After obtaining a sexual history from their patients, all
providers should encourage risk reduction by offering
prevention counseling. Prevention counseling is most effective
if provided in a nonjudgmental and empathetic manner
appropriate to the patient’s culture, language, sex and gender
identity, sexual orientation, age, and developmental level.
Prevention counseling for STIs and HIV should be offered
to all sexually active adolescents and to all adults who have
received an STI diagnosis, have had an STI during the
previous year, or have had multiple sex partners. USPSTF
recommends intensive behavioral counseling for all sexually
active adolescents and for adults at increased risk for STIs and
HIV (4). Such interactive counseling, which can be resource
intensive, is directed at a person’s risk, the situations in which
risk occurs, and the use of personalized goal-setting strategies.
One such approach, known as client-centered STI and HIV
prevention counseling, involves tailoring a discussion of risk
reduction to the person’s situation. Although one large study in
STI clinics (Project RESPECT) demonstrated that this approach
was associated with lower acquisition of curable STIs (e.g.,
trichomoniasis, chlamydia, gonorrhea, and syphilis) (5), another
study conducted 10 years later in the same settings but different
contexts (Project AWARE) did not replicate this result (6).
With the challenges that intensive behavioral counseling poses,
health care professionals might find brief prevention messages
and those delivered through video or in a group session to be
more accessible for the client. A review of 11 studies evaluated
brief prevention messages delivered by providers and health
counselors and reported them to be feasible and to decrease
subsequent STIs in STD clinic settings (7) and HIV care
settings (8). Other approaches use motivational interviewing
to move clients toward achievable risk-reduction goals. Clientcentered
counseling and motivational interviewing can be used
effectively by clinicians and staff trained in these approaches.
CDC provides additional information on these and other
effective behavioral interventions at https://www.cdc.gov/
std/program/interventions.htm. Training in client-centered
counseling and motivational interviewing is available through
the STD National Network of Prevention Training Centers
(https://www.nnptc.org).
In addition to one-on-one STI and HIV prevention
counseling, videos and large group presentations can provide
explicit information concerning STIs and reducing disease
transmission (e.g., how to use condoms consistently and
correctly and the importance of routine screening). Groupbased
strategies have been effective in reducing the occurrence
of STIs among persons at risk, including those attending
STD clinics (9). Brief, online, electronic-learning modules for
young MSM have been reported to be effective in reducing
incident STIs and offer a convenient client platform for
effective interventions (10). Because the incidence of certain
STIs, most notably syphilis, is higher among persons with
HIV infection, use of client-centered STI counseling for
persons with HIV continues to be encouraged by public health
agencies and other health organizations (https://www.cdc.gov/
std/statistics/2019/default.htm). A 2014 guideline from CDC,
the Health Resources and Services Administration, and the
National Institutes of Health recommends that clinical and
nonclinical providers assess a person’s behavioral and biologic
risks for acquiring or transmitting STIs and HIV, including
having sex without condoms, having recent STIs, and having
partners recently treated for STIs (https://stacks.cdc.gov/
view/cdc/44064). That federal guideline is for clinical and
nonclinical providers to offer or make referral for regular
screening for multiple STIs, on-site STI treatment when
indicated, and risk-reduction interventions tailored to the
person’s risks. Brief risk-reduction counseling delivered by
medical providers during HIV primary care visits, coupled
with routine STI screening, has been reported to reduce STI
incidence among persons with HIV infection (8). Other
specific methods have been designed for the HIV care setting
(https://www.cdc.gov/hiv/effective-interventions/index.html).