Prevention

The USPSTF recommends "high-intensity" behavioral counseling to at-risk adults and adolescents to prevent STIs. High-intensity counseling involves multiple sessions and often is delivered to groups of patients. Unfortunately, this type of intervention has limitations in its practicality for population-based delivery. No risk of harm was discovered in the delivery of counseling for STI prevention.

Vaccination is the most important form of primary prevention of common infectious diseases. Two vaccines are currently on the market for HPV prevention—one that protects against four viral subtypes (6,11,16,18) and is licensed for use in males and females 9 to 26 years of age, and the other against two subtypes (16,18), licensed for females 10 to 25 years of age. Hepatitis B is a sexually transmitted infection, and immunization is recommended for adolescents who have not been previously inoculated. This is a requirement in many states for school entry. Hepatitis A can be transmitted by oro-anal sexual contact, and vaccination should be offered to patients who are contemplating engaging in this sexual practice.

Recommendations surrounding the use of barrier methods for STI prevention should be tailored to the sex practices of the client. For example, a percentage of women use anal sex as a method of birth control but may not consider the need for condom use with this practice. The question, "Do you regularly use condoms?" has little relevance to infection control for many sexual practices. Evidence supports the advice to use barrier methods of latex or other approved material in a manner that prevents the exchange of blood and body fluids in decreasing STIs. Condoms confer a 30% risk reduction for herpes simplex and up to an 80% risk reduction for HIV, when used correctly (Weller and Davis-Beaty, 2002; Martin et al., 2009).

The secondary prevention of STIs is achieved through direct and nonjudgmental patient assessment and screening and avoiding assumptions about patient sexual practices. Screening is a tool to prevent the inadvertent spread of infection as well as the sequelae of undetected disease. Table 16-7 summarizes USPSTF and CDC recommendations for screening of STIs.

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