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The effect of correct and consistent condom use on chlamydial and
gonococcal infection among urban adolescents.
Archives of Pediatrics & Adolescent Medicine 2005;159(6):536-542.
Paz-Bailey G, Koumans EH, Sternberg M, Pierce A, Papp J, Unger ER, Sawyer
M, Black CM, Markowitz LE.
Abstract
OBJECTIVE: To evaluate the relationship between self-reported correct and consistent
condom use and chlamydial and gonococcal infection. DESIGN: Cross-sectional
study. SETTING: An urban adolescent health care clinic.Patients A total of
509 adolescent girls tested for Chlamydia trachomatis and Neisseria gonorrhoeae
infection by urine nucleic acid amplification tests.Main Outcome Measure
Effect of condom use on infection rates of chlamydia and gonorrhea. Consistent
condom use was defined as using condoms for every act of vaginal sex and
correct use as consistent use without any of the following: beginning sex
without a condom, taking it off before finishing sex, flipping it over, condom
breakage, or condom slippage. RESULTS: A total of 95% of the participants
were African American, with a mean age of 16.6 years. Chlamydia prevalence
was 21% (105/509) and gonorrhea prevalence was 7% (36/509). Condom errors
were reported by 316 (71%) of 442 participants who had reported using a condom
at least once in the previous 3 months. Consistent use was reported by 176
patients (35%); however, both correct and consistent use was reported by
only 80 patients (16%). After adjusting for confounders, correct and consistent
use was protective for chlamydia (odds ratio, 0.4; 95% confidence interval,
0.2-1.0) and highly protective for gonorrhea (odds ratio, 0.1; 95% confidence
interval, 0-0.7). CONCLUSION: Our findings indicate that assessing both correctness
and consistency of use is important for evaluation of condom effectiveness.