USPSTF: Counsel Young Adults on Risky Behaviors to Curb STIs

Diedtra Henderson

September 23, 2014

Young adults who are sexually active and adults at increased risk for sexually transmitted infections (STIs) should undergo intensive behavioral counseling to lower their risk of becoming infected, according new guidelines released by the US Preventive Services Task Force (USPSTF). In a second guideline, USPSTF recommends screening all sexually active women aged 24 years or younger, as well as older women at increased risk for chlamydia and gonorrhea.

Both evidence-based recommendations were published online September 23 in the Annals of Internal Medicine.

According to the Centers for Disease Control and Prevention, some 20 million new cases of STIs occur each year in the United States, accounting for $16.9 billion in direct medical costs. Adolescents aged 15 to 24 years account for half of the STIs each year. When analyzed by race, blacks are the hardest hit, with an 8 times higher incidence compared with whites, according to the Centers for Disease Control and Prevention. Other high-risk groups are men who have sex with men, poor people living in an urban setting, current or former inmates, military recruits, and prostitutes.

Because some infections leave few symptoms, disease can be transmitted unknowingly. The ultimate consequences from untreated infections, however, can be dire: pelvic inflammatory disease, infertility, cancer, and harms to infants born to mothers whose STIs were untreated during pregnancy.

Behavioral counseling, which stresses such basics as information about STI transmission, training in how to properly use condoms, problem solving, and goal setting, offers moderate benefit with little down side, apart from the value of the time spent in the counseling sessions, according to the USPSTF. In addition to adolescents from high school through college age, the task force recommends behavioral counseling for adults at higher risk, including people with an active infection, adults with more than 1 sex partner, or adults who use condoms inconsistently.

"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," the USPSTF writes.

Treating chlamydia costs between $30 and $364 in direct lifetime costs per case, or $516.7 million in total associated costs, according to the authors. Treating gonorrhea, which is less prevalent, costs from $79 to $354 per case, or $162.1 million in total associated costs. Newborns born to women with untreated infections may develop such conditions as neonatal chlamydial pneumonia.

The panel found convincing evidence that screening tests can accurately detect both STIs, allowing for use of antibiotics that curb new infections. Men and women aged 20 to 24 years are at the highest risk for infection. Other risk factors include having sex with more than 1 person, a sex partner with an STI, and inconsistent use of condoms.

The USPSTF did not find enough solid evidence to balance the potential benefits and harms of such screening for men. However, the new screening recommendation does apply to pregnant women.

The recommendations are based on a systematic evidence review by Elizabeth A. O’Connor, PhD, from Kaiser Permanente Center for Health Research, Portland, Oregon and colleagues, which is published in the same issue of the Annals of Internal Medicine.

The Agency for Healthcare Research and Quality provides financial support for the USPSTF, as mandated by Congress. The authors have disclosed no relevant financial relationships.

Ann Intern Med. Published online September 23, 2014. Behavioral counseling full text, Screening full text, Review full text

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