Behavioral sexual risk-reduction counseling in primary care to prevent sexually transmitted infections: a systematic review for the U.S. Preventive Services Task Force

Ann Intern Med. 2014 Dec 16;161(12):874-83. doi: 10.7326/M14-0475.


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.

Publication types

  • Research Support, N.I.H., Extramural
  • Review
  • Systematic Review

MeSH terms

  • Behavior Therapy*
  • Counseling*
  • Humans
  • Incidence
  • Primary Health Care*
  • Risk Assessment
  • Risk Reduction Behavior*
  • Sexual Behavior*
  • Sexually Transmitted Diseases / epidemiology
  • Sexually Transmitted Diseases / prevention & control*
  • United States / epidemiology