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Lee C, McManus H, Foster R, Davies SC. A survey of condom use among female sex workers in Northern Sydney; declining condom use for fellatio. Int J STD AIDS 2021; 32:1326-1337. [PMID: 34525849 DOI: 10.1177/09564624211040951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Condom use among female sex workers (FSWs) is dynamic. We conducted a survey, by anonymous questionnaire, of condom use among FSWs routinely attending our clinical service in Northern Sydney. Logistic regression models determined associations with inconsistent condom use. All 201 women approached completed a questionnaire. Chinese-born women comprised 67% of participants. The median age was 35 years. Clients requesting unprotected fellatio was reported by 95% of participants, and approximately two-thirds felt pressure to have unprotected fellatio and vaginal sex (VSI). Inconsistent condom use at work was reported by 74% for fellatio and by 24% for VSI. The strongest adjusted association with inconsistent condom use for fellatio was monetary inducement by clients (aOR = 40.7, 95% CI 4.87-340, p = 0.001). The only other significant adjusted association was age ≥ 30 years (p = 0.02). The strongest adjusted association with inconsistent condom use for VSI was also monetary inducement by clients (aOR = 56.1, 95% CI 9.26-340, p < 0.001). Other significant adjusted associations were Chinese-speaking participants (p = 0.03) and clients requesting unprotected VSI (p = 0.02). We report high levels of inconsistent condom use. Health promotion should assist FSWs, particularly those of Chinese ethnicity, develop skills in dealing with pressure for unprotected sex, particularly fellatio.
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Affiliation(s)
- Casey Lee
- Northern Sydney Sexual Health Service, 3960Northern Sydney Local Heath District, St Leonards, NSW, Australia
| | - Hamish McManus
- 2786The Kirby Institute, University of NSW, Sydney, NSW, Australia
| | - Rosalind Foster
- 2786The Kirby Institute, University of NSW, Sydney, NSW, Australia.,Sydney Sexual Health Centre, 379373South Eastern Sydney Local Health District, Sydney, NSW, Australia
| | - Stephen C Davies
- Northern Sydney Sexual Health Service, 3960Northern Sydney Local Heath District, St Leonards, NSW, Australia.,Northern Clinical School, Faculty of Medicine, 198092University of Sydney, St Leonards, NSW, Australia
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Oswalt SB, Wyatt TJ. Sexual health behaviors and sexual orientation in a U.S. national sample of college students. ARCHIVES OF SEXUAL BEHAVIOR 2013; 42:1561-72. [PMID: 23455622 DOI: 10.1007/s10508-012-0066-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Revised: 08/10/2012] [Accepted: 11/03/2012] [Indexed: 05/25/2023]
Abstract
Many studies have examined differences in sexual behavior based on sexual orientation with results often indicating that those with same-sex partners engage in higher risk sexual behavior than people with opposite sex partners. However, few of these studies were large, national sample studies that also include those identifying as unsure. To address that gap, this study examined the relationship of sexual orientation and sexual health outcomes in a national sample of U.S. college students. The Fall 2009 American College Health Association-National College Health Assessment was used to examine sexual health related responses from heterosexual, gay, lesbian, bisexual, and unsure students (N = 25,553). Responses related to sexual behavior, safer sex behaviors, prevention and screening behaviors, and diagnosis of sexual health related conditions were examined. The findings indicated that sexual orientation was significantly associated with engaging in sexual behavior in the last 30 days. Sexual orientation was also significantly associated with the number of sexual partners in the previous 12 months, with unsure men having significantly more partners than gay, bisexual and heterosexual men and heterosexual men having significantly less partners than gay, bisexual and unsure men. Bisexual women had significantly more partners than females reporting other sexual orientations. Results examining the associations between sexual orientation and safer sex, prevention behaviors, and screening behaviors were mixed. Implications for practice, including specific programmatic ideas, were discussed.
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Affiliation(s)
- Sara B Oswalt
- Department of Health and Kinesiology, University of Texas at San Antonio, One UTSA Circle, San Antonio, TX, 78249, USA,
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The threat of untreatable gonorrhoea: implications and consequences for reproductive and sexual morbidity. REPRODUCTIVE HEALTH MATTERS 2012; 20:76-82. [DOI: 10.1016/s0968-8080(12)40653-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Mor Z, Gefen D, Linhart Y, Amitai ZS, Dan M, Shohat T. The contribution of oral sex to male urethral Neisseria gonorrhoeae infections in Tel-Aviv district, Israel. Int J STD AIDS 2011; 22:251-5. [PMID: 21571972 DOI: 10.1258/ijsa.2009.009202] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The incidence of Neisseria gonorrhoeae (NG) in Tel-Aviv district, Israel has increased since the mid-1990s. This study aimed to address behavioural attributes and identify the sources of NG infection. Of 1234 NG cases in men reported between 2000 and 2004, 379 (31%) were interviewed. Most were single, heterosexual and Israeli-born. Insertive oral sex (OS) was reported by 77% patients and vaginal intercourse by 69%, where condoms were used by 4% and 40% for these practices, respectively. Unprotected OS was performed by 95% of the 151 men involved in protected vaginal sex. OS was the most common practice among the younger age group, and in sexual contacts with casual partners or commercial sex workers (CSWs): behaviours that were reported by 37% and 36% of patients, respectively. Unprotected OS is a common route for NG transmission, and it is suggested that the rise in NG may be attributed to unprotected OS with casual partners or CSWs.
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Affiliation(s)
- Z Mor
- Tel-Aviv Department of Health, Ministry of Health, E Wolfson Medical Centre, Holon, Israel.
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Salazar LF, Head S, Crosby RA, DiClemente RJ, Sales JM, Wingood GM, Rose E. Personal and social influences regarding oral sex among African American female adolescents. J Womens Health (Larchmt) 2011; 20:161-7. [PMID: 21247269 DOI: 10.1089/jwh.2010.2247] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To identify personal and social factors associated with performing oral sex among female adolescents. METHODS Sexually active African American female adolescents (n = 715) recruited from sexually transmitted infection (STI) clinics were assessed for self-esteem, sexual sensation seeking, unprotected vaginal sex (UVS), self-efficacy to communicate about sex and to refuse sex, fear of negotiating condoms, relationship power, peer norms surrounding risky sexual behavior, ever having performed oral sex, and three vaginally acquired STIs. RESULTS Prevalence for at least one STI was 29%. More than half reported performing oral sex. Controlling for age, performing oral sex was associated with relatively higher sexual sensation seeking, any UVS in past 60 days, relatively lower self-efficacy to refuse sex, and having peer norms supportive of risky sexual behaviors. CONCLUSIONS Given the potential for epidemic spread of orally acquired STIs to populations of female adolescents residing in communities with high rates of STI prevalence, this initial research provides guidance for intervention development and expanded research efforts.
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Affiliation(s)
- Laura F Salazar
- Rollins School of Public Health, Emory University, Atlanta, Georgia 30322, USA.
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Salazar LF, Crosby RA, Diclemente RJ, Wingood GM, Rose E, McDermott-Sales J, Caliendo AM. African-American female adolescents who engage in oral, vaginal and anal sex: "doing it all" as a significant marker for risk of sexually transmitted infection. AIDS Behav 2009; 13:85-93. [PMID: 18369721 DOI: 10.1007/s10461-008-9381-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2007] [Accepted: 03/12/2008] [Indexed: 11/25/2022]
Abstract
African-American female adolescents who engaged in vaginal sex only (N = 272) were compared to adolescents who engaged in two types (vaginal plus oral or anal; N = 295) and three types (vaginal, oral and anal; N = 144) on a constellation of other sexual risk behaviors (SRBs) and on sexually transmitted infections (STIs). Adjusted contrasts among groups revealed that adolescents who engaged in two and in three types of sex as compared to those who engaged in vaginal sex only were more likely to engage in six of the seven SRBs, but were just as likely to have a STI. One SRB, having >/= 4 lifetime sex partners, was in turn associated with STI. Two-way interactions indicated that having a casual sex partner and having multiple sex partners in the last 60 days increased the likelihood of STI, but only for adolescents who engaged in all three types.
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Affiliation(s)
- Laura F Salazar
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1520 Clifton Rd, Suite 214, Atlanta, GA, 30322, USA.
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Linhart Y, Shohat T, Amitai Z, Gefen D, Srugo I, Blumstein G, Dan M. Sexually transmitted infections among brothel-based sex workers in Tel-Aviv area, Israel: high prevalence of pharyngeal gonorrhoea. Int J STD AIDS 2008; 19:656-9. [DOI: 10.1258/ijsa.2008.008127] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Sex workers play a major role in spreading sexually transmitted infections (STIs). We studied the prevalence rates and risk factors for STIs among 300 brothel-based sex workers in Tel-Aviv. Throat swabs were cultured for Neisseria gonorrhoeae, urine samples were tested by polymerase chain reaction (PCR) for Chlamydia trachomatis and N. gonorrhoeae, and sera were tested for syphilis, human immunodeficiency virus (HIV) and type 2 herpes simplex virus (HSV) antibodies. N. gonorrhoeae was cultured from throat samples of 9.0% of participants; PCR testing of urine was positive for C. trachomatis in 6.3% and for N. gonorrhoeae in 5.0%. Syphilis serology was positive (Venereal Disease Research Laboratory [VDRL] titres >1:8) in 1.3% of women, HSV-2-specific immunoglobulin G was detected in 60% and HIV serology was positive in a single case (0.3%). Having STI was significantly associated with age, number of years in Israel, number of clients a week and condom use for vaginal sex. In a multivariate analysis, having STI was significantly associated with number of clients per week and condom use for vaginal sex. The high prevalence of pharyngeal gonorrhoea reflects most probably the expanding demand of clients for oral sex and the insufficient condom use in this form of sex.
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Affiliation(s)
- Y Linhart
- Tel-Aviv District Health Office, Ministry of Health, Tel-Aviv
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - T Shohat
- Tel-Aviv District Health Office, Ministry of Health, Tel-Aviv
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Z Amitai
- Tel-Aviv District Health Office, Ministry of Health, Tel-Aviv
| | - D Gefen
- Tel-Aviv District Health Office, Ministry of Health, Tel-Aviv
| | - I Srugo
- Department of Pediatrics, Bnei Zion Medical Center, Haifa
| | - G Blumstein
- Treponema Reference Laboratory, Public Health Laboratories, Ministry of Health, Tel-Aviv
| | - M Dan
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Infectious Diseases Unit, Wolfson Medical Center, Holon 58100, Israel
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Lau JTF, Wang R, Chen H, Gu J, Zhang J, Cheng F, Zhang Y, Zhang L, Tsui HY, Wang N, Lei Z, Zhong X, Lan Y. Evaluation of the overall program effectiveness of HIV-related intervention programs in a community in Sichuan, China. Sex Transm Dis 2007; 34:653-62. [PMID: 17717483 DOI: 10.1097/01.olq.0000260948.10572.b9] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The study evaluates the overall effectiveness of intervention programs among female sex workers in a Chinese community. STUDY DESIGN Behavioral surveillance data in 2003, 2004, and 2005 obtained from 2 communities (intervened and control) were compared. RESULTS The baseline data (2003) of the 2 counties were not significantly different. In 2004 and 2005, the intervened county had significantly higher prevalence of condom use with their clients and regular sex partners (last-time and consistent use in the last month; OR = 2.2-33.2 in 2004 and 3.8-8.3 in 2005), higher HIV-related knowledge level (OR = 7.9 in 2004 and 17.3 in 2005), and lower STD prevalence (OR = 0.22 in 2004 and 0.11 in 2005). Coverage rates of HIV antibody testing and HIV-related services increased in the intervened county but decreased in the control county. CONCLUSIONS Intervention programs may result in substantial behavioral changes in a community within a few years.
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Affiliation(s)
- Joseph T F Lau
- Centre for Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
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Kim S, De La Rosa M, Trepka MJ, Kelley M. Condom use among unmarried students in a Hispanic-serving university. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2007; 19:448-461. [PMID: 17967114 DOI: 10.1521/aeap.2007.19.5.448] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
This study compares the prevalence of risky sexual behavior between unmarried Hispanic and non-Hispanic students in southern Florida and assesses the role of substance use in risky sexual behavior. Among 815 unmarried respondents, approximately 35% had two or more sexual partners within the past 12 months. Compared with non-Hispanic White students, Hispanic students were less likely to engage in unprotected sex under the influence of alcohol (25% vs. 16%) but also less likely to have been tested for HIV infection (55% vs. 43%). The percentage of students using a condom during their last sexual encounter was 8% (oral), 35% (anal), and 50% (vaginal). For both Hispanic and non-Hispanic students, condom use was low regardless of smoking, heavy alcohol consumption, and marijuana use. From the problem behavior theory perspective, condom use and substance use may have different behavioral origins. These findings can help target and guide the development of prevention programs in university settings.
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Affiliation(s)
- Sunny Kim
- Department of Epidemiology and Biostatistics, School of Public Health, Florida International University, Miami, FL 33199, USA.
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Dan M, Poch F, Amitai Z, Gefen D, Shohat T. Pharyngeal Gonorrhea in Female Sex Workers: Response to a Single 2-g Dose of Azithromycin. Sex Transm Dis 2006; 33:512-5. [PMID: 16572040 DOI: 10.1097/01.olq.0000204675.92459.3c] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES A sharp increase in the incidence of gonorrhea has been observed in Tel Aviv, Israel, since 1999. Almost one half of interviewed patients admitted contracting the infection from a sex worker. In two thirds of the cases, oral sex (fellatio) was the most probable route of acquiring the disease. In the current study, we assessed the prevalence of pharyngeal gonorrhea among sex workers in Tel Aviv and evaluated the efficacy of a single 2-g dose of azithromycin in eradicating the infection. METHODS Throat specimens were obtained for gonococcal culture from 301 female sex workers practicing in brothels. A questionnaire covering demographic and sexual behavior information was administered to all participants, and a single 2-g dose was administered orally under supervision. Women with positive cultures were reexamined a week later for eradication of Neisseria gonorrhoeae. RESULTS N gonorrhoeae was isolated from 27 women (9%). The median age of women with pharyngeal gonorrhea was 23 years (range, 18-32 years); 85% were born in former Soviet Union (mostly Russia, Ukraine, Moldavia). Regular condom use in vaginal sex was reported by 88% of the participants, whereas only 60% reported always using condoms in oral sex. All isolates were susceptible to azithromycin (MIC < or = 0.5 microg/ml). Gonococci were eradicated in 20/21 individuals (95%). CONCLUSION A high carriage rate of gonococci in the throat and a low rate of condom use in oral sex were documented among sex workers in Tel Aviv. A single 2 g dose of azithromycin was very effective in eradicating gonococci from the throat.
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Little JW. Gonorrhea: update. ACTA ACUST UNITED AC 2006; 101:137-43. [PMID: 16448912 DOI: 10.1016/j.tripleo.2005.05.077] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2005] [Revised: 04/28/2005] [Accepted: 05/06/2005] [Indexed: 11/26/2022]
Abstract
Gonorrhea is a worldwide sexually transmitted disease (STD) caused by Neisseria gonorrhoeae. Gonorrhea is the second most often reported STD in the United States behind chlamydia. An estimated 600,000 people each year in the United States are infected. Only about half this number of cases are reported. From 1975 through 1997, the national gonorrhea rate declined 74.3%. After a small increase in 1998, the gonorrhea rate has decreased each year since 1999. In 2003 the South had the highest gonorrhea rate among the four regions of the country. Antimicrobial resistance remains an important consideration in the treatment of gonorrhea. In 2003 the Gonococcal Isolate Surveillance Project found about 16% of collected isolates were resistant to penicillin and/or tetracycline. Since 1998 the number of ciprofloxacin-resistant isolates has been increasing with 270 (4.1%) being reported in 2003. Oral gonorrhea is rare, nonspecific, and varied and may range from slight erythema to severe ulceration with a pseudomembranous coating. The patient with gonorrhea poses little threat of disease transmission to the dentist. However, patients who have or have had gonorrhea should be approached with a measure of caution because they are in a high-risk group for additional STDs. The CDC has published recommendations for standard precautions to be followed in controlling infection in dentistry that have become the standard for preventing cross-infection. Strict adherence to these recommendations will, for all practical purposes, eliminate the danger of disease transmission between dentist and patient. Dentists should be aware of local statutory requirements regarding reporting STDs to state health officials. Syphilis, gonorrhea, and AIDS are reportable diseases in every state. Local health departments or state STD programs are sources of information regarding this matter.
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Wong ML, Chan RKW, Koh D, Barrett ME, Chew SK, Wee SSH. A Comparative Study of Condom Use and Self-Reported Sexually Transmitted Infections Between Foreign Asian and Local Clients of Sex Workers in Singapore. Sex Transm Dis 2005; 32:439-45. [PMID: 15976602 DOI: 10.1097/01.olq.0000168279.05452.ad] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We conducted a survey to compare condom use and its associated factors between foreign Asian and local clients of female sex workers in Singapore. STUDY A survey was conducted between 2001 and 2002 on a random sample of 810 clients (677 foreign Asian workers and 133 locals) recruited from the streets and outside the brothels in Singapore. RESULTS Foreign clients were more likely than locals to be inconsistent condom users with sex workers. Clients from China reported the highest percentage of inconsistent condom use (29.2%) and sexually transmitted infections (16.7%) compared with 8.3% (P < 0.003) and 2.3% (P < 0.005), respectively, among locals. On multivariate analysis, inconsistent condom use among foreign clients increased significantly with the number of freelance sex workers. The reverse trend was found for local clients. CONCLUSION There is a need to design separate condom-promotion programs for foreign Asian and local clients of sex workers in Singapore.
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Affiliation(s)
- Mee Lian Wong
- Department of Community, Occupational and Family Medicine Faculty of Medicine, National University of Singapore.
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Wong ML, Chan R, Koh D. Long-term effects of condom promotion programmes for vaginal and oral sex on sexually transmitted infections among sex workers in Singapore. AIDS 2004; 18:1195-9. [PMID: 15166535 DOI: 10.1097/00002030-200405210-00013] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To evaluate the long-term impact of condom promotion programmes for vaginal and oral sex among female brothel-based sex workers in Singapore. DESIGN A pre-test/post-test comparison group followed by a time series design was used to compare trends in condom use for vaginal sex and cervical gonorrhoea incidence from 1990 to 2002 across cross-sectional samples of sex workers before and after programme implementation in 1995. The subsequent condom promotion programme for oral sex was evaluated using the interrupted time series with a retrospective pre-test to post-test matched control group design. METHODS Sex workers completed a questionnaire before and 6 months after participation in educational sessions. Cervical and pharyngeal swabs were taken monthly for cultures for Neisseria gonorrhoeae. RESULTS Consistent condom use for vaginal sex increased significantly from < 45.0% before 1995 (pre-intervention period) to 95.1% in 2002, with a corresponding decline in cervical gonorrhoea incidence from > 30 to 2/1000 person-months. Adjustment for temporal changes in sociodemographic characteristics did not materially alter the trends. Consistent oral condom use increased significantly from < 50% before 1996 to 97.2% in 2002, with a corresponding decline in pharyngeal gonorrhoea from > 12 to 4.7/1000 person-months. CONCLUSION The interventions produced sustained high levels of condom use for vaginal and oral sex with corresponding declines in cervical and pharyngeal gonorrhoea incidence.
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Affiliation(s)
- Mee Lian Wong
- Department of Community, Occupational and Family Medicine (MD 3), Faculty of Medicine, National University of Singapore, Singapore
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