Background: Despite advances in prevention and treatment, sexually transmitted infections (STIs) remain a significant cause of morbidity and mortality in the United States. There are an estimated 19 million new infections each year in the US costing about $13 billion.
Purpose: This systematic review supports the USPSTF in updating its prior recommendation on behavioral counseling to prevent STI.
Data Sources: For four key questions, we searched Medline (ML), Cochrane Central Registry of Controlled Trials (CCRCT), Cochrane Database of Systematic Reviews (CDSR), PsycINFO (PI), and the CDC's Prevention Synthesis Research (PRS) Project's database from 1988 through December 2006. For the fifth key question, we searched ML and CCRCT from 1988 to August 2006. Literature searches were supplemented with outside source material from experts in the field and from examining the bibliographies of existing systematic reviews on these topics.
Study Selection: This review included 19 articles representing 13 unique trials of counseling interventions and three trials for evaluating the effectiveness of female condoms. Included trials evaluated a primary care feasible behavioral counseling intervention addressing sexual behavior change to prevent the transmission of STIs.
Data Extraction: Two investigators independently screened all abstracts and rated all articles meeting inclusion criteria. One primary reviewer abstracted relevant information into standardized evidence tables. A second reviewer checked the abstraction process.
Data Synthesis and Results: Due to the heterogeneity of intervention methods, populations, and settings, we conducted a qualitative synthesis of our findings. The majority of evidence suggests a modest reduction in STIs at 6 or 12 months among “at-risk” adults in STI clinics receiving multiple intervention sessions, and at 12 months among sexually active adolescents. We also found evidence for increased compliance with treatment recommendations for adult women in STI clinics, general contraception use in male adolescents, and decreased nonsexual risky behavior and pregnancy in sexually active female adolescents. Overall, we found no evidence of significant behavioral or biological harms for risk-reduction counseling.
Limitations: We did not find sufficient trials evaluating primary care feasible behavioral counseling interventions to prevent STIs in a general-risk population or certain “at-risk” groups.
Conclusions: There is fair to good evidence suggesting that moderate- to high-intensity behavioral counseling conducted in STI clinics effectively reduces STI incidence in “at-risk” populations. Among sexually active adolescents, there is fair to good evidence that high-intensity behavioral counseling effectively reduces STI incidence in a primary care setting. There is a need for additional evidence for both lower-intensity behavioral counseling interventions and studies in lower-risk populations.