title: Condom use to prevent incident STDs: the validity of self-reported condom use.
abstract: BACKGROUND
  Studies of sexual behavior and of interventions designed to reduce human immunodeficiency virus risk usually depend on self-report. Validation of self-reported condom use measures has not been previously reported in an urban population at high risk for sexually transmitted diseases and human immunodeficiency virus.
  
  
  METHODS
  A prospective cohort study was performed in subjects recruited from sexually transmitted disease clinics in Baltimore. At enrollment, a questionnaire was administered that assessed human immunodeficiency virus risk factors and sexually transmitted disease history, and used a retrospective calendar to assess sexual events and condom use over the previous 30 days. Clinical evaluation was performed for sexually transmitted diseases. At follow-up 3 months later, the same procedures were repeated. Incident sexually transmitted diseases at follow-up were defined as new culture or serologically documented diagnoses of gonorrhea, chlamydia, syphilis, or trichomoniasis.
  
  
  RESULTS
  In the 323 male and 275 female (total = 598) subjects who completed a follow-up visit, 21% reported using condoms for every act of sexual intercourse over the previous 30 days, 21% reported occasionally using condoms, and 59% reported not using condoms. At follow-up, 21% of subjects had new incident gonorrhea, chlamydia, syphilis, or trichomoniasis. Fifteen percent of the men who were "always" condom users had incident sexually transmitted diseases compared with 15.3% of "never users;" 23.5% of women who were "always" users had incident sexually transmitted diseases compared with 26.8% of "never" users.
  
  
  CONCLUSIONS
  In this high-risk population, self-reported condom use is not associated with lower sexually transmitted disease incidence. This finding suggests that self-reported condom use measures, even in a research setting, may be subject to substantial reporting bias.
authors.affiliation: Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD 21205-2196.
authors.forename: J M
authors.initials: JM
authors.lastname: Zenilman
authors.forename: C S
authors.initials: CS
authors.lastname: Weisman
authors.forename: A M
authors.initials: AM
authors.lastname: Rompalo
authors.forename: N
authors.initials: N
authors.lastname: Ellish
authors.forename: D M
authors.initials: DM
authors.lastname: Upchurch
authors.forename: E W
authors.initials: EW
authors.lastname: Hook
authors.forename: D
authors.initials: D
authors.lastname: Celentano
mesh_terms: D000328:Adult; D015142:Baltimore / Q000453:epidemiology; D017280:Condoms / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000517:prevention & control; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015203:Reproducibility of Results; D017678:Sex Distribution; D012749:Sexually Transmitted Diseases / Q000453:epidemiology / Q000517:prevention & control*; D011795:Surveys and Questionnaires / Q000592:standards*