Comparison of sexually transmitted disease prevalence by reported level of condom use among patients attending an urban sexually transmitted disease clinic.
BACKGROUND
There is controversy as to the protective effect of condoms in preventing various sexually transmitted diseases (STDs).


OBJECTIVE
The goal of this study was to assess the association of various levels of condom use with a variety of STD.


METHODS
We conducted a cross-sectional study of female and heterosexual male visits to an urban STD clinic between 1990 and 2001.


METHODS
Prevalence rates were calculated for gonorrhea, chlamydia, trichomonas, recent-onset genital warts, first-episode herpes, and molluscum contagiosum by reported level of condom use over the past 4 months, with adjusted odds ratios (AOR) calculated by logistic regression.


RESULTS
Among 126,220 patient visits (39% women and 61% men), condom use over the past 4 months was reported by 54%, with 38% reporting inconsistent use and 16% consistent use. Condom users reported greater sexual risk in the past 4 months than nonusers (ie, new sex partners: 63% vs. 41%, P <0.001; multiple sex partners: 60% vs. 36%, P <0.001). When all condom users were compared with nonusers, there was limited evidence of protection against specific STD. However, when the analysis was restricted to condom users, infection rates were significantly lower in consistent than inconsistent users for both men and women for gonorrhea (AOR, 0.87 and 0.71, respectfully) and chlamydia (AOR, 0.66 and 0.74, respectfully), for trichomonas in women (AOR, 0.87), and for genital herpes in men (AOR, 0.73).


CONCLUSIONS
Comparisons of STD between condom users and nonusers are confounded by greater sexual risk in users. Comparing consistent with inconsistent users reduces this confounding, revealing protection for both men and women for nonviral STD and for genital herpes for men.
Shlay
Judith C
JC
Department of Public Health, Denver Health and Hospital Authority, Denver, Colorado 80204-4507, USA. jdshay@DHHA.org
McClung
Melissa W
MW
Patnaik
Jennifer L
JL
Douglas
John M
JM
D000293:Adolescent; D000328:Adult; D000368:Aged; D003120:Colorado / Q000453:epidemiology; D017280:Condoms / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D012306:Risk; D012725:Sexual Behavior; D012749:Sexually Transmitted Diseases / Q000453:epidemiology / Q000517:prevention & control*; D014505:Urban Population