Behavioral Sexual Risk-Reduction Counseling in Primary Care to Prevent Sexually Transmitted Infections – An Updated Systematic Evidence Review for the U.S. Preventive Services Task Force

September 26, 2014 at 8:23 am

Annals of Internal Medicine Sept.23, 2014

Elizabeth A. O’Connor, PhD; Jennifer S. Lin, MD, MCR; Brittany U. Burda, MPH; Jillian T. Henderson, PhD; Emily S. Walsh, MPH; and Evelyn P. Whitlock, MD, MPH

From Kaiser Permanente Center for Health Research, Portland, Oregon.

Background

Sexually transmitted infections (STIs) are common and preventable.

Purpose

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.

Data Sources

Selected databases from January 2007 through October 2013, manual searches of references lists and grey literature, and studies from the previous review.

Study Selection

English-language fair- or good-quality trials conducted in adolescents or adults.

Data Extraction

One investigator abstracted data and a second checked the abstraction. Study quality was dual reviewed.

Data Synthesis

31 trials were included: 16 were newly published (n = 56 110) 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.

Limitations

Low-risk populations and male adolescents were underrepresented. Reliability of self-reported behavioral outcomes was unknown.

Conclusion

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.

Primary Funding Source

Agency for Healthcare Research and Quality.

PDF (CLIC PDF)

Entry filed under: Antimicrobianos, Bacterias, Biología Molecular, Epidemiología, Infecciones de transmision sexual, Metodos diagnosticos, Resistencia bacteriana, REVIEWS, Update.

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