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Clive Anderson,
Maria F Gallo, Tina Hylton-Kong,
Markus J Steiner,
Marcia M Hobbs,
Maurizio Macaluso,
J Peter Figueroa,
Denise J Jamieson,
Jennifer Legardy-Williams,
Jeffrey Wiener,
Lee Warner
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ABSTRACT: BACKGROUND: The effectiveness of counseling messages to avoid unprotected sex during short-term treatment for curable sexually transmitted infections is unknown. METHODS: We randomized 300 female STI clinic patients 18 years or older with cervicitis and/or vaginal discharge in Kingston, Jamaica, in 2010 to 2011, to 1 of 2 counseling messages for their course of syndromic treatment: abstinence only or abstinence backed up by condom use. At a follow-up visit 6 days afterward, we collected vaginal swabs to test for prostate-specific antigen (PSA), a biological marker of recent semen exposure, and administered a questionnaire assessing sexual behavior. RESULTS: No differences were found in the proportions of women testing positive for PSA at follow-up in the abstinence-plus-condom group (11.9%) and abstinence-only group (8.4%) (risk difference, 3.5; 95% confidence interval, -3.5 to10.5). There also was no significant difference in reporting of unprotected sex between groups. Reporting a history of condom use before enrollment significantly modified the effect of counseling arm on PSA positivity (P = 0.03). Among those reporting recent condom use, 10.3% in the abstinence-only arm and 4.8% in the abstinence-plus-condom arm tested positive for PSA. Conversely, among those not reporting recent condom use, 6.5% in the abstinence-only arm and 17.3% in the abstinence-plus-condom arm had PSA detected. CONCLUSIONS: We found no evidence to support the superiority of either counseling message. Post hoc analyses suggest that women with recent condom experience may benefit significantly more from abstinence-plus-condom messages, whereas women without such experience may benefit significantly more from abstinence-only messages. Providers should weigh individual condom use history when determining the most appropriate counseling message.
Sexually transmitted diseases 02/2013; 40(2):105-110. · 2.58 Impact Factor
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ABSTRACT: Because of limitations in observational studies, a randomized controlled trial (RCT) would help clarify whether hormonal contraception increases the risks of acquiring a sexually transmitted infection (STI). However, the feasibility of such a trial is uncertain.
We conducted a study to assess the feasibility of conducting a RCT that would compare the acquisition risk for Chlamydia trachomatis and Neisseria gonorrhoeae in women randomized to an intrauterine device (IUD) or depot medroxyprogesterone acetate (DMPA). In our cross-sectional survey conducted at three clinics, we gave information on a potential RCT to clients, asked them questions to assess comprehensibility and finally asked respondents whether they would consider enrolling in such a trial. In addition, the 190 participants provided urine or endocervical swab specimens so we could estimate the prevalence of STIs.
Overall, 70% of participants stated that they would take part in a future trial and accept randomization to either the IUD or DMPA. Participant understanding of the trial requirements was high. Twenty-nine percent of the participants were infected with either N. gonorrhoeae or C. trachomatis.
With a high prevalence of STI in this population and the apparent willingness of appropriate candidates to participate, an RCT to measure risks of incident STI infection from hormonal contraception appears feasible.
Contraception 06/2008; 77(5):366-70. · 2.72 Impact Factor
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ABSTRACT: To evaluate the association between self-reported condom use and prevalent and incident chlamydia, gonorrhea, and trichomoniasis.
Prospective study of 414 males attending a sexually transmitted infection (STI) clinic in Jamaica. Condom use and STI status were assessed at enrollment and at 4 follow-up visits.
The analyses on condom use and prevalent STI included data from 414 men, while those on incident STI were based on 1111 intervals from 355 men. We diagnosed prevalent STI (chlamydia, gonorrhea, and/or trichomoniasis) in 54.6% (n = 226) of the participants at enrollment. About 14% (n = 51) of participants had at least 1 of the study STIs during follow-up. Follow-up visits in which participants reported consistent condom use (100% of acts) for the past 7 days had less incident STI (adjusted OR, 0.4; 95% CI, 0.2-0.9) compared with visits where no condom use was reported. Self-reported condom use was more closely correlated with incident than prevalent STI. For example, the adjusted OR for prevalent infection for participants reporting consistent versus no condom use in past 7 days was 0.7 (95% CI, 0.4-1.2). Classifications based on the number of unprotected acts yielded findings similar to those based on the proportion of acts protected.
Consistent condom use was associated with reduced risk of incident urethral STI. Research on condom effectiveness should focus on incident STI outcomes, where the temporal relationship between condom use and infection is clearer.
Sex Transm Dis 11/2007; 34(10):829-33. · 2.87 Impact Factor
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ABSTRACT: Our objective was to evaluate condom failure (breakage and slippage) rates before and those during a trial that provided instructions on correct condom use.
Our analysis was based on 314 men who presented with urethral discharge at Jamaica's largest sexually transmitted infection clinic and were enrolled into our 6-month trial.
Participants reported breaking 18.5% (95% confidence interval=12.8-24.1%) of their condoms during the 7 days prior to the screening visit and having 3.5% (95% confidence interval=1.2-5.7%) of their condoms slip off completely. After the condom counseling provided during the screening visit, breakage rates decreased (p<.05) and remained below 10% throughout the trial. During in-depth interviews, the men who reported frequent condom failures cited (1) improper storage/exposure to heat, (2) improper handling while putting on condoms and (3) use of lubricants/improper lubricants as the possible reasons for their high failure rates.
Although the rates of reported condom breakage and slippage decreased significantly after counseling, we need to improve the quality of condom counseling to further reduce failure rates.
Contraception 05/2007; 75(4):289-93. · 2.72 Impact Factor
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ABSTRACT: The objective of this study was to assess whether providing a choice of condoms would increase condom acceptability, increase self-reported use, and decrease incident sexually transmitted infection.
We randomized 414 men presenting with urethral discharge in Jamaica to receive either the "standard" clinic condom or a choice of 4 different types of condoms. Men were treated presumptively at enrollment and followed up at 1, 2, 4, and 6 months.
Participants in the choice group had a strong preference (P <0.01) for the most popular condom available in Jamaica. This preference did not translate into higher condom use (P = 0.16). The 6-month cumulative probability of first incidence of gonorrhea, chlamydia, or trichomoniasis was slightly higher in the choice group (21%; 95% confidence interval [CI], 15-28%) versus the control group (17%; 95% CI, 11-23%); the difference in the survival curves was not significant (P = 0.35).
A choice of condoms may increase perceived acceptability but not lead to increased condom use and subsequently lower sexually transmitted infection rates.
Sex Transm Dis 01/2006; 33(1):31-5. · 2.87 Impact Factor
