Behavioral Counseling Urged for Teens, Young Adults at Risk for STDs

'Intensive' instruction most effective for curbing dangerous practices, U.S. health experts say

By Mary Elizabeth Dallas

Monday, September 22, 2014

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MONDAY, Sept. 22, 2014 (HealthDay News) -- Teens and young adults at risk for sexually transmitted infections should undergo "intensive" behavioral counseling to help prevent risky sexual behaviors, according to new recommendations from the U.S. Preventive Services Task Force.

Every year, about 20 million new sexually transmitted infections such as gonorrhea and chlamydia occur in the United States. About half involve people between 15 and 24 years old, according to the task force.

Its new report, published Sept. 22 in Annals of Internal Medicine, updates its 2008 guidelines. The task force is an independent panel of health experts that reviews a broad range of preventive health care services and develops recommendations for health care providers.

Adults at risk for sexually transmitted infections include those who've had one within the past year, those who don't always wear condoms and those with multiple sexual partners, the recommendations say.

Sexually transmitted infections often develop without symptoms, according to the report. Untreated, they can cause serious complications, such as pelvic inflammatory disease, ectopic pregnancy and chronic pelvic pain. In severe cases, these infections can lead to infertility, cancer, and even death.

Moreover, in pregnancy, an untreated sexually transmitted infection can lead to serious harms for the unborn child, according to the report.

Behavioral counseling can reduce the odds of developing a sexually transmitted infection and encourage safe-sex practices, the experts concluded after reviewing previously published studies.

"Interventions ranging in intensity from 30 minutes to two or more hours of contact time are beneficial," task force member Dr. Michael LeFevre said in a news release.

Intensive counseling -- consisting of two hours or more -- was the most effective, he said. Moderate-intensity interventions -- defined as 30 minutes to two hours -- were less consistently beneficial, and low-intensity interventions -- less than 30 minutes -- were the least effective, he noted.

Primary care clinicians can provide the counseling or refer patients to trained behavioral counselors, the report said. Community organizations, schools, and health departments may also offer risk-reduction counseling.

"Clinicians should be aware of populations with a particularly high prevalence of [sexually transmitted infections]," LeFevre said.

In the United States, sexually transmitted infections are more prevalent among blacks and Latinos than whites, the health experts said. Others at higher risk include gay men, lower-income people living in cities, military recruits, people with mental illness, intravenous drug users and victims of sexual abuse.

Certain approaches to counseling have been successful in preventing sexually transmitted infections, the task force found. One effective strategy is providing people with basic information about the various infections and how they are spread.

Other beneficial strategies include assessing people's risk for sexually transmitted infections, teaching them how to use condoms correctly and providing them with tips on how to communicate with their partner about safe sex.

Many primary care doctors don't routinely provide counseling about sexual activity or contraception during health care visits, the task force said.

Stronger links between doctors and their communities could help improve the delivery of this service, the health experts said.

SOURCE: American College of Physicians, news release, Sept. 22, 2014

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