Problems with Condom Use among Patients Attending Sexually Transmitted Disease Clinics: Prevalence, Predictors, and Relation to Incident Gonorrhea and Chlamydia

Abstract

Condom use remains important for sexually transmitted disease (STD) prevention. This analysis examined the prevalence of problems with condoms among 1,152 participants who completed a supplemental questionnaire as part of Project RESPECT, a counseling intervention trial conducted at five publicly funded STD clinics between 1993 and 1997. Altogether, 336 participants (41%, 95% confidence interval: 38, 45) reporting condom use indicated that condoms broke, slipped off, leaked, or were not used throughout intercourse in the previous 3 months. Correspondingly, 8.9% (95% confidence interval: 7.0, 9.5) of uses resulted in STD exposure if partners were infected because of delayed application of condoms (4.3% of uses), breakage (2.0%), early removal (1.4%), slippage (1.3%), or leakage (0.4%). Use problems were significantly associated with reporting inconsistent condom use, multiple partners, and other condom problems. One-hundred thirty participants completing the questionnaire were tested for gonorrhea and chlamydia at this time and also 3 months earlier. Twenty-one (16.2%) were infected with incident gonorrhea and chlamydia, with no infections among consistent users reporting no use problems. Exact logistic regression revealed a significant dose-response relation between increased protection from condom use and reduced gonorrhea and chlamydia risk (p(trend) = 0.032). Both consistency of use and use problems must be considered in studies of highly infectious STD to avoid underestimating condom effectiveness.

Condom use around the globe: how can we fulfil the prevention potential of male condoms?

“…These problems range from those that could directly compromise effectiveness within a particular act of intercourse (e.g. breakage, slippage and failure to use condoms throughout intercourse) 18,20,24,55 to those that can directly impact the likelihood of condom use during future acts of intercourse (e.g. loss of erection, loss of sensation or inability to ejaculate).…”

“…[55][56][57][58] Two intentional user practices that have received increased attention of late -putting condoms on after starting intercourse or removing condoms before ejaculation 20,55,[59][60][61][62][63] -illustrate well the challenges of achieving effective use. And although the rate of any of single condom problem generally is low (less than 5-10% of coital acts), 55,59 the fraction of users reporting one or more problems often exceeds 40-50% even over brief periods of time. 55,62 These examples underscore the reality that condom use, despite features that give an appearance of simplicity (e.g.…”

“…And although the rate of any of single condom problem generally is low (less than 5-10% of coital acts), 55,59 the fraction of users reporting one or more problems often exceeds 40-50% even over brief periods of time. 55,62 These examples underscore the reality that condom use, despite features that give an appearance of simplicity (e.g. low technology, low cost and available without prescription), is a multi-faceted task.…”

Condom effectiveness: where are we now?

“…This second point is better illustrated by a prospective study of 132 clinic attendees tested for chlamydia and gonorrhoea at the beginning and end of a 3-month interval. 43 Although the small sample size precludes meaningful CI, the descriptive information from this study was intriguing. Among 18 people reporting consistent use of condoms in the recall period and a lack of problems (slippage, breakage, leaking, early removal, late application), none acquired either chlamydia or gonorrhoea.…”

“…Several prospective studies of condom effectiveness against gonorrhoea have been published; 20,36,[43][44][45][46] however, most of these are substantially underpowered, making the standard use of 95% CI a severe handicap to testing the null hypothesis fairly. Nonetheless, two of these six studies observed a significant protective effect.…”