Condom Use and Risk of Gonorrhea and Chlamydia: A Systematic Review of Design and Measurement Factors Assessed in Epidemiologic Studies

National Center for Chronic Disease Prevention and Health Promotion, Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA.
Sex Transm Dis (Impact Factor: 2.84). 02/2006; 33(1):36-51. DOI: 10.1097/01.olq.0000187908.42622.fd
Source: PubMed


Studies of condom use to reduce risk of most sexually transmitted infection provide inconsistent results. This inconsistency is often attributed to methodologic limitations yet has not been assessed systematically.
The objectives of this study were to review studies of condom use and risk of gonorrhea and chlamydia, and to evaluate the importance of 4 key design and measurement factors on condom effectiveness estimates.
We reviewed studies published 1966-2004 to assess risk reduction for gonorrhea and/or chlamydia associated with male condom use.
Of 45 studies identified, most found reduced risk of infection associated with condom use. All studies reviewed had methodologic limitations: only 28 (62%) distinguished consistent from inconsistent use; 2 (4%) reported on correct use or use problems; 13 (29%) distinguished incident from prevalent infection; and one (2%) included a population with documented exposure to infection. Eight of 10 studies with 2 or more of these attributes reported statistically significant protective effects for condom use versus 15 of 35 studies with zero or one attribute (80% vs. 43%, P = 0.04).
Condom use was associated with reduced risk of gonorrhea and chlamydia in men and women in most studies, despite methodologic limitations that likely underestimate condom effectiveness. Epidemiologic studies that better address these factors are needed to provide more accurate assessment of condom effectiveness.

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    • "Particularly, incarcerated persons are at a high risk for sexually transmitted infections (STIs). Inmates report multiple behaviors which increase the risk of STIs such as C. trachomatis, including sex with multiple partners, unprotected sex and inconsistent condom use, and substance use disorders [10-12]. Commercial sex work, which is frequent among incarcerated women, has also been associated with STIs [13,14]. "
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    ABSTRACT: Chlamydia trachomatis infection is the most common sexually transmitted infection (STI) in the western countries; its prevalence in the conservative Muslim population of Saudi Arabia is not known, but it is generally believed to be low. This study is the first to investigate the prevalence of and risk factors for C. trachomatis infection in the high-risk group of female inmates at Briman Prison in Jeddah. The inmates were interviewed using a pre-designed questionnaire, and their urine samples were tested for C. trachomatis infection by real-time PCR assay. The overall prevalence of C. trachomatis infection was 8.7% in the study population. The <=25 age group was predominantly affected, with an average prevalence of 16.6%. Two out of five (2/5, 40%) Yamani, (4/33 12.1%) Indonesian, (3/33, 9.1%) Somalian and (2/26, 7.7%) Ethiopian inmates were positive for infection. None of the Saudi inmates (0/14) were positive for infection. Among the studied variables, only age was significantly associated with the infection rate. The other variables (marital status, nationality, religion, employment status, education level, nature of the offense committed, knowledge about protection from STIs, and knowledge about condom use and the purpose of condom use) did not show a significant correlation with Chlamydia infection. The overall prevalence of C. trachomatis infection was within the range published by other reports in similar prison settings in developed countries. The results indicate the need for a countrywide screening and treatment program for all inmates at the time of entry into prison.
    BMC Public Health 03/2014; 14(1):267. DOI:10.1186/1471-2458-14-267 · 2.26 Impact Factor
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    • "Inconsistent condom use is common among heterosexuals [1] [2] [3] and increases the risk of sexually transmitted infections (STI) [4]. The decision to use condoms is based on perceived risk and beliefs [5] [6] and also perceived willingness of the partner [1]. "
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    ABSTRACT: Decisions to use condoms are made within partnerships. We examined the associations between inconsistent or no condom use and individual and partnership characteristics. We also examined the relative importance of individual versus partnership factors. Cross-sectional study of heterosexual individuals enrolled from the sexually transmitted infections (STI) outpatient clinic in Amsterdam, the Netherlands, from May to August 2010. Participants completed a questionnaire about sexual behaviour with the last four partners in the preceding year. Participant and partnership factors associated with inconsistent or no condom use in steady and casual partnerships were identified. 2144 individuals were included, reporting 6401 partnerships; 54.7% were female, the median age was 25 (IQR 22-30) years and 79.9% were Dutch. Inconsistent or no condom use occurred in 13.9% of 2387 steady partnerships and in 33.5% of 4014 casual partnerships. There was statistical evidence of associations between inconsistent condom use in steady partnerships and ethnic concordance, longer duration, higher number of sex acts, practising anal sex, and sex-related drug use. In casual partnerships, associations were found with having an older partner, ethnic concordance, longer duration, higher number of sex acts, anal sex, sex-related drug use, ongoing partnerships and concurrency. In multivariable models, partnership factors explained 50.9% of the variance in steady partnerships and 70.1% in casual partnerships compared with 10.5% and 15.4% respectively for individual factors. Among heterosexual STI clinic attendees in Amsterdam, partnership factors are more important factors related with inconsistent condom use than characteristics of the individual.
    Sexually transmitted infections 02/2014; 90(4). DOI:10.1136/sextrans-2013-051087 · 3.40 Impact Factor
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    • "Condom use at last intercourse with last partner may be associated with use at previous sexual encounters and thereby explain the protective effect against chlamydia observed in all participants. Most studies show that condom use is associated with reduced chlamydia risk in both women and men [20]. "
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    ABSTRACT: Background Early sexual behaviour has been shown to differ significantly between genders, but few studies have addressed this topic to explain the commonly observed differences in chlamydia rates between adolescent girls and boys. Our study aimed to determine chlamydia prevalence in adolescents aged 15–20 years in a high-incidence area in Norway, and to identify gender-specific early sexual behaviours associated with infection. Methods A population based cross-sectional study was conducted among all high school students in five towns in Finnmark county in 2009, using a web-based questionnaire and real-time Chlamydia trachomatis PCR in first-void urine samples (participation rate 85%, 800 girls/818 boys, mean age 17.2 years). Crude and multivariable logistic regression models were applied with chlamydia test result as dependent variable. Results Prevalence of chlamydia infection was 5.7% (95% confidence interval, CI, 4.4–7.3%). Girls were twice as likely to be infected as boys (7.3%, 5.3–9.7 vs 3.9%, 2.3–6.0). Girls reported earlier sexual debut, older partners, higher lifetime number of partners, and were poorer condom users. In girls, higher maternal education (odds ratio, OR, 2.2, 95% CI 1.1–4.4), ≥2 sexual partners past 6 months (OR 3.6, 1.8–7.3), and partner meeting venue at a private party, bar or disco (OR 5.0, 1.1–22.7) increased the odds of infection in the multivariable model. In boys, condom use at first intercourse (OR 0.06, 0.01–0.42) decreased the odds of infection, while having an older last sexual partner (OR 3.7, 1.3–11.0) increased the odds. In all participants, the risk of infection increased if residence outside the family home during school year (OR 2.0, 1.2–3.6), and decreased if condom was used at last intercourse (OR 0.2, 0.1–0.8). Conclusions We detected significant gender differences in chlamydia prevalence and sexual behaviours, and accordingly differing independent risk factors for chlamydia infection. We suggest that accumulation of essentially different experiences in the early sexually active years contribute to gender disparities in chlamydia risk in individuals this age. Gender-specific approaches may be the best alternative to control chlamydia infection in age group 15–20 years.
    BMC Infectious Diseases 11/2012; 12(1):319. DOI:10.1186/1471-2334-12-319 · 2.61 Impact Factor
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