A prospective event-level analysis of condom use experiences following STI testing among patients in three US cities

BACKGROUND: This study prospectively assessed and compared the incidence of condom use errors/problems among clinic patients testing positive for one or more of 3 sexually transmitted diseases (STDs) and those testing negative. The study also identified event-level condom use errors associated with condom breakage and slippage during sex. METHODS: Enrolled clinic patients (N = 928) were tested for 3 STDs, then patients electronically recorded sexual intercourse and condom use behaviors daily for up to 6 months. Data were available on condom use errors and problems for the >10,000 sex events involving condoms. Assessed errors/problems were as follows: (1) not using a new condom, (2) allowing condoms to contact sharp objects, (3) not using condoms from start to finish of sex, (4) condoms drying out, (5) erection loss during condom use, (6) breakage, (7) slippage during sex, and (8) slippage after sex. Because the event-level measures were correlated within individual, generalized estimation equation models were used for analyses. RESULTS: All 8 forms of errors/problems with condom use occurred, with varying levels of frequency, without significant differences by baseline STD status for either men or women. Condom breakage was associated with contact with sharp objects (P < 0.0001) and drying out (P < 0.0001). Slippage during sex was associated with erection loss (P < 0.0001) and drying out (P < 0.0001). CONCLUSION: Subsequent to STD evaluation, much of the sex occurring with the use of a condom may not confer adequate protection. Problems found to be associated with condom breakage and slippage are potentially amenable to counseling interventions.