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Comparative Study
. 2009 Jul 13;169(13):1233-40.
doi: 10.1001/archinternmed.2009.177.

A pooled analysis of the effect of condoms in preventing HSV-2 acquisition

Emily T Martin  1 , Elizabeth Krantz, Sami L Gottlieb, Amalia S Magaret, Andria Langenberg, Lawrence Stanberry, Mary Kamb, Anna Wald
Affiliations
Comparative Study

A pooled analysis of the effect of condoms in preventing HSV-2 acquisition

Emily T Martin et al. Arch Intern Med. .

Erratum in

  • Arch Intern Med. 2010 Jun 14;170(11):929

Abstract

Background: The degree of effectiveness of condom use in preventing the transmission of herpes simplex virus 2 (HSV-2) is uncertain. To address this issue, we performed a large pooled analysis.

Methods: We identified prospective studies with individual-level condom use data and laboratory-defined HSV-2 acquisition. Six studies were identified through a review of publications through 2007: 3 candidate HSV-2 vaccine studies, an HSV-2 drug study, an observational sexually transmitted infection (STI) incidence study, and a behavioral STI intervention study. Study investigators provided us individual-level data to perform a pooled analysis. Effect of condom use was modeled using a continuous percentage of sex acts during which a condom was used and, alternatively, using absolute numbers of unprotected sex acts.

Results: A total of 5384 HSV-2-negative people at baseline contributed 2 040 894 follow-up days; 415 persons acquired laboratory-documented HSV-2 during follow-up. Consistent condom users (used 100% of the time) had a 30% lower risk of HSV-2 acquisition compared with those who never used condoms (hazard ratio [HR], 0.70; 95% confidence interval [CI], 0.40-0.94) (P = .01). Risk for HSV-2 acquisition increased steadily and significantly with each unprotected sex act (HR, 1.16; 95% CI, 1.08-1.25) (P < .001). Condom effectiveness did not vary by gender.

Conclusions: To our knowledge, this is the largest analysis using prospective data to assess the effect of condom use in preventing HSV-2 acquisition. Although the magnitude of protection was not as large as has been observed with other STIs, we found that condoms offer moderate protection against HSV-2 acquisition in men and women.

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Figures

Figure 1
Figure 1
Distribution of average percent condom use during study follow-up
Figure 2
Figure 2. Study-specific hazard ratios (and 95 percent confidence intervals) for the effect of (a) a 25 percent increase in condom use and the effect of (b) increasing unprotected sex acts on HSV-2 acquisition
Size of dark squares are proportional to the inverse variance of the estimate and centered on the hazard ratio. Horizontal lines indicate the 95% confidence interval for effect on time until HSV-2 acquisition. Diamonds are centered on the pooled hazard ratio estimate (dashed line) and width indicates the 95% confidence interval.
See this image and copyright information in PMC

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