Condom use to prevent incident STDs: the validity of self-reported condom use

• Published in: Sexually transmitted diseases Vol. 22; no. 1; p. 15
• Main Authors: Zenilman, J M, Weisman, C S, Rompalo, A M, Ellish, N, Upchurch, D M, Hook, 3rd, E W, Celentano, D
• Format: Journal Article
• Language: English
• Published: United States 01.01.1995
• Subjects: Adult; Baltimore - epidemiology; Condoms - statistics & numerical data; Female; HIV Infections - prevention & control; Humans; Incidence; Male; Middle Aged; Prospective Studies; Reproducibility of Results; Sex Distribution; Sexually Transmitted Diseases - epidemiology; Sexually Transmitted Diseases - prevention & control; Surveys and Questionnaires - standards; Measurement; Americas; Prospective Studies; Condom; United States; Data Collection; Infections; Research Methodology; North America; Sexually Transmitted Diseases > prevention and control; Reproductive Tract Infections; Contraceptive Methods; Behavior; Risk Reduction Behavior; Cohort Analysis; Contraception; Barrier Methods; Family Planning; Diseases; Studies; Validity; Northern America; Developed Countries; Sex Behavior; Maryland
• ISSN: 0148-5717
• DOI: 10.1097/00007435-199501000-00003

Studies of sexual behavior and of interventions designed to reduce human immunodeficiency virus risk usually depend on self-report. Validation of self-reported condom use measures has not been previously reported in an urban population at high risk for sexually transmitted diseases and human immunodeficiency virus. A prospective cohort study was performed in subjects recruited from sexually transmitted disease clinics in Baltimore. At enrollment, a questionnaire was administered that assessed human immunodeficiency virus risk factors and sexually transmitted disease history, and used a retrospective calendar to assess sexual events and condom use over the previous 30 days. Clinical evaluation was performed for sexually transmitted diseases. At follow-up 3 months later, the same procedures were repeated. Incident sexually transmitted diseases at follow-up were defined as new culture or serologically documented diagnoses of gonorrhea, chlamydia, syphilis, or trichomoniasis. In the 323 male and 275 female (total = 598) subjects who completed a follow-up visit, 21% reported using condoms for every act of sexual intercourse over the previous 30 days, 21% reported occasionally using condoms, and 59% reported not using condoms. At follow-up, 21% of subjects had new incident gonorrhea, chlamydia, syphilis, or trichomoniasis. Fifteen percent of the men who were "always" condom users had incident sexually transmitted diseases compared with 15.3% of "never users;" 23.5% of women who were "always" users had incident sexually transmitted diseases compared with 26.8% of "never" users. In this high-risk population, self-reported condom use is not associated with lower sexually transmitted disease incidence. This finding suggests that self-reported condom use measures, even in a research setting, may be subject to substantial reporting bias.