title: Randomized controlled trial on the effectiveness of counseling messages for avoiding unprotected sexual intercourse during sexually transmitted infection and reproductive tract infection treatment among female sexually transmitted infection clinic patients.
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 to 10.5). 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.
authors: Comprehensive Health Centre/Epidemiology Research and Training Unit, Jamaica Ministry of Health, Kingston, Jamaica.
authors: Clive
authors: C
authors: Anderson
authors: Maria F
authors: MF
authors: Gallo
authors: Tina
authors: T
authors: Hylton-Kong
authors: Markus J
authors: MJ
authors: Steiner
authors: Marcia M
authors: MM
authors: Hobbs
authors: Maurizio
authors: M
authors: Macaluso
authors: J Peter
authors: JP
authors: Figueroa
authors: Denise J
authors: DJ
authors: Jamieson
authors: Jennifer
authors: J
authors: Legardy-Williams
authors: Jeffrey
authors: J
authors: Wiener
authors: Lee
authors: L
authors: Warner
mesh_terms: D000328:Adult; D000553:Ambulatory Care; D015415:Biomarkers / Q000032:analysis; D003075:Coitus; D017280:Condoms / Q000706:statistics & numerical data*; D037001:Directive Counseling; D005260:Female; D006801:Humans; D007563:Jamaica / Q000453:epidemiology; D017430:Prostate-Specific Antigen / Q000032:analysis*; D060737:Reproductive Tract Infections / Q000453:epidemiology; D012307:Risk Factors; D012309:Risk-Taking; D012661:Semen / Q000737:chemistry; D012746:Sexual Abstinence / Q000706:statistics & numerical data; D012749:Sexually Transmitted Diseases / Q000453:epidemiology / Q000517:prevention & control*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D047568:Unsafe Sex / Q000517:prevention & control* / Q000706:statistics & numerical data*; D014621:Vagina / Q000737:chemistry; D014626:Vaginal Smears
chemical_list: D015415:Biomarkers; D017430:Prostate-Specific Antigen