Condom-use errors are associated with gonorrhea infection in men, according to a recent study of patients at a clinic specializing in sexually transmitted diseases. The finding highlights the importance of promoting not only consistent condom usage, but also correct usage.

“The tendency to assume that consistent condom users are using condoms correctly seriously underestimates their risk of transmitting or contracting STDs or becoming pregnant unintentionally,” say authors led by Diane Grimley of the University of Alabama at Birmingham.

The study in the current issue of American Journal of Health Behavior drew predominantly low-income African-Americans participants from an urban, publicly funded STD clinic in the southeastern United States.

More than 1,100 men and women who reported using a condom in the preceding 30 days provided biological specimens along with information on sexual risk behaviors and condom problems. To promote honesty in discussing such sensitive topics, participants responded via computer-assisted self-interviewing technology.

The authors examined the association between incorrect condom use and the two most common STDs at the clinic: gonorrhea and chlamydia. More than 15 percent of the patients tested positive for one or both infections and nearly 24 percent reported condom-use errors.

Women were more likely to report “improper donning techniques” such as not leaving a space at the tip of the condom and not removing the air from the tip. Males were more likely to report condom breakage or putting a condom on inside out and then flipping it over.

Of the eight condom errors and problems studied, breakage was statistically associated with gonorrhea infection in males. “The importance of proper condom use seems obvious,” the researchers write, “yet the results from this study demonstrate that it must be taught even to sexually experienced individuals.”

The authors note that basing the study in an STD clinic means that some of the findings may not apply to other populations. In addition, relying on self-reports introduced possible inaccuracies. They also suggest that future studies should examine the association of condom use with other STDs.

More than 1 in 5 adults in the United States are currently living with a viral STD, which is the highest infection rate of any industrialized country, according to the American Social Health Association. STDs can cause cancer, liver diseases, infertility, still births and death.

The study was supported by a National Institutes of Health grant.