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Condom Use and Risk of Gonorrhea and Chlamydia: A Systematic Review of Design and Measurement Factors Assessed in Epidemiologic Studies

Warner, Lee PhD, MPH*†; Stone, Katherine M. MD; Macaluso, Maurizio MD, DrPH*; Buehler, James W. MD; Austin, Harland D. DSc

Sexually Transmitted Diseases: January 2006 - Volume 33 - Issue 1 - p 36-51
doi: 10.1097/01.olq.0000187908.42622.fd
Article

Background: Studies of condom use to reduce risk of most sexually transmitted infection provide inconsistent results. This inconsistency is often attributed to methodologic limitations yet has not been assessed systematically.

Objectives: The objectives of this study were to review studies of condom use and risk of gonorrhea and chlamydia, and to evaluate the importance of 4 key design and measurement factors on condom effectiveness estimates.

Design: We reviewed studies published 1966–2004 to assess risk reduction for gonorrhea and/or chlamydia associated with male condom use.

Results: Of 45 studies identified, most found reduced risk of infection associated with condom use. All studies reviewed had methodologic limitations: only 28 (62%) distinguished consistent from inconsistent use; 2 (4%) reported on correct use or use problems; 13 (29%) distinguished incident from prevalent infection; and one (2%) included a population with documented exposure to infection. Eight of 10 studies with 2 or more of these attributes reported statistically significant protective effects for condom use versus 15 of 35 studies with zero or one attribute (80% vs. 43%, P = 0.04).

Conclusions: Condom use was associated with reduced risk of gonorrhea and chlamydia in men and women in most studies, despite methodologic limitations that likely underestimate condom effectiveness. Epidemiologic studies that better address these factors are needed to provide more accurate assessment of condom effectiveness.

A systematic review found that condom use reduced risk of gonorrhea and chlamydia in men and women in most studies, despite methodologic limitations that would underestimate condom effectiveness.

From the *National Center for Chronic Disease Prevention and Health Promotion, Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia; †Department of Epidemiology, Rollins School of Public Health of Emory University, Atlanta, Georgia; ‡National Center for HIV, STD, and TB Prevention, Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia

The authors thank Ward Cates, Thomas Peterman, Dan Newman, Markus Steiner, Kate Curtis, Eileen Dunne, and John McGowan for their thoughtful comments and review of the manuscript. The authors also thank Summer Martins for providing invaluable assistance with development of Figure 1.

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An earlier version of this manuscript was presented at the 2004 National STD Prevention Conference, Philadelphia, PA, March 8–11 [P116].

The findings and conclusions in this article are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.

Correspondence: Lee Warner, PhD, MPH, Centers for Disease Control and Prevention, National Center for Chronic Disease and Health Promotion, Division of Reproductive Health, 4770 Buford Highway, Mailstop K-34, Atlanta, GA 30341. E-mail: dlw7@cdc.gov.

Received for publication March 11, 2005, and accepted June 14, 2005.

© Copyright 2006 American Sexually Transmitted Diseases Association