There are nearly 19 million new cases of sexually transmitted diseases (STDs) in the United States annually. Fifty percent of STDs occur in persons 15 to 24 years of age. Chlamydia and gonorrhea are the leading causes of pelvic inflammatory disease, chronic pelvic pain, ectopic pregnancy, and infertility. The highest prevalence of chlamydia and gonorrhea infections occurs in women 15 to 24 years of age.

Many studies have evaluated the effectiveness of condom use in preventing STDs. Although most have shown that lack of condom use can increase the risk of contracting chlamydia and gonorrhea infections, many studies do not assess consistency of condom use or errors during condom use, such as slippage or breakage. Paz-Bailey and associates examined the relationship between self-reported correct and consistent use of condoms and the prevalence of chlamydia and gonorrhea infections.

The study sample involved sexually active female adolescents 13 to 19 years of age who presented to an urban adolescent health care clinic. The young women were included in the study if there was an indication for a pelvic examination (i.e., no Papanicolaou smear within the past year, symptoms that required an evaluation, or patient request). Patients were excluded if they were pregnant, were positive for human immunodeficiency virus infection, or were treated with antibiotics within the previous 30 days. Trained interviewers questioned each participant about demographics, sexual and reproductive history, peer norms, attitudes toward and actual use of condoms, self-esteem, partner characteristics, mental health, and alcohol or drug use. Participants also were asked about consistent and correct use of condoms. The study defined consistent use as use for every act of vaginal sex, and correct use as condom use free from errors such as beginning sex without a condom, taking it off before finishing sex, flipping it over, and condom breakage or slippage. Each participant was then screened for chlamydia and gonorrhea infections using a urine nucleic acid amplification test.

A total of 509 female adolescents with a mean age of 16.6 years participated in the study. Eighty-six percent reported having sex within the preceding three months, and 78 percent reported using some form of birth control. The mean number of sexual partners within those three months was 1.8, and the mean number of partners in their lifetime was 5.8. Twenty-one percent of the participants tested positive for chlamydia infection, and 7 percent tested positive for gonorrhea infection.

Thirty-five percent of the participants reported consistent condom use in the three-month period, and 16 percent reported correct and consistent condom use. Of those who used condoms at least once within the three-month period, 71 percent reported at least one condom error (see accompanying figure). Irregular or no use of condoms or consistent but incorrect use did not reduce the risk of chlamydia or gonorrhea infection. Correct and consistent use of condoms provided significant protection against chlamydia and gonorrhea infection.

The authors conclude that assessing the correct and consistent use of condoms is important in evaluating condom effectiveness. They add that incorrect use of condoms and not product failure may account for the lack of effectiveness when condoms are used to reduce the risk of contracting STDs.

editor’s note: Guidelines concerning STDs from the Centers for Disease Control and Prevention include a section on prevention.¹ The prevention guidelines provide education and counseling concerning safer sex for persons who are at risk.¹ Primary prevention starts with helping patients change risky sexual behaviors that increase the risk of contracting STDs.¹ This message needs to be individualized and based on an accurate risk assessment. The study by Paz-Bailey and associates shows that the message also needs to include education concerning the appropriate use of condoms. Not only is it important to educate patients about using condoms, it is just as important to educate them about the proper use of condoms.—k.e.m.

1WorkowskiKALevineWCSexually transmitted diseases treatment guidelines 2002. Centers for Disease Control and Prevention.MMWR Morb Mortal Weekly Rep2002;51(RR-6):1–80.