Perspective

USPSTF: Counsel sexually active teens, adults at risk for STIs

Clinicians can help prevent sexually transmitted infections by providing behavioral counseling to all sexually active teenagers and adults who are at increased risk for STIs, the U.S. Preventive Service Task Force said in a draft recommendation today.

The recommendation comes several weeks after the CDC announced that around 2.4 million cases of chlamydia, gonorrhea and syphilis were reported in the United States last year, making it the fifth straight record-breaking year for STIs in the United States.

With the draft recommendation, “we have the potential to reduce new STI cases by up to a third,” Melissa A. Simon, MD, MPH, task force member, told Healio Primary Care.

Simon, who is also vice chair for clinical research in the department of obstetrics and gynecology at Northwestern University, added, “we’re hopeful that this draft recommendation will continue to encourage clinicians to have these critical conversations with their patients, and then provide this counseling directly or refer those in need to counseling interventions that can help them stay healthy.”

The USPSTF also identified several areas where more research would be helpful:

  • information on teenagers who are not sexually active; sexually active boys; pregnant women; gay, bisexual or transgender persons; and older adults who are at higher risk for STIs;
  • interventions that engage couples or sex partners of primary care patients;
  • trials that follow participants for more than 12 months; and
  • interventions that could extend group counseling to remote participants (such as interactive telemedicine).

Comments on the draft “B” grade recommendation can be submitted from now until Jan. 21, 2020, at www.uspreventiveservicestaskforce.org/tfcomment.htm. According to the USPSTF recommendation statement, the draft recommendation differs from the previous 2014 USPSTF recommendation in just one way: behavioral counseling sessions can be less than 30 minutes; before the total contact time was considered 30 minutes or more. – by Janel Miller

Disclosure: Simon reports no relevant financial disclosures.

Clinicians can help prevent sexually transmitted infections by providing behavioral counseling to all sexually active teenagers and adults who are at increased risk for STIs, the U.S. Preventive Service Task Force said in a draft recommendation today.

The recommendation comes several weeks after the CDC announced that around 2.4 million cases of chlamydia, gonorrhea and syphilis were reported in the United States last year, making it the fifth straight record-breaking year for STIs in the United States.

With the draft recommendation, “we have the potential to reduce new STI cases by up to a third,” Melissa A. Simon, MD, MPH, task force member, told Healio Primary Care.

Simon, who is also vice chair for clinical research in the department of obstetrics and gynecology at Northwestern University, added, “we’re hopeful that this draft recommendation will continue to encourage clinicians to have these critical conversations with their patients, and then provide this counseling directly or refer those in need to counseling interventions that can help them stay healthy.”

The USPSTF also identified several areas where more research would be helpful:

  • information on teenagers who are not sexually active; sexually active boys; pregnant women; gay, bisexual or transgender persons; and older adults who are at higher risk for STIs;
  • interventions that engage couples or sex partners of primary care patients;
  • trials that follow participants for more than 12 months; and
  • interventions that could extend group counseling to remote participants (such as interactive telemedicine).

Comments on the draft “B” grade recommendation can be submitted from now until Jan. 21, 2020, at www.uspreventiveservicestaskforce.org/tfcomment.htm. According to the USPSTF recommendation statement, the draft recommendation differs from the previous 2014 USPSTF recommendation in just one way: behavioral counseling sessions can be less than 30 minutes; before the total contact time was considered 30 minutes or more. – by Janel Miller

Disclosure: Simon reports no relevant financial disclosures.

    Perspective

    The USPSTF recommendation to counsel patients on how to reduce the risk for STIs can be helpful. Counseling as a means of risk reduction is an evidence-based practice. Individual counseling is not enough, however, and perpetuates the idea that the current STI epidemic is due to personal practices rather than failed governmental public health programs. Not until we rebuild our public health programs and adequately fund surveillance, epidemiology, policy development and evaluation, research and clinical services will we be able to turn the tide.

    We would have a much greater impact on the STI epidemic with local investments in public health infrastructure, adequately trained public health staff, public health education and health promotion programs, condom distribution and free same-day testing and treatment. The STI epidemic is a public health crisis, not an individual behavioral issue. Past experience and evidence show that public health programs can reduce the spread of STIs through health promotion, increased testing, timely treatment and delivery of prevention interventions.

    • Jeffery Klausner, MD
    • Spokesperson, Infectious Diseases Society of America
      Professor of medicine
      Fielding School of Public Health, University of California Los Angeles
      David Geffen School of Medicine at the University of California Los Angeles

    Disclosures: Klauser reports advisory fees from BioFire, Cepheid, Luminostics, Shield Bio, SpeedX and Visby Medical Center; donated research supplies from Cepheid, Hologic and SpeedX, and research grants from AbbVie, AIDS Healthcare Foundation, Gilead Sciences, Hologic, NIH and the National Science Foundation.