Counseling for Sexually Transmitted Infections

*Updated January 2022*

Clinical Recommendations

The Women’s Preventive Services Initiative recommends behavioral counseling by a health care clinician or other appropriately trained individual for sexually active adolescent and adult women at an increased risk for sexually transmitted infections (STIs).

The Women’s Preventive Services Initiative recommends that clinicians review a woman’s sexual history and risk factors to identify those at increased risk for STIs. Risk factors include, but are not limited to, age younger than 25 years, a recent history of an STI, a new sex partner, multiple partners, a partner with concurrent partners, a partner with an STI, and a lack of or inconsistent condom use. For those without identified risk factors, counseling to reduce the risk of STIs should be considered on an individual basis as determined by clinical judgment.

Implementation Considerations

The Women’s Preventive Services Initiative recommends as a preventive service for adolescent and adult women at increased risk for STIs, behavioral counseling that includes, but is not limited to, counseling sessions with adequate contact time (effectiveness is greatest with high- contact interventions), and may include multiple counseling sessions, group sessions, in-person and tech-based encounters, and educational and behavioral change components using motivational interviewing techniques and goal setting.

The Women’s Preventive Services Initiative recommends as a preventive service, STI counseling regardless of whether STI screening takes place during the same visit and regardless of the type of sexual activity or gender of sexual partner(s). Counseling may occur annually, or more frequently based on individual risk factors. Intensity of counseling may be individualized based on risk factors. Preventive counseling may be considered in women without identified risk factors. Clinicians should consider the cultural and linguistic needs of individual patients and maintain their privacy and confidentiality. Counseling should be respectful, affirming, and non- stigmatizing.

Additional recommendations about Human Immunodeficiency Virus (HIV) risk assessment, counseling, and testing, are provided in the WPSI HIV recommendation, the Recommendations for Well-Woman Care: A Well-Woman Chart, and the Clinical Summary Tables.

Research Recommendations

  • Effectiveness trials to determine optimal counseling methods, intensities, and intervals with long-term (i.e., longer than 6 to 12 months) follow-up of health outcomes in various patient populations.
  • Research comparing different types of counseling interventions in primary care settings including group and individual approaches and newer technologies and modes of delivery, such as text messaging and telemedicine, to improve the accessibility, acceptability, and effectiveness of lower intensity counseling interventions.
  • Studies of the effectiveness of risk assessment strategies in predicting STI incidence in adolescent and adult women.
  • Studies that include populations without identified risk factors to determine the role and effectiveness of universal counseling.

*These are the recommendations of the WPSI and not necessarily of any individual participating organization.