Goodall et al. BMC Public Health 2012, 12:747 http://www.biomedcentral.com/1471-2458/12/747 Table 2 Questions combined to assess condom problems Question Do you have problems obtaining condoms that fit your penis? (tick one) If you used condoms for anal sex in the last 12 months were there any problems with the condom? (tick as many as apply) The following can increase the chance of a condom tearing or slipping off. In the last year which of these have you done? (tick as many as apply) If you used a condom last time you had anal sex were there any problems with the condom? (tick as many as apply) Possible responses Yes No Condom defective when removed from packet Started to put the condom on inside-out Lost erection before putting condom on penis Tore condom with sharp object before use Had allergic reaction or irritation from condom Condom split/burst Condom slipped off Condom was removed during sex Used a condom without waterbased lubricant Used saliva as lubricant Fully unrolled the condom before putting on Used a condom that was too small for you Put lots of lubricant inside the condom before putting it on Condom defective when removed from packet Started to put the condom on inside-out Lost erection before putting condom on penis Tore condom with sharp object before use Had allergic reaction or irritation from condom Condom split/burst Condom slipped off Condom was removed during sex Yes No If you used a condom last time you had anal sex was the condom put on before penetration? (tick one) 55% of the community sample were educated to under- graduate degree level or above. 36% of the clinic sample and 7% of the community sample self-reported as being HIV positive. None of these demographic characteristics were associated with self-reported STI acquisition over the previous 12 months (Table 3). Number of UAI partners over the previous year was used as a measure of men’s STI risk. The mean number Page 4 of 8 of UAI partners in the previous 12 months was 1.5 in the clinic sample and 3.3 in the community sample. The range of UAI partners was wide in both samples (range 0–100 in the clinic sample and 0–245 in the community sample). In order to test associations between number of UAI partners and STI diagnosis, and to account for the possible influence of the few men reporting very high numbers of UAI partners, number of UAI partners was categorised as 0, 1, 2–4, 5–10, or >10. Number of UAI partners was found to be the strongest predictor of self- reported STI acquisition over the previous 12 months (Table 3). The condom proficiency score was significantly asso- ciated with self-reported STI diagnosis over the previous 12 months in both clinic and community samples. The condom problem score was associated with self-reported STI diagnosis in the clinic but not the community sam- ple (Table 4). Number of UAI partners (i.e. neither con- dom proficiency nor problem score) was the only variable to be significantly associated with laboratory confirmed STIs among the clinic sample. All variables found to be associated with self-reported STI diagnosis in univariate analysis (number of UAI partners, condom proficiency score and condom prob- lem score) were entered into a logistic regression model. Number of UAI partners in both samples and condom problem score among the clinic sample remained signifi- cant (Table 5) in explaining the variance in self-reported STI diagnosis. That is, among the clinic sample, condom problem score remained significantly associated with self-reported STI diagnosis after adjusting for UAI risk. In the community sample condom problem and profi- ciency scores were not associated with self-reported STI diagnosis after adjusting for UAI risk. Discussion For the first time in the UK, this study found significant associations linking measures of condom problems to STI risk amongst MSM. Although condom errors and other problems have been increasingly recognised as a likely factor in reducing condom effectiveness [16] and the correlates of condom problems in men have been explored [7,17], biological end point evidence of an asso- ciation with STI acquisition is scarce in all groups and absent in MSM. An association between condom pro- blems and incident chlamydial and gonococcal infections was shown in a small subsample (21 infections in 130 individuals) of the large Project Respect intervention trial [18]. In a study of 1973 consistent condom users, condom errors were reported much less frequently by MSM than men who have sex with women and an asso- ciation between condom problems and prevalent STI was seen in heterosexual but not homosexual subjects [13]. We found strong univariate associations between