What You Should Know About Condoms

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Do condoms protect you from STDs and pregnancy?

If you are young and sexually active or are considering becoming sexually active, this is a critical question. In the U.S. today there is a growing epidemic of STDs (sexually transmitted diseases). It is estimated that over 65 million people are now infected and 19 million new infections occur each year. Almost half of these new infections occur in young people 15-24 years old.[1] Some of these infections are simply embarrassing and treatable with antibiotics, but others are much more dangerous. Some STDs are incurable, life-long infections. Some can lead to life-threatening diseases and even death. In your parent’s day, the major STDs were syphilis and gonorrhea.[2] Today the list has grown to perhaps 25 STDs that should concern every young person.

What are some of these diseases?

Chlamydia spreads from vaginal, anal and oral sex. Most men and women have no symptoms. In women, if left untreated, it can lead to PID (pelvic inflamatory disease) up to 40% of the time. PID can cause chronic pelvic pain, infertility and possibly fatal ectopic (tubal) pregnancy.

HPV – Human papillomavirus is a group of more than 100 different viruses. Most people who become infected will clear the infection on their own. However, some HPV viruses are “high-risk” types, which may lead to cancer of the cervix, vulva, vagina, anus or penis. About 20 million people are currently infected with HPV with 6.2 million new infections each year. At least 50 percent of sexually active men and women will have genital HPV infection at some point in their lives.

HPV spreads primarily through genital contact. Most HPV infections have no symptoms so most people are unaware they are infected. Some people get visible warts on the genitals that can spread to the mouth by oral sex. There may also be changes in cells of the cervix, vulva, anus or penis that could lead to cancer.

About 10 of the genital HPV types can lead to the development of cervical cancer. The American Cancer Society estimated that in 2005 in the United States, about 10,370 women would develop invasive cervical cancer and about 3,710 women would die from this disease.

A new vaccine which will protect against four types of HPV viruses was approved by the FDA in June, 2006. Because the vaccine does not protect against all types of HPV, it will not prevent all cases of cervical cancer or genital warts. According to the Centers for Disease Control and Prevention (CDC), about 30% of cervical cancers and about 10% of genital warts will not be prevented by the vaccine – nor will it prevent other sexually transmitted infections.

Gonorrhea spreads from vaginal, anal, and oral sex in men and women. An estimated 700,000 people in the United States are infected each year. In men, it causes a burning sensation while urinating and penile discharge. Most women do not have symptoms. It is another common cause of PID. Without treatment, gonorrhea can spread to the blood or joints and become life-threatening.

Genital Herpes spreads from contact with sores of an infected person, often from sexual contact. It causes sores and flu-like symptoms. It is a life-long disease, with typically 4-5 repeated episodes each year. It increases the chance of a person acquiring HIV virus (HIV causes AIDS) if exposed to that virus.

Trichomoniasis spreads from sexual contact, especially in women who have had multiple sexual partners. Symptoms may include a frothy, yellowish vaginal discharge with a strong odor. In men, a burning sensation and urge to urinate.

Syphilis spreads through contact with a syphilis sore mainly from vaginal, oral or anal sex. It progresses without treatment in three stages. The last stage has no symptoms but can cause paralysis, numbness, gradual blindness, dementia and death.

HIV causes AIDS, a weakening of the immune system. It is spread by vaginal, oral or anal sex. Through 2004 there have been 944,306 AIDS cases in the U.S. with over 529,113 deaths. Having other STDs can increase a person’s risk of becoming infected with AIDS.

Hepatitis B and C are diseases spread through blood, and can be transmitted by sexual contact. Hepatitis B kills 5,000 people per year. Hepatitis C kills 8,000-10,000 per year and 20% of the cases are sexually transmitted.[3]

Are condoms effective?

The Centers for Disease Control and Prevention convened a symposium in June of 2000 to find the answer to this question. Experts were selected from many fields and scientific studies were gathered. Only those studies which met rigorous requirements were selected. This included the condition that a study be “peer reviewed” by other scientists for publication in scientific journals. Those 138 studies were used to draw conclusions. Here is what they found:

There is no clinical proof that condoms are effective in reducing the risk of infection from chlamydia, genital herpes, HPV*, syphilis, chancroid or trichomoniasis. Some protection was found for men against gonorrhea infection, but not for women. Condoms were found to reduce the risk of HIV/AIDs transmission during vaginal sex by 85% when used consistently (every time a person has sex, without exception) and “correctly” (following a specific 6 step procedure).[4] Using condoms 100% of the time still leaves a 15% risk of HIV infection compared to not using condoms at all. HIV is the virus that causes AIDS, a routinely fatal disease.

What this means is that you can be infected with any STD even when using condoms 100% of the time.

What is “slippage and breakage”?

Studies also show that condoms break or slip 1.6 to 3.6 percent of the time. This represents a potential risk of pregnancy and transmission of STDs.[5]

Are condoms actually used?

Condoms cannot completely protect against any STD that has been studied. The risk reduction against STDs that is found in scientific studies requires condom use 100% of the time (with the possible exception of two STDs).[6] For the last decade, the “safe sex” message (use a condom every time you have sex) has been taught to teens. What has been the effect? Studies by the National Survey of Family Growth and the Youth Risk Behavior Survey show that rarely do even 50% of those surveyed report consistent condom use.[7] This clearly puts sexually active teens at a higher risk of infection than what the studies show for perfect condom use.

What about pregnancy?

The U.S. Food and Drug Administration regulates the manufacture and sale of male condoms in the U.S. They provide written guidance for manufacturers for proper labeling of their products. The recommended label for condoms includes a pregnancy rate for each year of use of 14% for condoms used “typically” and 3% if they used exactly as directed every time without fail.[8] If condoms work so well, why does the FDA request such a failure rate be on every box of condoms?

You decide…

You have been presented with a summary of the evidence about condoms. They have been shown to provide some risk reduction for some STD infections. But using condoms is like playing Russian roulette – the “game” where one bullet is put in a six-shooter’s cylinder, the cylinder spun and the gun pointed at your head and fired. In chamber one you have a condom that breaks and you get syphilis, in chamber two, you have an STD that condoms don’t protect against at all, in chamber three you have a routinely fatal disease, in chamber four you have a new STD that hasn’t even been studied…

How much do you care about yourself? Sometimes it seems that there is a health care philosophy in America that assumes you are incapable of making choices that will completely protect you from STDs and pregnancy. It assumes that you cannot make a choice to save sex until you are married. That is why condoms have been so widely promoted, even when their many limitations are well known. The message seems to be, “They can’t control their passions, so let’s tell them condoms really work so at least they’ll wear them.” Why not tell the truth about condoms and the truth about how to truly protect yourself?

Here it is: Condoms do not provide complete protection from STDs or pregnancy. STD infection can occur in both males and females whether or not a condom is used.

The surest way to avoid pregnancy or any infection with a sexually transmitted disease is to practice sexual abstinence (abstain from any sexual contact) while single. If you marry, select a partner who is not infected with an STD and remain sexually faithful during marriage.

This is the only guaranteed, 100% effective way to avoid infection and pregnancy. All other methods leave you vulnerable. It’s your life and your decision. Make it a good one.

Notes

Disease information retrieved from:

1. Centers for Disease Control and Prevention, Department of Health and Human Services, National Center for HIV, STD and TB Prevention Division of Sexually Transmitted Diseases, Fact Sheets found at: http://www.cdc.gov/nchstp/dstd/disease_info.htm, accessed on 10-5-06.

2. Centers for Disease Control and Prevention, Department of Health and Human Services, Fact Sheet for Public Health Personnel, Male Latex Condoms and Sexually Transmitted Diseases, reviewed March 29, 2006, found at: http://www.cdc.gov/nchstp/od/latex.htm, accessed 10-5-06.

3. American Cancer Society. Cancer Facts & Figures 2005. Atlanta, Georgia: American Cancer Society; 2005. Found at http://www.cancer.org/downloads/STT/CAFF2005f4PWSecured.pdf, accessed 10-6-06.

4. Winer RL, Hughes JP, Feng Q, et al. Condom use and the risk of genital human papillomavirus infection in young women. N Engl J Med 2006;354:2645-2654, found at: http://content.nejm.org/cgi/content/abstract/354/25/2645, accessed 10-06-06. This single study of 82 women conducted at the University of Washington recently has demonstrated some protection from HPV by consistent and correct use of condoms at every sexual encounter, although 12 of 42 subjects (nearly 30%) developed infections associated with HPV viruses.

References

  1. ^ Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance, 2004. Atlanta, GA: U.S. Department of Health and Human Services, found at: http://www.cdc.gov/std/stats/trends2004.htm, accessed 10-5-06.
  2. ^ McIlhaney J, et al. Medical Institute of Sexual Health (MISH). Sex, C-ondoms and STDs: What We Now Know. 2002.
  3. ^ ibid.
  4. ^ Centers for Disease Control and Prevention, Department of Health and Human Services, National Center for HIV, STD and TB Prevention, Divisions of HIV/AIDS Prevention, Workshop Summary: Scientific Evidence on Condom Effectiveness for Sexually Transmitted Disease (STD) Prevention June 12-13, 2000, found at: http://www.niaid.nih.gov/dmid/stds/condomreport.pdf, (a review of 138 scientific studies concerning condom effectiveness published July 20, 2001) accessed on 10-5-06.
  5. ^ ibid.
  6. ^ McIlhaney J, et al. Medical Institute of Sexual Health (MISH). Sex, C-ondoms and STDs: What We Now Know. 2002.
  7. ^ Centers for Disease Control and Prevention, Department of Health and Human Services, National Center for HIV, STD and TB Prevention, Divisions of HIV/AIDS Prevention, Workshop Summary: Scientific Evidence on Condom Effectiveness for Sexually Transmitted Disease (STD) Prevention June 12-13, 2000, found at: http://www.niaid.nih.gov/dmid/stds/condomreport.pdf, (a review of 138 scientific studies concerning condom effectiveness published July 20, 2001) accessed on 10-5-06.
  8. ^ U.S. Food and Drug Administration, Centers for Devices and Radiological Health, Guidance for Industry – Uniform Contraceptive Labeling, July 23, 1998, http://www.fda.gov/cdrh/ode/contrlab.html, accessed on 10-5-06.