title: Problems with condom use among patients attending sexually transmitted disease clinics: prevalence, predictors, and relation to incident gonorrhea and chlamydia.
abstract: Condom use remains important for sexually transmitted disease (STD) prevention. This analysis examined the prevalence of problems with condoms among 1,152 participants who completed a supplemental questionnaire as part of Project RESPECT, a counseling intervention trial conducted at five publicly funded STD clinics between 1993 and 1997. Altogether, 336 participants (41%, 95% confidence interval: 38, 45) reporting condom use indicated that condoms broke, slipped off, leaked, or were not used throughout intercourse in the previous 3 months. Correspondingly, 8.9% (95% confidence interval: 7.0, 9.5) of uses resulted in STD exposure if partners were infected because of delayed application of condoms (4.3% of uses), breakage (2.0%), early removal (1.4%), slippage (1.3%), or leakage (0.4%). Use problems were significantly associated with reporting inconsistent condom use, multiple partners, and other condom problems. One-hundred thirty participants completing the questionnaire were tested for gonorrhea and chlamydia at this time and also 3 months earlier. Twenty-one (16.2%) were infected with incident gonorrhea and chlamydia, with no infections among consistent users reporting no use problems. Exact logistic regression revealed a significant dose-response relation between increased protection from condom use and reduced gonorrhea and chlamydia risk (p(trend) = 0.032). Both consistency of use and use problems must be considered in studies of highly infectious STD to avoid underestimating condom effectiveness.
authors.affiliation: National Center for Chronic Disease Prevention and Health Promotion, Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA. dlw7@cdc.gov
authors.forename: Lee
authors.initials: L
authors.lastname: Warner
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Newman
authors.forename: Mary L
authors.initials: ML
authors.lastname: Kamb
authors.forename: Martin
authors.initials: M
authors.lastname: Fishbein
authors.forename: John M
authors.initials: JM
authors.lastname: Douglas
authors.forename: Jonathan
authors.initials: J
authors.lastname: Zenilman
authors.forename: Laura
authors.initials: L
authors.lastname: D'Anna
authors.forename: Gail
authors.initials: G
authors.lastname: Bolan
authors.forename: Judy
authors.initials: J
authors.lastname: Rogers
authors.forename: Thomas
authors.initials: T
authors.lastname: Peterman
mesh_terms: D002690:Chlamydia Infections / Q000453:epidemiology*; D017280:Condoms / Q000706:statistics & numerical data*; D018562:Disease Transmission, Infectious / Q000517:prevention & control; D004868:Equipment Failure; D005260:Female; D005500:Follow-Up Studies; D006069:Gonorrhea / Q000453:epidemiology*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D015994:Incidence; D008297:Male; D015999:Multivariate Analysis; D012307:Risk Factors; D012725:Sexual Behavior; D012749:Sexually Transmitted Diseases / Q000517:prevention & control; D011795:Surveys and Questionnaires