Correct and Consistent Condom Use Protects Against Infection with Chlamydia Trachomatis

Braslins, Phillip

Wednesday, March 14, 2012

Hyatt Exhibit Hall

Phillip Braslins, MD, FRACP, MPHTM, PhD, Rural Clinical Division, School of Medicine, University of Queensland, Toowoomba, Queensland, Australia, Julia Schillinger, MD, MSc, US Centers for Disease Control and Prevention, CDC Division of STD Prevention;, NYC DOHMH Bureau of STD,The New York City Department of Health and Mental Hygiene;, New York, NY, Lauri Markowitz, MD, Centers for Disease Control and Prevention, Division of STD Prevention, Atlanta, GA, Charles Robert Horsburgh Jr., MD, MSC, School of Public Health, Boston University, Boston, MA, Byron Batteiger, MD, Departments of Medicine and Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, IN, Lydia Shrier, MD, MPH, Division of Adolescent/Young Adult Medicine, Children's Hospital Boston, Boston, MA and Peter Rice, MD, Department of Medicine/Division of Infectious Diseases and Immunology, University of Massachusetts Medical School, Worcester, MA

Background: Methodologic issues have impeded definitive demonstration of the protective effect of condoms against Chlamydia trachomatis (CT) acquisition.

Objectives: To assess the protective effect of correct and consistent condom use against CT.

Methods: Heterosexual patients age 14-24 were recruited from STD and adolescent clinics and emergency departments. A structured calendar interview elicited coitus-specific condom use (past 30 days). Condom use errors were defined as: 1) genital contact before application, 2) condom breakage during sex, 3) condom not staying on for entire sex act, and 4) genital contact after condom removal. CT infection was detected by nucleic-acid amplification and culture. We examined bivariate associations of CT infection with condom use (any, consistent, correct). Multivariate models adjusted for age, gender, race/ethnicity, and number of life-time sex-partners.

Results: There were 1029 participants (60% female), all reported sex on >1 day (median 4 days). Overall, 28% reported consistent condom use. Compared to non-condom users, participants who reported any condom use had lower CT prevalence (28% v. 32%), odds ratio (OR) 0.84, [95%CI 0.64-1]. After controlling for age, gender, race/ethnicity, and number of life-time sex-partners, the adjusted OR [aOR] for CT infection (any vs. no condom use) was 0.75, [95%CI 0.57-0.99], p<0.0001. In the multivariate model, participants reporting consistent condom use with no errors had aOR for CT infection of 0.54 [95% CI 0.35-0.85] compared to non-users. Participants reporting consistent condom use with any errors had aOR 0.61 [95%CI 0.39-0.95]. Participants reporting inconsistent condom use with or without errors had aOR 0.96 [95%CI 0.69-1.33].

Conclusions: These results strengthen evidence that condom use protects against CT. Consistency of use has stronger influence on the protective effect of condoms than the occurrence of condom use errors.

Implications for Programs, Policy, and Research: Condom use can prevent CT infection. Programs need to emphasize consistent as well as correct condom use.

P38 Correct and Consistent Condom Use Protects Against Infection with Chlamydia Trachomatis