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New Guidelines for Prevention and Detection of Sexually Transmitted Infections

Experts support behavioral counseling

The U.S. Preventive Services Task Force has published three final recommendations on the prevention and detection of sexually transmitted infections (STIs). In the recommendation on behavioral counseling interventions to prevent STIs, the task force recommends intensive behavioral counseling for all sexually active adolescents and for adults at increased risk for STIs.

In separate but related recommendations on screening for chlamydia and gonorrhea (the most commonly reported STIs), the task force recommends screening sexually active women aged 24 years and younger and older women who are at increased risk for infection.

STIs are a serious health concern for Americans, the task force says. According to the Centers for Disease Control and Prevention (CDC), approximately 20 million cases occur each year, with half of those cases occurring in individuals 15 to 24 years of age. If untreated, STIs, such as gonorrhea and chlamydia infections, can lead to serious complications, including pelvic inflammatory disease, ectopic pregnancy, chronic pelvic pain, infertility, cancer, and death.

“We can do a lot to prevent STIs and their serious complications through effective prevention, screening, and treatment,” said task force chair Michael LeFevre, MD, MSPH. “Evidence shows that intensive behavioral counseling for sexually active teens and for adults at increased risk can help to prevent STIs, reduce high-risk behaviors, and increase protective behaviors. Primary care providers can make a difference by offering or referring patients to intensive behavioral counseling.”

Successful counseling approaches to prevent STIs include providing basic information about the infections and their transmission, assessing individual risk, providing education regarding condom use, and providing strategies for communicating with partners about safe sex.

In addition, the task force found evidence that screening women aged 24 years and younger (who have the highest rates of infection) and older women at increased risk for chlamydia and gonorrhea infections is effective at reducing long-term complications from these STIs.

“Often, women with gonorrhea or chlamydia infections do not experience any initial symptoms, which means that they may not consider talking to their doctor about testing and treatment,” said task force co-vice chair Kirsten Bibbins-Domingo, PhD, MD. “If a woman has an STI that is left untreated, she may be at higher risk for serious and long-term complications. The good news is that evidence shows that screening for chlamydia and gonorrhea infections can make a difference for all young, sexually active women and also older women at increased risk.”

For men, the task force concluded that there is not enough evidence to determine the effectiveness of screening for chlamydia and gonorrhea. Unlike women, men with chlamydia or gonorrhea infections are more likely to experience symptoms for which they would seek medical attention. Because of earlier detection and treatment, men with these STIs are less likely than women to develop long-term complications. The task force found insufficient evidence that screening men would translate into better health outcomes for women.

The task force’s final recommendation statements were published online in the Annals of Internal Medicine and are available on the group’s Web site.

Source: USPSTF; September 23, 2014.

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