Abstract
BackgroundIt is believed that sexually active people, i.e. people having multiple or concurrent sexual partners, are at a high risk of sexually transmitted infections (STI), but they are likely to be more aware of the risk and may exhibit greater fraction of the use of condom. The purpose of the present study is to examine the correlation between condom use and sexual contact pattern and clarify its impact on the transmission dynamics of STIs using a mathematical model.MethodsThe definition of sexual contact pattern can be broad, but we focus on two specific aspects: (i) type of partnership (i.e. steady or casual partnership) and (ii) existence of concurrency (i.e. with single or multiple partners). Systematic review and meta-analysis of published studies are performed, analysing literature that epidemiologically examined the relationship between condom use and sexual contact pattern. Subsequently, we employ an epidemiological model and compute the reproduction number that accounts for with and without concurrency so that the corresponding coverage of condom use and its correlation with existence of concurrency can be explicitly investigated using the mathematical model. Combining the model with parameters estimated from the meta-analysis along with other assumed parameters, the impact of varying the proportion of population with multiple partners on the reproduction number is examined.ResultsBased on systematic review, we show that a greater number of people used condoms during sexual contact with casual partners than with steady partners. Furthermore, people with multiple partners use condoms more frequently than people with a single partner alone. Our mathematical model revealed a positive relationship between the effective reproduction number and the proportion of people with multiple partners. Nevertheless, the association was reversed to be negative by employing a slightly greater value of the relative risk of condom use for people with multiple partners than that empirically estimated.ConclusionsDepending on the correlation between condom use and the existence of concurrency, association between the proportion of people with multiple partners and the reproduction number can be reversed, suggesting the sexually active population is not necessary a primary target population to encourage condom use (i.e., sexually less active individuals could equivalently be a target in some cases).
Highlights
It is believed that sexually active people, i.e. people having multiple or concurrent sexual partners, are at a high risk of sexually transmitted infections (STI), but they are likely to be more aware of the risk and may exhibit greater fraction of the use of condom
The purpose of the present study is to examine the correlation between condom use and sexual contact pattern and clarify its impact on the transmission dynamics of STIs using a mathematical model
Systematic review sexual contact pattern can be broadly interpreted and defined in various ways, we focus on two specific aspects as explanatory variables: (i) whether the partnerships were steady or casual and (ii) whether the persons had a single or multiple partners at the same time
Summary
It is believed that sexually active people, i.e. people having multiple or concurrent sexual partners, are at a high risk of sexually transmitted infections (STI), but they are likely to be more aware of the risk and may exhibit greater fraction of the use of condom. Transmitted infection (STI) remains to be a serious concern of public health, involving more than 30 pathogens [1, 2]. Major eight STIs include syphilis, gonorrhoea, chlamydia, trichomoniasis, hepatitis B virus infection, herpes simplex virus infection, human immunodeficiency virus (HIV) infection, and human papilloma virus infection (HPV), that are mainly linked to sexual contact. Even among curable STIs, acute course of infection can sometimes develop to urethritis, cervicitis, genital ulceration and pelvic inflammatory disease (PID) [3]. Bacterial STIs including syphilis and chlamydia are known to be associated with elevated risk of HIV infection [6]
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