,  et al.  Can text messages increase safer sex behaviours in young people? intervention development and pilot randomised controlled trial.   Health Technol Assess. 2016;20(57):1-82. doi:10.3310/hta20570PubMedGoogle ScholarCrossref
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Tzilos Wernette  G, Plegue  M, Kahler  CW, Sen  A, Zlotnick  C.  A pilot randomized controlled trial of a computer-delivered brief intervention for substance use and risky sex during pregnancy.   J Womens Health (Larchmt). 2018;27(1):83-92. doi:10.1089/jwh.2017.6408PubMedGoogle ScholarCrossref
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Shafii  T, Benson  SK, Morrison  DM, Hughes  JP, Golden  MR, Holmes  KK.  Results from e-KISS: electronic-KIOSK Intervention for Safer Sex: a pilot randomized controlled trial of an interactive computer-based intervention for sexual health in adolescents and young adults.   PLoS One. 2019;14(1):e0209064. doi:10.1371/journal.pone.0209064PubMedGoogle Scholar
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Henderson  JT, Henninger  M, Bean  SI, Senger  CA, Redmond  N, O’Connor  EA.  Behavioral Counseling Interventions to Prevent Sexually Transmitted Infections: Updated Systematic Review for the U.S. Preventive Services Task Force. Evidence Synthesis No. 192. Agency for Healthcare Research and Quality; 2020. AHRQ publication 19-05260-EF-1.
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Hoffmann  TC, Glasziou  PP, Boutron  I,  et al.  Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide.   BMJ. 2014;348:g1687. doi:10.1136/bmj.g1687PubMedGoogle ScholarCrossref
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LeFevre  ML; U.S. Preventive Services Task Force.  Screening for chlamydia and gonorrhea: U.S. Preventive Services Task Force recommendation statement.   Ann Intern Med. 2014;161(12):902-910. doi:10.7326/M14-1981PubMedGoogle ScholarCrossref
28.
Curry  SJ, Krist  AH, Owens  DK,  et al; US Preventive Services Task Force.  Screening for syphilis infection in pregnant women: US Preventive Services Task Force reaffirmation recommendation statement.   JAMA. 2018;320(9):911-917. doi:10.1001/jama.2018.11785PubMedGoogle ScholarCrossref
29.
Owens  DK, Davidson  KW, Krist  AH,  et al; US Preventive Services Task Force.  Screening for HIV infection: US Preventive Services Task Force recommendation statement.   JAMA. 2019;321(23):2326-2336. doi:10.1001/jama.2019.6587PubMedGoogle ScholarCrossref
30.
Owens  DK, Davidson  KW, Krist  AH,  et al; US Preventive Services Task Force.  Screening for hepatitis B virus infection in pregnant women: US Preventive Services Task Force reaffirmation recommendation statement.   JAMA. 2019;322(4):349-354. doi:10.1001/jama.2019.9365PubMedGoogle ScholarCrossref
31.
Curry  SJ, Krist  AH, Owens  DK,  et al; US Preventive Services Task Force.  Screening for cervical cancer: US Preventive Services Task Force recommendation statement.   JAMA. 2018;320(7):674-686. doi:10.1001/jama.2018.10897PubMedGoogle ScholarCrossref
32.
Owens  DK, Davidson  KW, Krist  AH,  et al; US Preventive Services Task Force.  Preexposure prophylaxis for the prevention of HIV infection: US Preventive Services Task Force recommendation statement.   JAMA. 2019;321(22):2203-2213. doi:10.1001/jama.2019.6390PubMedGoogle ScholarCrossref
33.
Curry  SJ, Krist  AH, Owens  DK,  et al; US Preventive Services Task Force.  Screening for intimate partner violence, elder abuse, and abuse of vulnerable adults: US Preventive Services Task Force recommendation statement.   JAMA. 2018;320(16):1678-1687. doi:10.1001/jama.2018.14741PubMedGoogle ScholarCrossref
34.
Henderson  JT, Senger  CA, Henninger  M, Bean  SI, Redmond  N, O’Connor  EA.  Behavioral counseling interventions to prevent sexually transmitted infections: updated evidence report and systematic review for the US Preventive Services Task Force.   JAMA. Published August 25, 2020. doi:10.1001/jama.2020.10371Google Scholar
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Billings  DW, Leaf  SL, Spencer  J, Crenshaw  T, Brockington  S, Dalal  RS.  A randomized trial to evaluate the efficacy of a web-based HIV behavioral intervention for high-risk African American women.   AIDS Behav. 2015;19(7):1263-1274. doi:10.1007/s10461-015-0999-9PubMedGoogle ScholarCrossref
36.
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(2):159-163. doi:10.1016/j.jadohealth.2010.06.007PubMedGoogle ScholarCrossref
37.
Whiteley  LB, Brown  LK, Curtis  V, Ryoo  HJ, Beausoleil  N.  Publicly available internet content as a HIV/STI prevention intervention for urban youth.   J Prim Prev. 2018;39(4):361-370. doi:10.1007/s10935-018-0514-yPubMedGoogle ScholarCrossref
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Guilamo-Ramos  V, Benzekri  A, Thimm-Kaiser  M,  et al.  A triadic intervention for adolescent sexual health: a randomized clinical trial.   Pediatrics. 2020;145(5):e20192808. doi:10.1542/peds.2019-2808PubMedGoogle Scholar
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US Public Health Service. Preexposure Prophylaxis for the Prevention of HIV Infection in the United States—2017 Update: A Clinical Practice Guideline. Centers for Disease Control and Prevention. Published 2018. Accessed June 30, 2020. https://www.cdc.gov/hiv/pdf/risk/prep/cdc-hiv-prep-guidelines-2017.pdf
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Advisory Committee on Immunization Practices (ACIP). Human papillomavirus (HPV) ACIP vaccine recommendations. Centers for Disease Control and Prevention. Published November 21, 2014. Accessed June 30, 2020. https://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/hpv.html
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Schillie  S, Vellozzi  C, Reingold  A,  et al.  Prevention of hepatitis B virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices.   MMWR Recomm Rep. 2018;67(1):1-31. doi:10.15585/mmwr.rr6701a1PubMedGoogle ScholarCrossref
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Clinical preventive services recommendation: sexually transmitted infections. American Academy of Family Physicians. Accessed June 30, 2020. https://www.aafp.org/patient-care/clinical-recommendations/all/stis.html
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American College of Obstetricians and Gynecologists, Committee on Adolescent Health Care.  ACOG Committee Opinion No. 598: Committee on Adolescent Health Care: the initial reproductive health visit.   Obstet Gynecol. 2014;123(5):1143-1147. doi:10.1097/01.AOG.0000446826.46833.c0PubMedGoogle ScholarCrossref
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American College of Obstetricians and Gynecologists, Committee on Gynecologic Practice.  ACOG Committee Opinion No. 706 summary: sexual health.   Obstet Gynecol. 2017;130(1):251-252. doi:10.1097/AOG.0000000000002154PubMedGoogle Scholar
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American College of Obstetricians and Gynecologists, Committee on Health Care for Underserved Women.  ACOG Committee Opinion No. 423: motivational interviewing: a tool for behavioral change.   Obstet Gynecol. 2009;113(1):243-246. doi:10.1097/AOG.0b013e3181964254PubMedGoogle ScholarCrossref
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US Preventive Services Task Force
Recommendation Statement
August 18, 2020

Behavioral Counseling Interventions to Prevent Sexually Transmitted Infections: US Preventive Services Task Force Recommendation Statement

US Preventive Services Task Force
JAMA. 2020;324(7):674-681. doi:10.1001/jama.2020.13095
Abstract

Importance  Approximately 20 million new cases of bacterial or viral sexually transmitted infections (STIs) occur each year in the US, and about one-half of these cases occur in persons aged 15 to 24 years. Rates of chlamydial, gonococcal, and syphilis infection continue to increase in all regions. Sexually transmitted infections are frequently asymptomatic, which may delay diagnosis and treatment and lead persons to unknowingly transmit STIs to others. Serious consequences of STIs include pelvic inflammatory disease, infertility, cancer, and AIDS.

Objective  To update its 2014 recommendation, the US Preventive Services Task Force (USPSTF) commissioned a review of the evidence on the benefits and harms of behavioral counseling interventions for preventing STI acquisition.

Population  This recommendation statement applies to all sexually active adolescents and to adults at increased risk for STIs.

Evidence Assessment  The USPSTF concludes with moderate certainty that behavioral counseling interventions reduce the likelihood of acquiring STIs in sexually active adolescents and in adults at increased risk, including for example, those who have a current STI, do not use condoms, or have multiple partners, resulting in a moderate net benefit.

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

Summary of Recommendation
Importance

Quiz Ref IDBacterial and viral sexually transmitted infections (STIs) are common in the US. 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.1,2 Rates of chlamydial, gonococcal, and syphilis infection continue to increase in all regions.2 Sexually transmitted infections are frequently asymptomatic, which may delay diagnosis and treatment and lead persons to unknowingly transmit STIs to others. Serious consequences of STIs include pelvic inflammatory disease, infertility, cancer, and AIDS. Untreated STIs that present during pregnancy or birth may cause harms to the mother and infant, including perinatal infection, serious physical and developmental disabilities, and death.3,4

USPSTF Assessment of Magnitude of Net Benefit

Quiz Ref IDThe US Preventive Services Task Force (USPSTF) concludes with moderate certainty that behavioral counseling interventions reduce the likelihood of acquiring STIs in sexually active adolescents and in adults at increased risk, resulting in a moderate net benefit.

See the Figure and Table 1 for more information on the USPSTF recommendation rationale and assessment. For more details on the methods the USPSTF uses to determine the net benefit, see the USPSTF Procedure Manual.5

Practice Considerations
Patient Population Under Consideration

Quiz Ref IDThis recommendation applies to all sexually active adolescents and to adults at increased risk for STIs.

Definition of STIs

Sexually transmitted infections are transmitted through sexual activity and intimate physical contact. In the US, common STIs with significant clinical and public health effects include HIV, herpes simplex virus, human papillomavirus (HPV), hepatitis B virus (HBV), Chlamydia trachomatis, Neisseria gonorrhea, Treponema pallidum (syphilis), and Trichomonas vaginalis.1-4

Assessment of Risk

All sexually active adolescents are at increased risk for STIs because of the high rates of STIs in this age group and should receive behavioral counseling interventions. Quiz Ref IDAdults at increased risk for STIs include those who currently have an STI or were diagnosed with one within the past year, do not consistently use condoms, have multiple sex partners, or have sex partners within populations with a high prevalence of STIs. Populations with a high prevalence of STIs include persons who seek STI testing or attend STI clinics; sexual and gender minorities; persons who are living with HIV, inject drugs, have exchanged sex for money or drugs, or have entered correctional facilities; and some racial/ethnic minority groups.1-4 Difference in STI rates among racial/ethnic groups may reflect differences in social determinants of health.2 To determine which adolescents are sexually active, and which adults might engage in activities that may increase their risk for STIs, clinicians should routinely ask their patients for pertinent information about their sexual history.

Behavioral Counseling Interventions

Quiz Ref IDIntervention approaches include in-person counseling, videos, websites, written materials, telephone support, and text messages. Most successful approaches provide information on common STIs and STI transmission; assess the person’s risk for acquiring STIs; aim to increase motivation or commitment to safer sex practices; and provide training in condom use, communication about safer sex, problem solving, and other pertinent skills. Interventions that include group counseling and involve high total contact times (defined in the evidence review as more than 120 minutes), often delivered over multiple sessions, are associated with larger STI prevention effects. However, some less intensive interventions have been shown to reduce STI acquisition, increase condom use, or decrease number of sex partners. Interventions shorter than 30 minutes tended to be delivered in a single session. There is not enough evidence to determine whether several intervention characteristics were independently related to effectiveness, including degree of cultural tailoring, counselor characteristics, or setting.

Implementation

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. For more information about risk assessment methods and behavioral counseling interventions, see the Additional Tools and Resources section and Table 2.

Additional Tools and Resources

The following resources may help clinicians implement this recommendation.

  • Additionally, the CDC provides the following resources on how to help persons experiencing sexual violence or sex trafficking:

Other Related USPSTF Recommendations

The USPSTF has issued several recommendations about screening for STIs (chlamydia,27 gonorrhea,27 syphilis,28 HIV,29 HBV,30 and HPV31) and cervical cancer31 and offering preexposure prophylaxis to prevent HIV acquisition.32 The USPSTF has also issued a recommendation on screening for intimate partner violence and elder abuse.33

Update of Previous USPSTF Recommendation

In 2014, the USPSTF recommended intensive behavioral counseling (defined as total contact time of 30 minutes or more) to prevent STIs for all sexually active adolescents and for adults at increased risk for STIs (B recommendation).33 This updated recommendation statement is consistent with the 2014 USPSTF statement but slightly differs by recommending a broader range of effective counseling approaches, including those involving less than 30 minutes of total contact time. The USPSTF continues to conclude that the current evidence is lacking on the benefits and harms of behavioral counseling to prevent STIs in nonsexually active adolescents and in adults not at increased risk for STIs.

Supporting Evidence
Scope of Review

To update its 2014 recommendation, the USPSTF commissioned a systematic review of the benefits and harms of behavioral counseling interventions for preventing STI acquisition.25,34 The review included randomized and nonrandomized clinical trials in adolescents or adults of any sexual orientation, level of reported sexual activity, or pregnancy status that were published after 1999.

Benefits of Behavioral Counseling Interventions

Twenty trials assessed STI acquisition in persons at increased risk for STIs based on follow-up test results or diagnoses in medical records or public health registries at least 3 months after interventions started. Most reported STI outcomes after 12 or more months of follow-up. About one-half of trials were conducted in, or recruited participants from, US STI clinics. Other trials recruited participants from primary care, adolescent health, family planning, women’s health, or behavioral health clinics, mostly in the US. A few trials recruited participants directly from the community. Nine trials enrolled members of populations with higher rates of STIs such as sexually active adolescents or young adults and persons who reported unprotected intercourse, sex with multiple concurrent sex partners, or other STI risk behaviors. Eleven trials enrolled persons classified as at “highest risk for STI” who had current, recent, or suspected STI diagnosis or were attending STI clinics. Most participants were younger than 25 years, female, heterosexual, and reported African American or Hispanic race/ethnicity, and most trials specifically enrolled subpopulations defined by race/ethnicity, sexual orientation, age, gender, pregnancy, or other factors.

Many interventions used techniques or concepts from motivational interviewing, cognitive behavioral therapy, or other established behavioral counseling approaches that aimed to increase STI risk perception, knowledge, motivation, and skills for preventing STI acquisition; to increase consistent condom use; and to reduce unprotected intercourse and the number and concurrency of sex partners. Interventions for adolescents who were not yet sexually active aimed to delay sexual activity or encourage abstinence. Interventions were delivered in person and through computer, video, telephone, text message, or print formats over 1 or more sessions. A majority of the interventions that were shorter than 30 minutes delivered the content in a single session. Control conditions included usual care, attention controls, wait list, or minimal interventions (such as less than 15 minutes of STI information).

Behavioral counseling interventions were effective for reducing STI acquisition by approximately 30% based on pooled analysis of 19 trials in persons at increased risk for STIs, of which 10 trials enrolled persons at highest risk (n = 52 072; odds ratio [OR], 0.66 [95% CI, 0.54-0.81]; I2 = 74%). Sexually transmitted infection prevention effects were stronger for interventions involving group counseling (8 trials; n = 6567; OR, 0.47 [95% CI, 0.28-0.78]; I2 = 75%) than for interventions without group counseling (11 trials; n = 45 505; OR, 0.90 [95% CI, 0.74-1.08]; I2 = 43%) (P = .02). Effects were also stronger for interventions with high total contact times (>120 minutes) (8 trials; n = 3974; OR, 0.46 [95% CI, 0.28-0.75; I2 = 65%) (P = .02) than for interventions with moderate total contact times (30 to 120 minutes) (8 trials; n = 9072; OR, 0.90 [95% CI, 0.66-1.25]; I2 = 59%) or low total contact times (<30 minutes) (4 trials; n = 39 230; OR, 0.66 [95% CI, 0.36-1.24]; I2 = 44%). However, it was unclear whether group counseling format, contact time, or both were responsible for intervention effects because all but 1 group counseling intervention entailed more than 120 minutes.25,34

Although interventions with more than 120 minutes of contact time, group counseling, or both were generally more effective, 3 interventions with moderate11,14 or low19 contact times and 2 interventions without group counseling14,19 yielded statistically significant reductions in STI acquisition in STI clinic patients. One brief, video-based intervention without in-person counseling was tested in a nonrandomized clinical trial of 40 282 adults in STI clinic waiting rooms.19 Patients who viewed 23 minutes of information about HIV and STI prevention; how couples communicate about newly diagnosed STIs; building skills, self-efficacy, and positive attitudes about condom use; and how to acquire, negotiate, and use condoms were significantly less likely than patients receiving usual care to acquire STIs after a mean of 15 months of follow-up (adjusted hazard ratio, 0.91 [95% CI, 0.84-0.99]).

Meta-regression analysis revealed that intervention effects were stronger in trials limited to adolescents (3 trials; n = 1166; OR, 0.22 [95% CI, 0.02-2.30]; I2 = 73%) than in trials that included adolescents and adults (16 trials; n = 50 906; OR, 0.78 [95% CI, 0.67-0.91]; I2 = 51%). However, it was difficult to isolate specific effects because the most effective intervention format (interventions involving group counseling) was tested in trials with similar participant characteristics (girls and women who identified as racial/ethnic minorities), and only 1 trial of adolescents included boys.25,34

Thirty-four trials evaluated self-reported behavioral outcomes at least 3 months after interventions started in adolescents, young adults, or older adults, most of whom were at increased risk for STIs (30 trials). Intervention and participant characteristics were similar to those in trials that assessed STI outcomes. Behavioral counseling interventions were effective for increasing condom use, specifically dichotomous measures of consistent condom use or condom use at last sexual encounter (13 trials; n = 5253; OR, 1.31 [95% CI, 1.10-1.56]; I2 = 40%) and for decreasing unprotected intercourse based on number of sexual acts or days of intercourse without a condom (14 trials; n = 9183; mean difference, –0.94 [95% CI, –1.40 to –0.48]; I2 = 16%).25,34

Several trials found that interventions with high contact time were significantly associated with increased condom use or reductions in unprotected sex or the number of sex partners.25,34 Two interventions with moderate contact time were also significantly associated with increased condom use14,35 or abstinence from vaginal sex.36 One intervention with low contact time that sent adolescents and young adults numerous emails with links to STI information and motivational content was significantly associated with a reduction in unprotected sex.37 Most of the 8 trials that reported both STI acquisition and behavioral outcomes found that persons reporting more consistent condom use were less likely to acquire STIs.25,34

Four trials evaluated behavioral counseling interventions in adults or adolescents at average STI risk who were recruited without respect to individual STI risk factors from primary care clinics (3 trials) or through community advertising (1 trial).25,34 None reported significant effects on STI acquisition. One trial found a significant effect on self-reported sexual behavior in adolescents aged 11 to 14 years (of whom most were not yet sexually active) who enrolled with their mothers in a multisession family therapy intervention that was endorsed by their clinician and aimed to reduce adolescent sexual activity. After 9 months of follow-up, adolescents in the intervention group were less likely to report vaginal intercourse than adolescents offered usual care (OR, 0.24 [95% CI, 0.11-0.55]).36 A recent follow-up study using an updated version of the intervention in a broader group found similar results.38

Harms of Behavioral Counseling Interventions

Seven of the trials that assessed STI or behavioral outcomes (n = 3458) also reported on potential harms of interventions in adolescents or adults at increased risk for STIs. None of these trials reported significant harms.25,34 There was no consistent evidence that interventions increased sexual activity in adolescents, unintended pregnancy, perceptions of shame or stigma, or mental health problems.

Response to Public Comment

A draft version of this recommendation statement was posted for public comment on the USPSTF website from December 17, 2019, through January 21, 2020. Many comments requested clarification about taking a sexual history and identifying which adults are considered at increased risk for STIs. In response, the USPSTF added clarifying language to the Risk Assessment section. Comments seeking additional clarification on recommended interventions were also received. Where the USPSTF was able to provide more details, it did so in the Behavioral Counseling Interventions subsection of the Practice Considerations section. Comments also highlighted additional research needs, which have been included in the Research Needs and Gaps section. Some comments requested that the current recommendation discuss HIV preexposure prophylaxis; HIV preexposure prophylaxis is addressed in a separate USPSTF recommendation.32 A few comments requested clearer guidance on how to provide counseling in situations in which the sexual activity is not in the control of the patient (such as sexual trafficking or abuse). The USPSTF acknowledges the importance of helping persons in this situation, which goes beyond counseling on how to prevent STIs. The USPSTF added a link to relevant resources provided by the CDC in the Additional Tools and Resources section.

Research Needs and Gaps

  • Most studies identified by the USPSTF enrolled heterosexual girls, women, and men at increased risk for STI acquisition. More research on counseling interventions to prevent STIs is needed in sexually active boys; pregnant persons; gay, lesbian, bisexual, nonbinary, and transgender persons; and older adults at increased risk; as well as in adolescents who are not yet sexually active. Research on interventions that engage couples or sex partners of primary care patients is also needed. More national-level data on prevalence of STIs in certain risk groups are also needed, including lesbian, bisexual, nonbinary, and transgender persons. Additional research is needed on understanding the role of social determinants of health in contributing to increased STI rates.

  • Few trials incorporated sexual risk assessment performed by primary care clinicians, and less than one-half of trials assessed interventions delivered by clinicians, nurses, psychologists, or other health professionals. Because many trials were conducted in STI clinics, research that is more applicable to general primary care populations would be valuable, such as trials that test interventions delivered in primary care settings, obstetrics clinics, and family planning and women’s health clinics, or that is endorsed by primary care clinicians for patients who report increased STI risk based on well-defined risk assessment methods.

  • Trials that follow up participants for longer than 12 months are needed to assess the durability of intervention effects.

  • Research is needed to develop and test interventions that could extend group counseling to remote participants (such as interactive telemedicine) and that would be more feasible for asymptomatic patients in general primary care settings, such as brief or media-based interventions involving less than 30 minutes.

Recommendations of Others

The CDC recommends that all clinicians routinely obtain a sexual history and encourage abstinence, condom use, limiting number of sex partners, and other sexual risk–reduction strategies,4,39 as well as routine vaccination against HPV and HBV infection.40,41 Many organizations advise clinicians to periodically obtain sexual histories, conduct sexual risk assessments, discuss sexual risk reduction, or some combination thereof; these organizations include the American Academy of Pediatrics,42 the American Academy of Family Physicians,43 the American College of Obstetricians and Gynecologists,44-49 the Society for Adolescent Health and Medicine,50 the National Coalition of Sexually Transmitted Disease Directors and the National Alliance of State and Territorial AIDS Directors,51 and the National Health Care for the Homeless Council.52 Although it does not address STI prevention counseling directly, the Sexual Assault Forensic Examiner Technical Assistance Organization provides guidance on how to evaluate and provide STI care to persons who have experienced sexual assault.53

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Article Information

Corresponding Author: Alex H. Krist, MD, MPH, Virginia Commonwealth University, One Capitol Square, 6th Floor, 830 E Main St, Richmond, VA 23219 (chair@uspstf.net).

Accepted for Publication: July 8, 2020.

The US Preventive Services Task Force (USPSTF) members: Alex H. Krist, MD, MPH; Karina W. Davidson, PhD, MASc; Carol M. Mangione, MD, MSPH; Michael J. Barry, MD; Michael Cabana, MD, MA, MPH; Aaron B. Caughey, MD, PhD; Katrina Donahue, MD, MPH; Chyke A. Doubeni, MD, MPH; John W. Epling Jr, MD, MSEd; Martha Kubik, PhD, RN; Gbenga Ogedegbe, MD, MPH; Lori Pbert, PhD; Michael Silverstein, MD, MPH; Melissa A. Simon, MD, MPH; Chien-Wen Tseng, MD, MPH, MSEE; John B. Wong, MD.

Affiliations of The US Preventive Services Task Force (USPSTF) members: Fairfax Family Practice Residency, Fairfax, Virginia (Krist); Virginia Commonwealth University, Richmond (Krist); Feinstein Institute for Medical Research at Northwell Health, Manhasset, New York (Davidson); University of California, Los Angeles (Mangione); Harvard Medical School, Boston, Massachusetts (Barry); University of California, San Francisco (Cabana); Oregon Health & Science University, Portland (Caughey); University of North Carolina at Chapel Hill (Donahue); Mayo Clinic, Rochester, Minnesota (Doubeni); Virginia Tech Carilion School of Medicine, Roanoke (Epling Jr); George Mason University, Fairfax, Virginia (Kubik); New York University, New York, New York (Ogedegbe); University of Massachusetts Medical School, Worcester (Pbert); Boston University, Boston, Massachusetts (Silverstein); Northwestern University, Evanston, Illinois (Simon); University of Hawaii, Honolulu (Tseng); Pacific Health Research and Education Institute, Honolulu, Hawaii (Tseng); Tufts University School of Medicine, Boston, Massachusetts (Wong).

Author Contributions: Dr Krist had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. The USPSTF members contributed equally to the recommendation statement.

Conflict of Interest Disclosures: Authors followed the policy regarding conflicts of interest described at https://www.uspreventiveservicestaskforce.org/uspstf/about-uspstf/conflict-interest-disclosures. All members of the USPSTF receive travel reimbursement and an honorarium for participating in USPSTF meetings. Dr Barry reported receiving grants and personal fees from Healthwise.

Funding/Support: The USPSTF is an independent, voluntary body. The US Congress mandates that the Agency for Healthcare Research and Quality (AHRQ) support the operations of the USPSTF.

Role of the Funder/Sponsor: AHRQ staff assisted in the following: development and review of the research plan, commission of the systematic evidence review from an Evidence-based Practice Center, coordination of expert review and public comment of the draft evidence report and draft recommendation statement, and the writing and preparation of the final recommendation statement and its submission for publication. AHRQ staff had no role in the approval of the final recommendation statement or the decision to submit for publication.

Disclaimer: Recommendations made by the USPSTF are independent of the US government. They should not be construed as an official position of AHRQ or the US Department of Health and Human Services.

Additional Contributions: We thank Tina Fan, MD, MPH (AHRQ), who contributed to the writing of the manuscript, and Lisa Nicolella, MA (AHRQ), who assisted with coordination and editing.

Additional Information: The US Preventive Services Task Force (USPSTF) makes recommendations about the effectiveness of specific preventive care services for patients without obvious 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.

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