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Comparison of sexually transmitted disease prevalence by
reported level of condom use among patients attending an urban sexually
transmitted
disease clinic.
Sexually Transmitted Diseases 2004;31(3):154-160.
Shlay JC, McClung MW, Patnaik JL, Douglas JM Jr.
Abstract
BACKGROUND: There is controversy as to the protective effect of condoms in
preventing various sexually transmitted diseases (STDs). GOAL: The goal of
this study was to assess the association of various levels of condom use
with a variety of STD. STUDY DESIGN: We conducted a cross-sectional study
of female and heterosexual male visits to an urban STD clinic between 1990
and 2001. METHODS: Prevalence rates were calculated for gonorrhea, chlamydia,
trichomonas, recent-onset genital warts, first-episode herpes, and molluscum
contagiosum by reported level of condom use over the past 4 months, with
adjusted odds ratios (AOR) calculated by logistic regression. RESULTS: Among
126,220 patient visits (39% women and 61% men), condom use over the past
4 months was reported by 54%, with 38% reporting inconsistent use and 16%
consistent use. Condom users reported greater sexual risk in the past 4 months
than nonusers (ie, new sex partners: 63% vs. 41%, P <0.001; multiple sex
partners: 60% vs. 36%, P <0.001). When all condom users were compared
with nonusers, there was limited evidence of protection against specific
STD. However, when the analysis was restricted to condom users, infection
rates were significantly lower in consistent than inconsistent users for
both men and women for gonorrhea (AOR, 0.87 and 0.71, respectfully) and chlamydia
(AOR, 0.66 and 0.74, respectfully), for trichomonas in women (AOR, 0.87),
and for genital herpes in men (AOR, 0.73). CONCLUSIONS: Comparisons of STD
between condom users and nonusers are confounded by greater sexual risk in
users. Comparing consistent with inconsistent users reduces this confounding,
revealing protection for both men and women for nonviral STD and for genital
herpes for men.