Table 1.

Individual-Level Biomedical Approaches to Prevention of Sexually Transmitted Infections, Including HIV Infection, by Level of Adherence Required^a

Level of adherence	Intervention	Effectiveness (level of evidence)b in men	Effectiveness (level of evidence)b in women
Single-time; susceptible individual	Male circumcision	Prevents acquisition of HIV, genital HPV, genital herpes; may prevent acquisition of trichomoniasis (level I/RCTs in heterosexual men)	Reduces incidence of bacterial vaginosis, trichomoniasis, genital ulcer disease (level 1/RCT)
Several times; time-limited (months)	Vaccines	Prevents acquisition of hepatitis A, hepatitis B (level I/RCTs; ecological data)	Prevents acquisition of HPV, hepatitis A, hepatitis B (level I/RCTs)
Situationally timed with sexual behaviors	Male condom	Prevents acquisition of gonorrhea, chlamydia, syphilis, genital HPV, trichomoniasis, HIV, genital herpes (level II-2); facilitates regression of HPV associated penile lesions (level II-2)	Prevents acquisition of gonorrhea, chlamydia, syphilis, genital HPV, trichomoniasis, HIV, genital herpes, PID (level II-2); facilitates regression of cervical intraepithelial neoplasia and clearance of genital HPV infection (level II-2)
	Female condom	Unknown	Prevents acquisition of gonorrhea, chlamydia, trichomoniasis, syphilis (level III)
	Diaphragm	Unknown	May prevent acquisition of gonorrhea (RCT; level I, subanalysis of self-reported use)
	Topical microbicides	Unknown	PRO2000 did not prevent acquisition of HIV-1 (RCT; level I); coitally dependent use of 1% tenofovir gel prevented acquisition of HIV-1 and HSV-2 (RCT; level I)
Daily use	Suppressive therapy for genital herpes	Prevents transmission of genital HSV-2 (RCT; level I); does not prevent transmission or acquisition of HIV (RCT; level I)	Prevents transmission of genital HSV-2 (RCT; level I); does not prevent transmission or acquisition of HIV (RCT; level I)
	Oral and topical antiretroviral drugs	Prevents transmission of HIV in men who have sex with men and men in heterosexual serodiscordant couples	Oral agents prevent transmission of HIV in women in serodiscordant couples; under study for HIV prevention in larger populations of womenc

Abbreviations: HIV, human immunodeficiency virus; HPV, human papillomavirus; HSV-2, herpes simplex virus, type 2; PID, pelvic inflammatory disease. RCT, randomized controlled trial.

^aAdapted from reference 61, with authors’ permission.

^bLevels of evidence are summarized using the classification scheme of the US Preventive Services Task Force (available at http://www.ahrq.gov/CLINIC/uspstfix.htm).

^cSee www.avac.org for details on ongoing clinical trials.