Time for the US food and drug administration approval of condoms for anal intercourse

Abstract

h 2 Research centering on men who have sex with men (MSM) ommonly examines the role of anal intercourse in HIV transmision. However, anal intercourse is increasingly common and overooked among heterosexual couples, possibly contributing to the ising rate of sexually transmitted infection (STI) in the United tates (US). National surveys of heterosexually active women estiate recent and lifetime receipt of anal intercourse at 13.2% and 6.3%, respectively [1] . Similar surveys of men estimate proporions at 5.7% and 42.6% [2] . In the STI clinic setting, rates of heteroexual, unprotected anal intercourse have risen to approximately 8% [3] . As the probability of HIV transmission is greater with unrotected anal rather than vaginal intercourse, measures to prevent nfections associated with anal intercourse are increasingly imporant, regardless of sexual orientation, and should neither be undermphasized nor stigmatized. Despite the introduction of PreP and advances in microbicidal evelopment, external and internal condoms remain the mainstay or STI prevention. However, currently available condoms are FDApproved only for vaginal intercourse; usage for oral or anal inercourse is off-label. The complete lack of guidelines for use durng anal intercourse for either the female condom [4] and limited uidelines for the male condom [5] perpetuate professional couneling based on anecdotal experience and limited evidence. The ow utilization of condoms with anal sex among MSM, women ith known HIV-infected partners, and commercial sex workers ighlights the need for research on condoms for use in these seting. Recognizing the importance of such information, Siegler et al. 6] conducted a rigorous, blinded, crossover randomized trial of atex condoms for anal and vaginal intercourse in Atlanta, Geor-