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Benefits of Condom Use at Sexual Debut Go Beyond Contraception

Several years after sexual debut, early condom users had lower STI rates than did nonusers.

Several studies have shown that condom use at sexual debut is associated with continued condom use. To assess the relation between condom use at first vaginal coitus with rates of sexually transmitted infections (STIs), investigators analyzed data from more than 4000 sexually active participants (52% women; average age of all participants at sexual debut, 15.2) in the National Longitudinal Study of Adolescent Health. Beginning in 1994, the investigators conducted three waves of in-home interviews; at the time of the third wave (when the average age of participants was 22.2), urine samples were collected and tested with ligase chain reaction (LCR) for Neisseria gonorrhoeae and Chlamydia trachomatis DNA.

In comparisons adjusted for factors such as socioeconomic status, education level, and risk-taking characteristics, condom users at initial coitus were 36% more likely to have used a condom at their most recent coitus (P<0.01) and half as likely to test positive for C. trachomatis or N. gonorrhoeae (P<0.05) compared with non-condom users. The number of sexual partners was similar in the two groups.

Comment: By making adjusted comparisons, the authors have addressed the possibility that initial condom users simply are not risk takers in general. Given that the adjustment had little effect and that the number of sexual partners was similar between the groups, that explanation is not likely. The authors conclude that initial condom use is an independent factor associated with healthy outcomes many years later. A unique strength of this study is the authors’ use of LCR as a biomarker to validate self-reported sexual behavior. A reduction in STI rates of this magnitude is nothing short of amazing. Promoting abstinence should always be our first line — but these results show that all adolescents should also be educated about condom use and availability so that if they choose to become sexually active, they will have the means to use condoms at first coitus.

— Ann J. Davis, MD

Published in Journal Watch Women's Health August 23, 2007

Citation(s):

Shafii T et al. Association between condom use at sexual debut and subsequent sexual trajectories: A longitudinal study using biomarkers. Am J Public Health 2007 Jun; 97:1090-5.

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