1. High-intensity counseling reduces the risk of acquiring an STI in high-risk patient groups.
2. Counseling does not increase adolescent sexual activity and has no significant adverse effects.
Evidence Rating Level: 1 (Excellent)
Study Rundown: Sexually transmitted infections (STI) are highly prevalent among sexually active adolescents and adults with certain risk factors (e.g. a history of one or more STI diagnoses). This study, conducted by the US Preventive Services Task Force (USPSTF), assessed whether or not behavioral counseling affects the risk of acquiring an STI in the patient populations mentioned above. The task force found that the longer a counseling session lasts, the more effective it is; thus, high-intensity sessions (>2 hours) were found to be the most effective, trumping both moderate-intensity sessions (30 minutes to 2 hours) and low-intensity sessions (<30 minutes). The review of studies involving adolescents found that a 12 month regimen of high-intensity sessions reduced the odds of acquiring an STI by 62% versus a decrease of 43% after two moderate-intensity sessions. Studies examining high-risk adult populations found that high-intensity counseling sessions led to a 30% decrease in the odds of infection, while moderate- and low-intensity sessions had no effect.
Based on the evidence gathered, the USPSTF recommends intensive behavioral counseling for all sexually active adolescents and adults at increased risk for STIs. This recommendation is limited because most of the studies examined by the USPSTF were conducted with either high-risk adult populations or sexually active girls. More studies examining the effect of behavioral interventions on sexually active boys, younger adolescents who are not yet having sex, and older adults are needed.
In-Depth [systematic review]: The USPSTF examined evidence found in 7 trials documenting the effects of counseling interventions on odds of acquiring an STI in adolescents and 4 similar trials examining effects in high-risk adults. Pooled analyses of the adolescent studies’ showed that there was a 62% reduction in risk of acquiring an STI after 12 months of high-intensity counseling (OR 0.38; 95%CI 0.24-0.60), and a 43% reduction in risk after two moderate-intensity counseling sessions (OR 0.57; 95%CI 0.37-0.96). Analysis of the adult studies found that high-intensity interventions produced a 30% decrease in risk of acquiring an STI (OR 0.70; 95%CI 0.56-0.87), while moderate- and low-intensity interventions did not reduce this risk. With regard to potential harms of behavioral counseling, three studies reported no adverse effects and the USPSTF could find no evidence suggesting that counseling increased sexual activity in adolescents.
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