A Pooled Analysis of the Effect of Condoms in Preventing HSV-2 Acquisition

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Abstract
Studies that prospectively measure sexual activity, condom use, and sexually transmitted infection (STI) incidence are necessary to assess preventive effect of condom use on STI acquisition. In the absence of randomized controlled trials, the best evidence available on condom use and STI acquisition comes from prospective observational studies, or intervention trials conducted for other purposes in which the STI of interest was an end point. Compelling evidence from such studies indicates that consistent condom use reduces transmission of human immunodeficiency virus (HIV).1 Additionally, increasingly strong data support condom effectiveness in preventing STIs that target urethral or cervical epithelia, such as chlamydia and gonorrhea.2 However, the effectiveness of condoms in preventing the transmission of herpes simplex virus 2 (HSV-2) is less certain.3-5 A 2001 panel convened by the National Institute of Allergy and Infectious Diseases concluded that the available evidence on condom effectiveness was insufficient to establish that condoms were protective against HSV-2 acquisition6 because the research was derived from studies that used prevalent HSV-2 infection as the outcome and thus were unable to determine the temporal relationship between condom use and HSV-2 acquisition.6,7 Since that time, 3 studies have been published that show moderate efficacy (approximately 50%) for condom use.8-10 However, in these studies, measures of condom use and definitions of condom effectiveness differed. More precise measurement of condom efficacy, with attention to subgroups in which condom effectiveness may differ, is desirable.

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