Public Release: 

News from Annals of Internal Medicine tip sheet -- Sept. 23, 2014

American College of Physicians

1. USPSTF publishes two new recommendations on preventing sexually transmitted infections

USPSTF recommends counseling to reduce risky sexual behavior among teens and adults at risk for STIs

The U.S. Preventive Services Task Force (USPSTF) recommends intensive behavioral counseling to reduce risky sexual behaviors among all sexually active adolescents and for those adults who are at risk for sexually transmitted infections (STIs), according to an evidence-based recommendation being published in Annals of Internal Medicine. Approximately 20 million new cases of STIs occur each year in the United States and half of these cases occur in persons ages 15 to 24 years. Adults at risk for STIs are those who have had an STI or other infections within the past year, those who have multiple sex partners, and those who do not consistently use condoms. If left untreated, STIs such as gonorrhea and chlamydia can lead to serious complications including pelvic inflammatory disease, ectopic pregnancy, chronic pelvic pain, infertility, cancer, and death. Successful counseling approaches to prevent STIs include providing basic information about the infections and their transmission, assessing individual risk, providing condom use education, and providing strategies for communicating with partners about safe sex. The USPSTF found adequate evidence that intensive behavioral counseling interventions reduce risky sexual behaviors and increase the likelihood of condom use and other protective sexual practices.

All sexually active young women should be screened for chlamydia and gonorrhea.

Older women at high risk, including those who are pregnant, should also be screened.

In separate but related recommendations also being published in Annals of Internal Medicine, the USPSTF recommends chlamydia and gonorrhea screening for sexually active women ages 24 years and younger and older women who are at increased risk for infection, including women who are pregnant. Chlamydia and gonorrhea are two of the most common STIs. Most infections are asymptomatic and, therefore, go undiagnosed. Untreated infections may lead to serious complications for women and for their babies. Young women have the highest rates of infection from chlamydia and gonorrhea, and older women are at risk if they engage in risky sexual behaviors, such as having multiple partners, not using condoms consistently, and exchanging sex for money or drugs. Women should be screened using nucleic acid amplification tests (NAATs) and then screened again when their sexual history reveals new or persistent risk factors since the last negative test result. Pregnant women who screen positive for chlamydial or gonoccoccal infection in the first trimester should be retested 3 months after treatment. The USPSTF found insufficient evidence to recommend for or against screening for chlamydia and gonorrhea in men.

Note: URLs will be live at 5:00 p.m. on Monday, September 22 and can be included in news stories. For a PDF, please contact Megan Hanks. To interview a member of the USPSTF, please contact Nicole Raisch at newsroom@uspstf.net or 202-572-2044.

2. New mosquito-borne infection may spread in United States

Chikungunya, a mosquito-borne virus that causes fever, rash, and severe, incapacitating pain, could spread in the United States, warn the authors a commentary being published in Annals of Internal Medicine. Physicians should be aware of the emergence of this virus because there is substantial overlap of symptoms among patients infected with chikungunya and dengue fever, and co-infection can occur. The severity of the joint pains and their persistence is one clue to distinguish the two viral infections. Chikungunya should be considered in the differential diagnosis of febrile travelers with arthralgias and rash when traveling to regions with chikungunya transmission. Clinicians also should advise their patients to wear mosquito protection when traveling to such regions, which include the Caribbean, Central and South America, and the southeastern United States.

Note: The URL will be live at 5:00 p.m. on Monday, September 22 and can be included in news stories. For a PDF, please contact Megan Hanks. The lead author may be contacted through Steven Crimaldi at 617-414-1267 or crimaldi@bu.edu.

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