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Use and Effectiveness of Condoms During Anal Intercourse: A Review

SILVERMAN, BARBARA G. MD, MPH; GROSS, THOMAS P. MD, MPH

Sexually Transmitted Diseases: January 1997 - Volume 24 - Issue 1 - p 11–17
Original Article

Background and Objectives: Anal intercourse has been associated with a high risk of human immunodeficiency virus transmission. Survey data suggest that unprotected anal intercourse is practiced by a substantial proportion of the sexually active population, regardless of sexual orientation.

Goal: To review the literature related to the use and effectiveness of condoms during anal intercourse, with emphasis on prevention of human immunodeficiency virus transmission.

Study Design: Literature review.

Results: Epidemiologic studies have shown that consistent, correct condom use reduces the overall risk of sexual transmission of human immunodeficiency virus. Evidence for the effectiveness of condoms used during anal intercourse is less definitive. Survey and clinical trials data indicate that condom breakage and slippage rates vary during anal intercourse and may be considerably higher than during vaginal intercourse. Although condoms designed for anal intercourse have been studied and marketed in Europe, data on their actual performance are scarce. In addition, no information exists on the effectiveness of polyurethane or other nonlatex condoms for use during anal intercourse.

Conclusions: Development of newer and more effective condoms for use during anal intercourse requires consideration of the ethical issues involved in testing and marketing devices used during an activity that carries with it the potential for a substantial risk to health.

From the Office of Surveillance and Biometrics, Center For Devices and Radiological Health, U. S. Food and Drug Administration

The authors thank Donald E. Marlowe, MSE, Nancy Alexander, PhD, Pamela Stratton, MD, and D. Bruce Burlington, MD, for their review and comment on the manuscript.

The opinions or assertions presented herein are the private views of the authors and are not to be construed as conveying either an official endorsement or criticism by the U.S. Department of Health and Human Services, the Public Health Service, or the U.S. Food and Drug Administration.

Reprint requests: Barbara G. Silverman, MD, MPH, U.S. Food and Drug Administration, Center for Devices and Radiological Health, 1350 Piccard Drive, Room 3080A HFZ-541, Rockville, MD 20850.

Received for publication December 8, 1995, revised March 14, 1996, and accepted April 5, 1996.

© Copyright 1997 American Sexually Transmitted Diseases Association