Condom Use Questions as Predictors of Urogenital Gonorrhea

1. Condom Use Questions as Predictors of Urogenital Gonorrhea Adrianne M. Williams, MD, Philana Liang, PA-C, MPH, Renee M. Gindi, MPH, Khalil G. Ghanem, MD, and Emily Erbelding, MD Johns Hopkins University School of Medicine and Johns Hopkins Bloomberg School of Public Health

2. Introduction • The use of condoms has been shown to decrease the risk of acquiring sexually transmitted infections (STIs). • In the clinic setting, clinicians may ask individuals about condom use as one part of a behavioral risk assessment.

3. Introduction • One proposed approach to obtaining information about condom use is to ask specifically about use at the last sexual encounter. • However, the utility of this approach has not been formally analyzed.

4. Introduction • The objective of this study was to examine two different approaches to asking individuals about condom use as a predictor of STI risk. • We hypothesized that the response to critical incident condom use (last event use) would be a useful predictor of gonococcal (GC) infection.

5. Methods • Records-based historical cohort study • We used the electronic medical records of 20,602 individuals who received care at two STD clinics in Baltimore, Maryland, 2004-2005. • Risk assessment was completed by structured interview.

6. Methods • Example of patient interview: (1) “When was the last time you had sex?” (2) “Did you use a condom?” (3) “Do you use condoms always, often, sometimes, or never?”

7. Methods • Patient condom use was recorded in two different ways: (1) Critical incident use: condom use at the last sexual encounter (2) Graded proportional estimate of condom use for all sexual encounters: “always”, “often”, “sometimes”, or “never”

8. Methods • All patients had GC culture as part of the standard STD exam • Urethral specimen (males) • Cervical specimen (females) • Outcome measure: GC infection as a surrogate indicator of STI/HIV risk

9. Statistical Methods • Logistic regression models were used to adjust for known potential confounders (age, race, gender, # of sex partners, known contact to GC). • Odds ratios (ORs) and 95% confidence intervals are presented. • Data analyses were performed using STATA 8.1 (STATA Corp, College Station, TX).

10. Results(N=20,602)

11. Results: Odds of GC Infection Adjusted for: age, race, # of sex partners, known contact to GC

12. Conclusions • Critical incident condom use (last event use) which focuses on a specific event may be predictive of risk of GC infection. • Patient report of graded condom use was more difficult to interpret, may be subject to recall bias, and may vary depending upon how the clinician asks the question.

13. Conclusions • Strengths: - Critical incident condom use (last event use) is a brief and easy question to ask - Able to validate self-report of condom use with a biomarker (i.e. GC infection) - Able to focus on GC exposed individuals

14. Conclusions • Limitations: - Data obtained from clinician-directed interview may not generalize to research setting - Patient interview is not scripted amongst clinicians - Lack of information about partner specificity, i.e. whether condom use is with a regular versus casual sex partner

15. Conclusions • Condom use at the last sexual encounter was a reliable measure to discriminate risk of a sexually transmitted infection. • The critical incident approach that focuses on behavior at the last sexual encounter was a useful component of risk assessment in the STD clinic setting.

16. Acknowledgements • Clinical staff of the Baltimore City Health Department Eastern Health District and Druid Health District STD clinics