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Background: The Chlamydia trachomatis incidence rate in Finnmark county, North Norway, has been twice the national average. Consistent condom use remains a centerpiece of public health efforts to prevent chlamydia infections.
Objectives: To examine whether prevalent chlamydia infection is associated with self-reported condom use at first intercourse with first partner, and first and last intercourse with last partner.
Methods: This population-based cross-sectional study inviting all students in five Finnmark high-schools in fall 2009, included a web-based questionnaire and first-void urine samples (participation rate 85%, n = 1573, girls 781/ boys 792, mean age 17.0 years, range 15-20 years). C. trachomatis was detected using real-time PCR (ProCelo as, Tromsø, Norway).
Results: The chlamydia prevalence was 5.7% (girls 7.3%, boys 3.9%, p = 0.02). Among boys, the non-use of condom rate was 44% and 55% for first intercourse with first and last partner, respectively. Among girls, the corresponding rates were 39% and 68%. Boys not using condom at first intercourse with first partner had odds ratio (OR) 15.8 (95% CI 1.7-148.9) for chlamydia infection, independent of condom use at the two later occasions. Among girls, non-use of condoms at last intercourse with last partner was an independent predictor of chlamydia infection (OR = 4.7, 95% CI 1.1-21.5). In both genders, condom use at last intercourse with last partner was strongly correlated with condom use at first intercourse with last partner (p < 0.001), but not with condom use at the first occasion.
Conclusions: The high odds for predicting chlamydia in boys related to condom use at first intercourse with first partner may indicate that boys have better control of their exposure than girls. Other factors may be important for condom use and chlamydia infections.
Implications for Programs, Policy, and Research: A gender-specific approach to enforce protective behaviour may be efficient.