The United States Preventive Services Task Force (USPSTF) is the most evidence-based and authoritative organization making recommendations on preventive services in the US. During 2005, 20 recommendations were made on a total of 10 conditions. TABLE 1 lists the recommendations made in 2005. TABLE 2 describes the criteria for the recommendations coming from the task force.
Several of these recommendations deserve elaboration.
TABLE 1
USPSTF recommendations made in 2005
| A RECOMMENDATION (STRONGLY RECOMMENDS) |
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| B RECOMMENDATION (RECOMMENDS) |
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| C RECOMMENDATION (NO RECOMMENDATION FOR OR AGAINST) |
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| D RECOMMENDATION (RECOMMENDS AGAINST) |
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| I RECOMMENDATION (INSUFFICIENT EVIDENCE TO RECOMMEND FOR OR AGAINST) |
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TABLE 2
Meaning of recommendations by the USPSTF
| A RECOMMENDATION: STRONGLY RECOMMENDS |
| The USPSTF found good evidence that the service improves important health outcomes and concludes that benefits substantially outweigh harms. |
| B RECOMMENDATION: RECOMMENDS |
| The USPSTF found at least fair evidence that the service improves important health outcomes and concludes that benefits outweigh harms. |
| C RECOMMENDATION: NO RECOMMENDATION FOR OR AGAINST |
| The USPSTF found at least fair evidence that the service can improve health outcomes but concludes that the balance of the benefits and harms is too close to justify a general recommendation. |
| D RECOMMENDATION: RECOMMENDS AGAINST |
| The USPSTF found at least fair evidence that the service is ineffective or that harms outweigh benefits. |
| I RECOMMENDATION: INSUFFICIENT EVIDENCE TO RECOMMEND FOR OR AGAINST |
| Evidence that the service is effective is lacking, of poor quality, or conflicting and the balance of benefits and harms cannot be determined. |
Sexually transmitted infections
Among the conditions studied in 2005 were gonorrhea, herpes simplex virus (HSV), and human immunodefeciency virus (HIV). The recommendations were different for each. The task force strongly recommends (A recommendation) screening all pregnant women and all high-risk adolescents and adults for HIV. No recommendation is made regarding HIV screening in adolescents and adults who are not at high risk.
The task force recommends (B recommendation) screening high-risk women for gonorrhea, including those who are pregnant.
It recommends against (D recommendation) screening for gonorrhea in men and women at low risk and believes there is insufficient evidence (I recommendation) to advocate for or against screening men at high risk and pregnant women at low risk. It recommends against screening for HSV during pregnancy and among asymptomatic adolescents and adults.
The Task Force defines high risk a little differently for gonorrhea and HIV. These definitions are listed in TABLE 3.
What the C and I recommendations do and do not mean. Keep several points in mind regarding these recommendations. When no recommendation is made for or against (C recommendation), it signifies there is evidence of some benefit but not clear enough to outweigh harms. An I recommendation means that there is not enough quality evidence to make a recommendation. These 2 recommendations are often misinterpreted as a recommendation against the service, which they are not.