One STD counseling session may not be enough

NEW YORK (Reuters Health) - Screening young women for sexually transmitted diseases (STD) can identify those who need treatment, but it may take more extensive efforts to lower their risk of future infections, new research suggests.

In a study of female military recruits, researchers found that screening, treatment and a brief counseling session did not change the women's sexual behavior or lower their odds of again becoming infected with an STD.

The findings suggest that young women need more than screening and one-time counseling, the study authors report in the journal Obstetrics & Gynecology.

Young women between the ages of 15 and 24 have the highest rate of STDs, including gonorrhea, chlamydia and trichomoniasis. Experts recommend routine STD screening for sexually active young women as a way to curb the problem.

However, it's been unclear whether people's behavior changes after STD screening and treatment, according to Dr. Loris Y. Hwang and colleagues at the University of California, San Francisco.

To investigate, the researchers followed 1,712 women, an average of 18 years old, in the Marine recruit training program. The women were screened for chlamydia, gonorrhea and trichomoniasis when they began the first 13 weeks of their training. Hwang's team also gave them a questionnaire about sexual history.

The women then had an average of 10 days vacation time before becoming another 3 weeks of training. At the end of this second phase, the women were again screened for STDs and were given questionnaires about their sexual activity during vacation.

At the start of the study, 12 percent of the recruits had one of the three STDs, most commonly chlamydia. These women received treatment and underwent a short counseling session about STDs and safer sex.

In the second round of questionnaires, the researchers found that 61 percent of the recruits said they'd had sex during vacation. Women who'd tested positive for an STD at the outset and those who did not were just as likely to report risky sex practices, including inconsistent condom use and casual sex.

Despite similar sexual behaviors, the women who initially tested positive for an STD were again more likely than their fellow recruits to test positive for an STD during the second round of screening.

The findings suggest that the "standard-of-care approach" of STD screening followed by a brief counseling session is not enough to change young women's sexual behavior, Hwang and her colleagues report.

In addition, the results suggest that STD "acquisition cannot be reliably predicted by a woman's history of risky sexual behaviors."

The researchers suggest that more detailed counseling, tailored to individuals rather than a one-size-fits-all approach, might be necessary.

SOURCE: Obstetrics & Gynecology, January 2007.