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Task force offers guidelines for clinicians to prevent STIs

Wednesday April 30, 2014
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The U.S. Preventive Services Task Force has posted two draft recommendations on the prevention of sexually transmitted infections by clinicians in primary care settings.

The task force will accept comments on the proposals through May 26 before developing its final recommendations, according to a news release.

According to CDC estimates, approximately 20 million cases of STI occur each year, with half those cases in people ages 15 to 24. If untreated, STIs such as gonorrhea and chlamydia can lead to serious complications including pelvic inflammatory disease, ectopic pregnancy, chronic pelvic pain, infertility, cancer and death.

In a draft recommendation on behavioral counseling interventions to prevent STIs, the task force recommends intensive behavioral counseling for all sexually active adolescents and adults who are at increased risk for STIs. High-risk groups include adults with current STIs or infections within the past year, adults who have multiple current sexual partners and adults who do not consistently use condoms.

In a separate but related recommendation on screening for chlamydia and gonorrhea (the most commonly reported STIs), the task force recommends screening sexually active women ages 24 and younger and older women who are deemed to be at increased risk of infection.

“We can do a lot to prevent STIs and their serious complications through our knowledge of effective prevention, screening and treatment,” Michael LeFevre MD, MSPH, task force chairman, said in the news release. “Evidence shows that intensive behavioral counseling for sexually active teens and adults at increased risk for STIs can help to prevent STIs, reduce high-risk behaviors and increase protective behaviors.”

Successful counseling approaches to prevent STIs include providing basic information about the infections and their transmission, assessing individual risk, providing training in condom use, communicating with partners about safe sex, problem solving and goal setting, according to the news release.

Additionally, the task force found evidence that screening women ages 24 and younger and older women at increased risk for chlamydia and gonorrhea infections is effective at reducing long-term complications from these STIs.

“Women with gonorrhea or chlamydia infections often do not experience any initial symptoms and may not know to talk to their doctor about testing and treatment,” Mark Ebell, MD, MS, task force member, said in the news release. “If untreated, these STIs in women can lead to serious complications. Fortunately, for women under age 24 and those at increased risk, evidence shows that screening for chlamydia and gonorrhea infections can make a difference.”

The task force concluded that evidence is insufficient to determine the effectiveness of screening men to prevent 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 improved health outcomes for women.

Both of these draft recommendations apply to all sexually active adolescents and adults. The draft recommendation on screening for chlamydia and gonorrhea infections also applies to pregnant women.

Read the recommendation statements and comment (through May 26): www.uspreventiveservicestaskforce.org/tfcomment.htm


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