USPSTF recomenda aconselhamento para prevenir infeções sexualmente transmissíveis

 

 

Pergunta clínica: Deverão os médicos dos cuidados de saúde primários realizar aconselhamento comportamental a adolescentes sexualmente ativos e adultos de risco para a prevenção de infeções sexualmente transmissíveis (IST)?

Tipo de artigo: Revisão da evidência e recomendação da United States Preventive Services Task Force

Enquadramento: Nos EUA estima-se que, por ano, ocorram aproximadamente 20 milhões de novos casos de infeções bacterianas ou víricas transmitidas por via sexual e que metade dos casos sejam em indivíduos entre os 15 e os 24 anos. As infeções por clamídia, gonorreia e sífilis continuam a aumentar em todas as regiões. As IST são frequentemente assintomáticas, o que poderá atrasar o diagnóstico e tratamento, levando à sua propagação de forma involuntária. As consequências das IST podem conduzir a doença inflamatória pélvica, infertilidade, cancro e SIDA.

Resumo: Nesta revisão da United States Preventive Services Task Force, foram identificados vários ensaios aleatorizados de qualidade razoável/boa, que demonstraram que o aconselhamento comportamental se associa a uma redução da incidência de IST em adolescentes sexualmente ativos e adultos de risco. Os fatores de risco incluem história de IST no último ano, uso irregular de preservativos, múltiplos parceiros sexuais ou parceiro com elevado risco de IST. Apesar de se verificar que o aconselhamento com duração superior a 120 minutos e ao longo de maior número de sessões se associa a maior redução de incidência de IST, as intervenções inferiores a 30 minutos são também provavelmente eficazes. A evidência é ainda limitada no que concerne a manutenção da redução da incidência de IST um ano após o aconselhamento. Não foi encontrado malefício com o aconselhamento. Os temas abordados no aconselhamento podem incluir informações sobre IST comuns e sua transmissão, práticas de sexo seguro, ensino sobre o uso de preservativos, resolução de problemas e negociação.
Em linha com estas recomendações, também o CDC, a Academia Americana de Pediatria, o Colégio Americano de Obstetras e Ginecologistas e a Academia Americana de Médicos de Família recomendam a obtenção de uma história sexual por rotina e o aconselhamento comportamental sobre prevenção de IST.

Recomendação: A USPSTF recomenda o aconselhamento comportamental para a prevenção de IST a todos os adolescentes sexualmente ativos e adultos pertencentes a grupos de risco (recomendação B).

Artigo original: JAMA

Por Marta Fraga, USF Araceti

 

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