Condom Use and Human Papillomavirus in Men

of decreasing exposure risk, were no steady sex partner; nonmonogamous, nonsteady sex partner; nonmonogamous, steady sex partner; and monogamous. Condom use in the previous 6 months was defined at a single time point (the baseline visit) and assessed at 3 levels (always, sometimes, and never). This baseline measure was extrapolated to represent condom use during the entire follow-up period. HPV infection was classified into 3 categories on the basis of HPV type: any HPV type, oncogenic HPV types, and nononcogenic HPV types. In the highest HPV exposure risk category (ie, men with no steady sex partners), those who reported always using condoms in the 6 months before study entry were about 50% less likely to become newly infected with any HPV types in the 12-month follow-up period, compared with men who never used condoms (adjusted hazard ratio [HR], 0.54; 95% confidence interval [CI], .31–.95). Similar reductions were reported when HPV types were stratified by oncogenic risk, but these associations did not reach statistical significance. No significant associations were observed between condom use and HPV incidence in the other 3 HPV exposure risk groups. Evaluating duration of infection, the authors found a faster rate of oncogenic HPV clearance only in the group of men who reported always using condoms with their nonsteady sex partners, compared with men who reported never using condoms (adjusted HR, 1.29; 95% CI, 1.03– 1.61). Condom use did not impact the duration of infection in the other 3 HPV exposure risk groups, including the group with no steady sex partners, the same group for which consistent use decreased HPV incidence. Condom use is a frequently examined cofactor in epidemiologic investigations of HPV infection and associated diseases in both men and women. Yet findings from a growing number of studies, including the present one, have been difficult to interpret, partly because many are based on secondary analyses of studies that were not designed to evaluate condom effectiveness [3–20]. Evaluating condom usein observational studies of sexually transmitted infections (STIs), particularly HPV infection, is inherently complex and subject to measurement errors that contribute to the heterogeneity in findings [21, 22]. Importantly, because incorrect or inconsistent use can diminish the protective