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Biological Markers of Sexual Activity: Tools for Improving Measurement in HIV/Sexually Transmitted Infection Prevention Research

Gallo, Maria F. PhD*; Steiner, Markus J. PhD; Hobbs, Marcia M. PhD; Warner, Lee PhD*; Jamieson, Denise J. MD, MPH*; Macaluso, Maurizio MD, DrPH§

Sexually Transmitted Diseases: June 2013 - Volume 40 - Issue 6 - p 447–452
doi: 10.1097/OLQ.0b013e31828b2f77

Research on interventions to prevent HIV and other sexually transmitted infections (STIs) is heavily influenced by participant reporting of sexual behavior, despite uncertainty about its validity. Exclusive reliance on participant self-report often is based, overtly or by implication, on 4 assumptions: (1) no feasible alternatives exist; (2) misreporting can be minimized to levels that can be disregarded; (3) misreporting tends to underreport sensitive behaviors; and (4) misreporting tends to be nondifferential with respect to the groups being compared. The objective of this review are to evaluate these assumptions, including a review of studies using semen biomarkers to evaluate the validity of self-reported data, and to make recommendations for applying biological markers of semen exposure detectable in women to further strengthen research on HIV/STI prevention. Increasing evidence shows that semen biomarkers provide an important means of assessing and augmenting the validity of studies on HIV/STI prevention. Additional biomarkers are needed to assess male exposure to vaginal sex and both male and female exposure to anal sex. Methods and study designs that incorporate biomarkers into studies collecting self-reported behavioral data should be considered where possible.

Biological markers of semen exposure women can be applied to strengthen research on prevention of HIV/sexually transmitted infections.

From the *Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA; †FHI 360, Research Triangle Park, NC; ‡Departments of Medicine and Microbiology & Immunology, University of North Carolina, Chapel Hill, NC; and §Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH

The authors thank Susie Childrey for assistance in creating the figure and Peggy Williams for her editorial assistance.

Conflicts of interest and source of funding: None.

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention or FHI 360.

Correspondence: Maria F. Gallo, PhD, Division of Reproductive Health, 4770 Buford Highway, Mail Stop K-34, Atlanta, GA 30341-3724. E-mail:

Received for publication September 11, 2012, and accepted January 2, 2013.

© Copyright 2013 American Sexually Transmitted Diseases Association