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Condom Use and Risk of Gonorrhea and Chlamydia: A Systematic Review of Design and Measurement Factors Assessed in Epidemiologic Studies Background: APPROXIMATELY 19 MILLION CASES of sexually transmitted infection (STI) occur in the United States each year.1 For sexually active persons, male latex condoms are the most commonly used contraceptive method to prevent STIs. Studies of condom use to reduce risk of most sexually transmitted infection provide inconsistent results. This inconsistency is often attributed to methodologic limitations yet has not been assessed systematically. Objectives: Epidemiologic studies show that condoms are highly effective against Chlamydia and Gonorrhea. Recent meta-analyses of studies of discordant couples indicate consistent condom use reduces HIV risk by at least 80% to 94% The objectives of this study is to review studies of condom use and risk of gonorrhea and chlamydia, and to evaluate the importance of 4 key design and measurement factors on condom effectiveness estimates. Study Population Study populations consisted of attendees at STD clinics (n = 20), family planning clinics (n = 3), teen clinics (n = 3), college health clinics (n = 2), and other medical clinics (n = 1), or multiple clinic types (n = 5); commercial sex workers (n = 6); military recruits (n = 2); vocational school students (n = 1); and community members (n = 2). Studies used cross-sectional study on 27 participants, cohort study on 13, and case–control study on the rest of the 5 The control group was compared to the case group to determine if there is any increase in STI cases for non condome users and condom users Sample size was 45 participants. Recruiting Stratetgies To be eligible, studies had to assess condom use during penile–vaginal intercourse; assess Neisseria gonorrhoeae or Chlamydia trachomatis infection using culture, antigen detection, or polymerase chain reaction (PCR); Control group : have a control or comparison group that included condom nonusers; and report a qualitative or quantitative association for the effect of condom use or provide data from which this association could be calculated The type of statistics used here was inferential statistics. A stated hypothesis was tested and an the estimation derived

Choice of Study Design. Thirteen studies (29%) used prospective or retrospective cohort designs to distinguish incident from prevalent infection and could establish whether condom users acquired gonorrhea or chlamydia before or after they reported initiating condom use. Eight of these studies also assessed whether condoms were used with every sex act to document that infection occurred after onset of consistent condom use. The proportion of studies that found one or more statistically significant protective effects for condom use did not differ statistically between those that assessed incident versus prevalent infection (46% vs. 59%, P >0.20).

Results: Of 45 studies identified, most found reduced risk of infection associated with condom use. All studies reviewed had methodologic limitations: only 28 (62%) distinguished consistent from inconsistent use; 2 (4%) reported on correct use or use problems; 13 (29%) distinguished incident from prevalent infection; and one (2%) included a population with documented exposure to infection. Eight of 10 studies with 2 or more of these attributes reported statistically significant protective effects for condom use versus 15 of 35 studies with zero or one attribute (80% vs. 43%, P = 0.04). Conclusions: Condom use was associated with reduced risk of gonorrhea and chlamydia in men and women in most studies, despite methodologic limitations that likely underestimate condom effectiveness. Epidemiologic studies that better address these factors are needed to provide more accurate assessment of condom effectiveness. I agree with the conclusion since the incidence rate of STIs reduced.

We assessed 4 key design or measurement elements by determining whether each study 1. Distinguished consistent from inconsistent condom use 2. 2. Measured correct use and/or condom use problems; 3. . Used a study design that distinguished incident (new) infection from prevalent (pre-existing) infection; 4. Selected a study population with documented exposure to gonorrhea or chlamydia during the time period pertaining to condom use There was underestimation and exaggeration of condom use. For example, although the majority of studies assessed consistent use, reports that condoms were used “consistently” may not indicate use during every act of intercourse Self-reports of condom use also may be inaccurate, with overreporting being of greater concern than underreporting because of desirability, which could lead to underestimation of effectiveness. In these studies, failure to use condoms throughout genital contact 69 and breakage and slippage were predictive of infection

Anything they did not consider? Consistent use should be defined as use during every act of intercourse. Correctness of use and use problems should be limited to condom behaviors that result in direct STI exposure risk.

Selection bias involves individuals being more likely to be selected for study than others, biasing the sample. This can also be termed Berksonian bias. The selection of the female partners were only those infected with STI therefore increasing risk of STI transmission and effecting results. What would be the ideal study design for their hypothesis? Ideal Study for the design for the whole hypothesis was good. However individual studies should have use all the 4 key design or measurement elements mentioned above. The study of incidence rate should have include both males and females since STI risk infection is different in male and females New biologic markers that detect the presence of semen or other male genital fluids in the vagina also hold promise for documenting use or nonuse of condoms. Investigators should continue efforts to document the validity of self-reported use, given direct observation of condom use is not feasible.

Their findings were applicable to the population chosen for the study since they wanted to mearsure the effectiveness of condom use in preventing Sexual transmitted diseases and the population chosen was sexually actuve age group which is ideall for the study.

http://journals.lww.com/stdjournal/Fulltext/2006/01000/Condom_Use_and_Risk_of_Gonorrhea_and_C hlamydia__A.11.aspx#P147...