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Emily T. Martin, MPH; Elizabeth Krantz, MS; Sami L. Gottlieb, MD, MSPH; Amalia S. Magaret, PhD; Andria Langenberg, MD; Lawrence Stanberry, MD, PhD; Mary Kamb, MD, MPH; Anna Wald, MD, MPH

Arch Intern Med. 2009;169(13):1233-1240.

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.

Author Affiliations: Departments of Epidemiology (Ms Martin and Dr Wald), Laboratory Medicine (Ms Krantz and Drs Magaret and Wald), and Medicine (Dr Wald), University of Washington, Seattle; Seattle Children's Hospital, Seattle (Ms Martin); Division of Sexually Transmitted Disease Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia (Drs Gottlieb and Kamb); Vaccine and Infectious Diseases Institute, Fred Hutchinson Cancer Research Center, Seattle (Drs Magaret and Wald); Chiron Corporation, Emeryville, California (Dr Langenberg); and Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, New York (Dr Stanberry). Ms Krantz is now with the Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison; Dr Langenberg is now an employee of Medivation Inc.

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