Condom use and use-effectiveness in high-risk populations

Sex Transm Dis. Jul-Sep 1989;16(3):157-60. doi: 10.1097/00007435-198907000-00008.

Abstract

In vitro evidence strongly suggests that latex condoms provide an impenetrable barrier for the passage of infectious agents, but few have studied the use-effectiveness of condoms in preventing sexually transmitted diseases. In 1971, a prospective evaluation of the condom failed to demonstrate efficacy against infections with gonorrhea because users were exposed to infectious secretions before the condom was used. An ongoing multicenter study of female prostitutes in the United States shows that none of 22 women who always use condoms with all male partners has antibody to human immunodeficiency virus (HIV), but differences in HIV antibody status by patterns of condom use are not statistically significant. An educational campaign to promote the proper and consistent use of condoms as prophylactics is needed to stop the spread of gonorrhea, infections with HIV, and other sexually transmitted diseases.

PIP: Despite in vitro evidence of the effectiveness of latex condoms in preventing the passage of infectious agents, there have been few studies of condom's use-effectiveness in terms of the transmission of sexually transmitted diseases (STDs). The Sacramento (California) Special Study sought to address this research gap through a survey of all patients presenting to the County Health Department from May 24-August 13, 1971. Patients were asked to complete a questionnaire and given a coupon that could be exchanged for 3 regular and 3 lubricated condoms. Of the 2045 individuals who visited the clinic during the study period, 557 (27%) accepted condoms. These acceptors were significantly more likely to be male, Black, or Hispanic and to have histories of both previous condom use (43%) and gonococcal infection (31%). Of the 122 patients who returned to the clinic for follow-up and had sexual intercourse since the last visit, 91 (75%) had not used a condom at any time in this period, 21 (17%) had used a condom at least once, and 10 (8%) had used a condom at each sexual exposure. There was no significant difference between users and nonusers in terms of whether they were diagnosed with nongonococcal urethritis, gonorrhea, and other STDs at the follow-up visit. However, questioning of condom users who presented with reinfection with gonorrhea indicated that, in some cases, the condom was not put on until the man had already been exposed to vaginal fluids. This suggests a need for thorough education on proper condom use, including avoidance of all exposure to infectious semen, blood, and vaginal secretions.

Publication types

  • Clinical Trial
  • Multicenter Study

MeSH terms

  • Centers for Disease Control and Prevention, U.S.
  • Contraceptive Devices, Male*
  • Female
  • HIV Seropositivity / epidemiology*
  • Humans
  • Male
  • Multicenter Studies as Topic
  • Risk Factors
  • Sex Factors
  • Sex Work
  • Sexually Transmitted Diseases / prevention & control*
  • Socioeconomic Factors
  • Surveys and Questionnaires
  • United States