Condom use and first-time urinary tract infection
Foxman, B.; Marsh, J.; Gillespie, B.; Rubin, N.; Koopman, J.S.; Spear, S.
Epidemiology 8(6): 637-641
1997
ISSN/ISBN: 1044-3983 PMID: 9345662 DOI: 10.2307/3702655Document Number: 269550
This study evaluated the effects of condom use, lubricated condom use, and spermicide use on risk of acquiring first urinary tract infection in a case-control study of sexually active college women aged 18-39 years in the USA. Cases (N=144) were women with first urinary tract infection that was confirmed by culture recruited at the student health service; controls (N=286) were women without a history of urinary tract infection who were randomly sampled from all women enrolled at the university. Participants completed a self-administered questionnaire regarding type and frequency of condom use during the previous 2 weeks. Condoms and spermicides usually were used in combination with each other or oral contraceptives. After adjusting for frequency of vaginal intercourse, using unlubricated condoms compared with using no birth control method strongly increased the risk of first urinary tract infection (odds ratio = 29.1; 95% CI=3.1-1335). Using a lubricated condom (with or without spermicide in the lubricant) or a spermicidal cream or gel with an unlubricated condom was associated with 2 to 8-fold risk of first urinary tract infection. Unlubricated condom use was strongly associated with risk of first urinary tract infection, but this effect was largely neutralized by using a spermicidal cream or gel with the unlubricated condom or by using a lubricated condom. Editorial comment:Condoms are able to decrease the risk of transmission of STDs including HIV infection. This study documents an unappreciated disadvantage of condoms. Condoms, especially those which are unlubricated, are associated with a significantly increased incidence of urinary tract infection in women. UTIs are very common. Up to half of all women will have had a UTI by their late 20s. They are uncomfortable and potentially serious and even lethal. In this study, lubricated condoms were less frequently associated with UTIs than unlubricated ones, although there are conflicting data on this issue. The possible relation of condom use to UTIs is potentially important, since it could affect the acceptability of condoms in preventing sexually transmitted diseases [see also editorial by Steiner, M. J. and Cates, W. Jr (Epidemiology (1997) 8 612), and article by Rugpao, S. et al.,(Sexually Transmitted Disease (1997) 24 546)].