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

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 gray 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 (n = 56 110) were newly published 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. [ABSTRACT FROM AUTHOR]