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Open Access Article << Previous     |     Next >>   Contents Vol 9(1)

Condom effectiveness: where are we now?

Richard Crosby A B C and Sarah Bounse A

A College of Public Health, University of Kentucky, 121 Washington Avenue, Lexington, KY 40506-0003, USA.
B The Kinsey Institute for Research in Sex, Gender, and Reproduction, Morrison Hall 313, 1165 East Third Street, Bloomington, IN47405, USA.
C Corresponding author. Email: crosby@uky.edu

Sexual Health 9(1) 10-17 http://dx.doi.org/10.1071/SH11036
Submitted: 2 March 211  Accepted: 20 June 2011   Published: 17 October 2011

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After performing a review of prospective cohort evaluations, a focussed assessment of the current knowledge base and methodology pertaining to condom effectiveness against sexually transmissible infections, including HIV, was also conducted. Key observations included the point that studies of condom effectiveness are inherently complex and the potential forms of study bias all generally favour the null hypothesis. Perhaps the most challenging obstacle to rigor in these studies lies in determining which events of condom-protected sex occurred before infection as opposed to after infection when, in fact, infection occurs. This problem leads to misclassification bias; however, other sources of misclassification bias are common. Greater attention to the selection of a recall period, improved precision of self-reported measures, and accounting for condom use errors and problems are critical steps that must occur to promote rigor in these studies. Despite multiple shortcomings, prospective studies of condom effectiveness provide a reasonably favourable evaluation. Subsequent studies, however, should be designed to greatly reduce the error variance that predisposes condom effectiveness studies to type 2 errors that mask the potential value of condoms.

Additional keywords: misclassification bias, rigor, study design.


[1]  Lytle CD. An in vitro evaluation of condoms as barriers to a small virus. Sex Transm Dis 1997; 24: 161–4.
CrossRef |

[2]  United States Department of Health and Human Services (USDoHaHS). Workshop summary: scientific evidence on condom effectiveness for sexually transmitted disease (STI) prevention. USDoHaHS; Available online at: http://www.niaid.nih.gov/about/organization/dmid/documents/condomreport.pdf [verified July 2001].

[3]  Cates W. The NIH condom report: the glass is 90% full. Fam Plann Perspect 2001; 33: 231–3.
CrossRef |

[4]  Holmes KK, Levine R, Weaver M. Effectiveness of condoms in preventing sexually transmitted infections. Bull World Health Organ 2004; 82: 454–461.

[5]  Warner L, Stone KM, Macaluso M, Buehler J, Austin HD. Condom use and risk of gonorrhea and chlamydia: a systematic review of design and measurement factors assessed in epidemiologic studies. Sex Transm Dis 2006; 33: 36–51.
CrossRef |

[6]  Warner L, Macaluso M, Austin HD, Kleinbaum DK, Artz L, Fleenor ME, et al Application of the case-crossover design to reduce unmeasured confounding in studies of condom effectiveness. Am J Epidemiol 2005; 161: 765–73.
CrossRef |

[7]  Warner L, Newman DR, Austin HD, Kamb ML, Douglas JM. Warner L, Newman DR, Austin HD, Kamb ML, Douglas JM. Condom effectiveness for reducing transmission of gonorrhea and chlamydia: the importance of assessing partner infection status. Am J Epidemiol 2004; 159: 242–51.
CrossRef |

[8]  Winer RL, Hughes JP, Feng Q, O’Reilly S, Kiviat NB, Holmes KK, et al Condom use and the risk of genital human papillomavirus infection in young women. N Engl J Med 2006; 354: 2645–54.
CrossRef |

[9]  Hogewoning CJA, Bleeker MCG, van den Brule AJC, Voorhorst FJ, Snijders PJF, Berkhof J, et al Condom use promotes regression of cervical intraepithelial neoplasia and clearance of human papillomavirus: a randomized controlled trial. Int J Cancer 2003; 107: 811–6.
CrossRef |

[10]  Crosby RA, DiClemente RJ, Holtgrave DR, Wingood GM. Design, measurement, and analytic considerations for testing hypotheses relative to condom effectiveness against non-viral STIs. Sex Transm Infect 2002; 78: 228–31.
CrossRef |

[11]  Crosby RA, Salazar LF, DiClemente RJ, Yarber WL, Caliendo AM, Staples-Horne M. Accounting for failures may improve precision: evidence supporting improved validity of self-reported condom use. Sex Transm Dis 2005; 32: 513–5.
CrossRef |

[12]  De Vincenzi I. A longitudinal study of human immunodeficiency virus transmission by heterosexual partners. N Engl J Med 1994; 331: 341–6.
CrossRef |

[13]  Saracco A, Musicco M, Nicolosi A. Man-to-woman sexual transmission of HIV: longitudinal study of 343 steady partners of infected men. J AIDS 1993; 6: 497–502.

[14]  Weller SC, Davis-Beaty K. Condom effectiveness in reducing heterosexual HIV transmission Cochrane Database of Systematic Reviews 2002; : .
CrossRef |

[15]  Peterman TA, Lin LS, Newman DR, Kamb ML, Bolan G, Zenilman J, et al Does measured behavior reflect STD risk? An analysis of data from a randomized controlled behavioral intervention study. Sex Transm Dis 2000; 27: 446–51.
CrossRef |

[16]  Zimmerman RS, Atwood KA, Cupp PK. Improving validity of self-reports for sensitive behaviors. In: RJ DiClemente, RA Crosby, LF Salazar, editors. Research methods for health promotion. San Francisco: Jossey-Bass Wiley; 2006. pp. 229–259.

[17]  Fairley CK, Sze JK, Vodstrcil LA, Chen MY. Computer-assisted self interviewing in sexual health clinics. Sex Transm Dis 2010; 37: 665–8.
CrossRef |

[18]  Steiner KC, Davila V, Kent CK, Chaw JK, Fischer L, Klausner JD, et al Field-delivered therapy increases treatment for chlamydia and gonorrhea. Am J Public Health 2003; 93: 882–4.
CrossRef |

[19]  Rose E, DiClemente RJ, Wingood GM, Sales JM, Latham T, Crosby RA, et al The validity of self-report: data from a sexual risk-reduction trial with African American female adolescents. Arch Pediatr Adolesc Med 2009; 163: 61–4.
CrossRef |

[20]  Zenilman JM, Weisman CS, Rompalo AM, Ellish N, Upchurch DM, Hook EW. Zenilman JM, Weisman CS, Rompalo AM, Ellish N, Upchurch DM, Hook EW. Condom use to prevent incident STDs: the validity of self-reported condom use. Sex Transm Dis 1995; 22: 15–21.
CrossRef |

[21]  Crosby RA, DiClemente RJ, Yarber WL, Snow G, Troutman A. An event-specific analysis of condom breakage among African American men at risk of HIV acquisition. Sex Transm Dis 2008; 35: 174–7.
CrossRef |

[22]  Crosby RA, DiClemente RJ, Wingood GM, Lang D, Harrington KF. The value of consistent condom use: a study of STD prevention among African American adolescent females. Am J Public Health 2003; 93: 901–2.
CrossRef |

[23]  Crosby RA, Sanders S, Yarber WL, Graham CA, Dodge B. Condom use errors and problems among college men. Sex Transm Dis 2002; 29: 552–7.
CrossRef |

[24]  Crosby RA, Sanders SA, Yarber WL, Graham CA. Condom use errors and problems: a neglected aspect of studies assessing condom effectiveness. Am J Prev Med 2003; 24: 367–70.
CrossRef |

[25]  Sanders SA, Graham CA, Yarber WL, Crosby RA. Condom use errors and problems among young women who apply condoms on their male partners. J Am Med Womens Assoc 2003; 58: 95–8.

[26]  Macaluso M, Kelaghan J, Artz L, Austin H, Fleenor M, Hook EW. Macaluso M, Kelaghan J, Artz L, Austin H, Fleenor M, Hook EW. Mechanical failure of the latex condom in a cohort of women at high STI risk. Sex Transm Dis 1999; 26: 450–8.
CrossRef |

[27]  Mertz KJ, Finelli L, Levine WC, Mognoni RC, Berman SM, Fishbein M, et al Gonorrhea in male adolescents and young adults in Newark, New Jersey: implications of risk factors and patient preferences for prevention strategies. Sex Transm Dis 2000; 27: 201–7.
CrossRef |

[28]  Warner L, Clay-Warner J, Boles J, Williamson J. Assessing condom use practices: implications for evaluating method and user effectiveness. Sex Transm Dis 1998; 25: 273–7.
CrossRef |

[29]  Civic D, Scholes D, Ichikawa L, Grothaus L, McBride CM, Yarnall KSH, et al Ineffective use of condoms among young women in managed care. AIDS Care 2002; 14: 779–88.
CrossRef |

[30]  Richters J, Gerofi J, Donovan B. Why do condoms break or slip off in use? An exploratory study. Int J STI AIDS 1995; 6: 11–8.

[31]  Spruyt A, Steiner MJ, Joanis C, Glover LH, Piedrahita C, Alvarado G, et al Identifying condom users at risk for breakage and slippage: findings from three international sites. Am J Public Health 1998; 88: 239–44.
CrossRef |

[32]  Sanders SA, Yarber WL, Crosby RA, Graham CA. Starting early, ending late: correlates of incomplete condom use among young adults. Health Educ Monogr 2008; 25: 45–50.

[33]  Winer RL, Lee S, Hughes JP, Adam DE, Kiviat NB, Koutsky LA. Genital human papillomavirus infection: incidence and risk factors in a cohort of female university students. N Engl J Med 2003; 157: 218–26.

[34]  Winer RL, Hughes JP, Feng Q, O’Reilly S, Kiviat NB, Holmes KK, et al Condom use and the risk of genital human papillomavirus infection in young women. N Engl J Med 2006; 354: 2645–54.

[35]  Wald A, Langenberg AGM, Link K, Izu AE, Ashley R, Warren T, et al Effect of condoms on reducing the transmission of herpes simplex virus type 2 from men to women. JAMA 2001; 285: 3100–6.
CrossRef |

[36]  Koss CA, Dunne EF, Warner L. A systematic review of epidemiologic studies assessing condom use and risk of syphilis. Sex Transm Dis 2009; 36: 401–5.
CrossRef |

[37]  Levine WC, Revollo R, Kaune V, Vega J, Tinajeros F, Garnica M, et al Decline in sexually transmitted disease prevalence in female Bolivian sex workers: impact of an HIV prevention project. AIDS 1998; 12: 1899–906.
CrossRef |

[38]  Taha TE, Canner JK, Chiphangwi JD, Dallabetta GA, Yang L-P, Mtimavalye LAR, et al Reported condom use is not associated with incidence of sexually transmitted diseases in Malawi. AIDS 1996; 10: 207–12.
CrossRef |

[39]  Crosby RA, Yarber WL, Sanders SA, Graham CA. Condom use as a dependent variable: a brief commentary about classification of inconsistent users. AIDS Behav 2004; 8: 99–103.
CrossRef |

[40]  Burstein GR, Gaydos CA, Diener-West M, Howell MR, Zenilman JM, Quinn TC. Incident Chlamydia trachomatis infections in inner-city adolescent females. JAMA 1998; 280: 521–6.
CrossRef |

[41]  Baeten JM, Nyange PM, Richardson BA, Lavreys L, Chohan B, Martin HL, et al Hormonal contraception and risk of sexually transmitted disease acquisition: results from a prospective study. Am J Obstet Gynecol 2001; 185: 380–5.
CrossRef |

[42]  Fennema JSA, Van Ameijden EJC, Coutinho RA, Van Den Hoek A. Clinical sexually transmitted diseases among human immunodeficiency virus-infected and noninfected drug-using prostitutes: Associated factors and interpretation of trends 1986 to 1994. Sex Transm Dis 1997; 24: 363–71.
CrossRef |

[43]  Warner L, Newman DR, Kamb ML, Fishbein M, Douglas JM. Warner L, Newman DR, Kamb ML, Fishbein M, Douglas JM. Problems with condom use among patients attending sexually transmitted disease clinics: prevalence, predicators, and relation to incident gonorrhea and chlamydia. Am J Epidemiol 2007; 167: 341–9.
CrossRef |

[44]  Paz-Bailey G, Koumans EH, Sternberg M, Pierce A, Papp J, Unger ER, et al The effect of correct and consistent condom use on chlamydial and gonococcal infection among urban adolescents. Arch Pediatr Adolesc Med 2005; 159: 536–42.
CrossRef |

[45]  Sanchez J, Campos PE, Courtois B, Gutierrez L, Carrillo C, Alarcon J, et al Prevention of sexually transmitted diseases (STDs) in female sex workers: a prospective evaluation of condom promotion and strengthened STD services. Sex Transm Dis 2003; 30: 273–9.
CrossRef |

[46]  Gallo MF, Steiner MJ, Warner L, Hylton-Kong T, Figueroa JP, Hobbs MM, et al Self-reported condom use is associated with reduced risk of chlamydia, gonorrhea, and trichomoniasis. Sex Transm Dis 2007; 34: 829–33.

[47]  Niccolai LM, Rowhani-Rahbar A, Jenkins H, Dunne DW. Condom effectiveness for prevention of Chlamydia trachomatis infection. Sex Transm Infect 2005; 81: 323–5.
CrossRef |

[48]  Shlay JC, McClung MW, Patnick JL, Douglas JM. Comparison of sexually transmitted diseases prevalence by reported level of condom use among patients. Sex Transm Dis 2004; 31: 154–60.
CrossRef |

[49]  Do condoms protect against non-viral STIs? Grant # R01A1068119 to Dr. Richard A. Crosby.

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