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STD Information Center
STD Prevention
Taking safety precautions is essential
to not catching an STD.
The best method of protecting
yourself from catching an STD is through abstinence
and not having any contact with your partners genitals.
When engaging in sexual relations, honesty
between partners, knowledge of STDs, and the use of
proper protection is essential to minimizing your chances
of catching an STD.
It's also important to have an
STD tests done regularly, particularly if you are sexually active. In
June 2000, the National Institutes of Health (NIH),
in collaboration with the Centers
for Disease Control and Prevention (CDC), the Food
and Drug Administration (FDA), and the United States
Agency for International Development (USAID), convened
a workshop to evaluate the published evidence establishing
the effectiveness of latex male condoms in preventing
STDs, including HIV. Here are the results of that evaluation:
Recommendations
concerning the male latex condom and the prevention
of sexually transmitted diseases (STDs), including
human immunodeficiency virus (HIV), are based on
information about how different STDs are transmitted,
the physical properties of condoms, the anatomic
coverage or protection that condoms provide, and
epidemiologic studies of condom use and STD risk.
The surest way to avoid transmission of sexually
transmitted diseases is to abstain from sexual intercourse,
or
to be in a long-term mutually monogamous relationship
with a partner who has been tested and you know is
uninfected.
For persons whose sexual behaviors place them at risk
for STDs, correct and consistent use of the male latex
condom can reduce the risk of STD transmission. However,
no protective method is 100 percent effective,
and condom use cannot guarantee absolute protection
against
any STD. Furthermore, condoms lubricated with spermicides
are no more effective than other lubricated condoms
in protecting against the transmission of HIV and other
STDs. In order to achieve the protective effect of
condoms, they must be used correctly and consistently.
Incorrect use can lead to condom slippage or breakage,
thus diminishing their protective effect. Inconsistent
use, e.g., failure to use condoms with every act of
intercourse, can lead to STD transmission because transmission
can occur with a single act of intercourse.
While condom use has been associated with a lower
risk of cervical cancer, the use of condoms should
not be a substitute for routine screening with Pap
smears to detect and prevent cervical cancer.
Sexually transmitted diseases, including HIV
Latex condoms, when used consistently and correctly,
are highly effective in preventing transmission of
HIV, the virus that causes AIDS. In addition, correct
and consistent use of latex condoms can reduce the
risk of other sexually transmitted diseases (STDs),
including discharge and genital ulcer diseases. While
the effect of condoms in preventing human papillomavirus
(HPV) infection is unknown, condom use has been associated
with a lower rate of cervical cancer, an HPV-associated
disease.
There
are two primary ways that STDs can be transmitted.
Human immunodeficiency virus (HIV), as well as gonorrhea,
chlamydia, and trichomoniasis – the discharge
diseases – are transmitted when infected
semen or vaginal fluids contact mucosal surfaces
(e.g., the male urethra, the vagina or cervix).
In contrast, genital ulcer diseases – genital
herpes, syphilis, and chancroid – and human
papillomavirus are primarily transmitted through
contact with infected skin or mucosal surfaces.
Laboratory studies have demonstrated that latex condoms
provide an essentially impermeable barrier to particles
the size of STD pathogens.
Theoretical basis for protection. Condoms can be expected
to provide different levels of protection for various
sexually transmitted diseases, depending on differences
in how the diseases are transmitted. Because condoms
block the discharge of semen or protect the male urethra
against exposure to vaginal secretions, a greater level
of protection is provided for the discharge diseases.
A lesser degree of protection is provided for the genital
ulcer diseases or HPV because these infections may
be transmitted by exposure to areas, e.g., infected
skin or mucosal surfaces, that are not covered or protected
by the condom.
Epidemiologic
studies seek to measure the protective effect of
condoms by comparing rates of STDs between condom
users and nonusers in real-life settings. Developing
such measures of condom effectiveness is challenging.
Because these studies involve private behaviors that
investigators cannot observe directly, it is difficult
to determine accurately whether an individual is a
condom user or whether condoms are used consistently
and correctly. Likewise, it can be difficult to determine
the level of exposure to STDs among study participants.
These problems are often compounded in studies that
employ a “retrospective” design, e.g.,
studies that measure behaviors and risks in the past.
As a result, observed measures of condom effectiveness
may be inaccurate. Most epidemiologic studies of STDs,
other than HIV, are characterized by these methodological
limitations, and thus, the results across them vary
widely--ranging from demonstrating no protection to
demonstrating substantial protection associated with
condom use. This inconclusiveness of epidemiologic
data about condom effectiveness indicates that more
research is needed--not that latex condoms do not work.
For HIV infection, unlike other STDs, a number of carefully
conducted studies, employing more rigorous methods
and measures, have demonstrated that consistent condom
use is a highly effective means of preventing HIV transmission.
Another
type of epidemiologic study involves examination
of STD rates in populations rather than individuals.
Such studies have demonstrated that when condom use
increases within population groups, rates of STDs decline
in these groups. Other studies have examined the relationship
between condom use and the complications of sexually
transmitted infections. For example, condom use has
been associated with a decreased risk of cervical cancer – an
HPV associated disease.
The following includes specific information for HIV,
discharge diseases, genital ulcer diseases and human
papillomavirus, including information on laboratory
studies, the theoretical basis for protection and epidemiologic
studies.
HIV/AIDS
Latex condoms, when used consistently and correctly,
are highly effective in preventing the sexual transmission
of HIV, the virus that causes AIDS.
AIDS
is, by far, the most deadly sexually transmitted
disease, and considerably more scientific evidence
exists regarding condom effectiveness for prevention
of HIV infection than for other STDs. The body of
research on the effectiveness of latex condoms in
preventing sexual transmission of HIV is both comprehensive
and conclusive. In fact, the ability of latex condoms
to prevent transmission of HIV has been scientifically
established in “real-life” studies of sexually
active couples as well as in laboratory studies.
Laboratory studies have demonstrated that latex condoms
provide an essentially impermeable barrier to particles
the size of STD pathogens.
Theoretical basis for protection. Latex condoms cover
the penis and provide an effective barrier to exposure
to secretions such as semen and vaginal fluids, blocking
the pathway of sexual transmission of HIV infection.
Epidemiologic
studies that are conducted in real-life
settings, where one partner is infected with HIV and
the other partner is not, demonstrate conclusively
that the consistent use of latex condoms provides a
high degree of protection.
Discharge Diseases (Gonorrhea, Chlamydia, and Trichomoniasis)
Latex condoms, when used consistently and correctly,
can reduce the risk of transmission of gonorrhea, chlamydia,
and trichomoniasis.
Gonorrhea, chlamydia,
and trichomoniasis are termed discharge diseases
because they are sexually transmitted by genital
secretions, such as semen or vaginal fluids. HIV
is also transmitted by genital secretions.
Laboratory studies have demonstrated that latex condoms
provide an essentially impermeable barrier to particles
the size of STD pathogens.
Theoretical basis for protection. The physical properties
of latex condoms protect against discharge diseases
such as gonorrhea, chlamydia, and trichomoniasis, by
providing a barrier to the genital secretions that
transmit STD-causing organisms.
Epidemiologic studies that compare infection rates
among condom users and nonusers provide evidence that
latex condoms can protect against the transmission
of chlamydia, gonorrhea and trichomoniasis. However,
some other epidemiologic studies show little or no
protection against these infections. Many of the available
epidemiologic studies were not designed or conducted
in ways that allow for accurate measurement of condom
effectiveness against the discharge diseases. More
research is needed to assess the degree of protection
latex condoms provide for discharge diseases, other
than HIV.
Genital ulcer diseases and HPV infections
Genital ulcer diseases and HPV infections can occur
in both male or female genital areas that are covered
or protected by a latex condom, as well as in areas
that are not covered. Correct and consistent use of
latex condoms can reduce the risk of genital herpes,
syphilis, and chancroid only when the infected area
or site of potential exposure is protected. While the
effect of condoms in preventing human papillomavirus
infection is unknown, condom use has been associated
with a lower rate of cervical cancer, an HPV-associated
disease.
Genital ulcer
diseases include genital herpes, syphilis, and
chancroid. These diseases are transmitted
primarily through “skin-to-skin” contact
from sores/ulcers or infected skin that looks normal. HPV infections are transmitted through contact
with infected genital skin or mucosal surfaces/fluids.
Genital ulcer diseases and HPV infection can occur
in male or female genital areas that are, or are
not, covered (protected by the condom).
Laboratory studies have demonstrated that latex condoms
provide an essentially impermeable barrier to particles
the size of STD pathogens.
Theoretical basis for protection. Protection against
genital ulcer diseases and HPV depends on the site
of the sore/ulcer or infection. Latex condoms can only
protect against transmission when the ulcers or infections
are in genital areas that are covered or protected
by the condom. Thus, consistent and correct use of
latex condoms would be expected to protect against
transmission of genital ulcer diseases and HPV in some,
but not all, instances.
Epidemiologic studies that compare infection rates
among condom users and nonusers provide evidence that
latex condoms can protect against the transmission
of syphilis and genital herpes. However, some other
epidemiologic studies show little or no protection.
Many of the available epidemiologic studies were not
designed or conducted in ways that allow for accurate
measurement of condom effectiveness against the genital
ulcer diseases. No conclusive studies have specifically
addressed the transmission of chancroid and condom
use, although several studies have documented a reduced
risk of genital ulcers in settings where chancroid
is a leading cause of genital ulcers. More research
is needed to assess the degree of protection latex
condoms provide for the genital ulcer diseases.
While some epidemiologic studies have demonstrated
lower rates of HPV infection among condom users, most
have not. It is particularly difficult to study the
relationship between condom use and HPV infection because
HPV infection is often intermittently detectable and
because it is difficult to assess the frequency of
either existing or new infections. Many of the available
epidemiologic studies were not designed or conducted
in ways that allow for accurate measurement of condom
effectiveness against HPV infection.
A number of studies, however, do show an association
between condom use and a reduced risk of HPV-associated
diseases, including genital warts, cervical dysplasia
and cervical cancer. The reason for lower rates of
cervical cancer among condom users observed in some
studies is unknown. HPV infection is believed to be
required, but not by itself sufficient, for cervical
cancer to occur. Co-infections with other STDs may
be a factor in increasing the likelihood that HPV infection
will lead to cervical cancer. More research is needed
to assess the degree of protection latex condoms provide
for both HPV infection and HPV-associated disease,
such as cervical cancer.
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