Risk of HIV/STD with condom use

A preventive question....I hear that condom-protected sex is not truly protected when it comes to things like HPV and genital herpes.  I am a male who wants to know what the true likelihood is of becoming infected by one of those (or other STD) if condom is rolled to near base of penis.

1.  As an epidemiologist and statistician:  if male had sex with 100 different women, all infected with HIV, HPV @ HSV, how many times (if one could be infected more than once) would he become infected with each?

2.  Regarding HPV...I have read that the kind that causes cervical cancer does not cause warts.  Therefore, can I assume that the cervical kind affects only the cervix itself.  So, if a male wears a condom can he become infected with cervical HPV and become a threat to take that one home?  Or does the kind that causes dysplasia and cervical cancer also reside on the labia or entrance to vagina?  To make it clearer, can the kind of HPV that a guy would get on the base of penis or scrotum be able to cause cervical HPV or cervical cancer in long-term female partner?

Thank you very much for your response and your great work on this forum.

[H. Hunter Handsfield, M.D.]

Well, this depends on what you mean by 'truly protected'.  Virtually every safety device that exists is not 100% protective:  people die in auto accidents while wearing seat belts, batteries fail in smoke alarms, etc, etc.  That doesn't mean we should stop recommending seat belts and smoke alarms.

Condoms provide a high degree of protection against HPV and HSV.  But the protection is less than for HIV, gonorrhea or chlamydia; those infections require exchange of secretions, but HPV and HSV are transmitted skin-to-skin, so there is opporunity for contact above the condom range.

1) The data on herpes are not sufficiently precise to answer your question.  Of course the risk depends on the infection status of one's partner, and even that isn't straightforward:  symptomatic infection? how long since that person was infected (the shorter the time since infection, the higher the risk of transmission)? asymptomatic shedding?  But even without condoms, in couples in which one person has HSV-2 who have sex 2-3 times a week, WITHOUT condoms, the infection is transmitted in 3-5% of couples per year.  So the risk per exposure is obviously low.  As a generalization, that risk probably is reduced by 80-90% when a condom is used.

2) The cellular proliferation that causes pap abnormalities and cancer occur primarily in the cervix, but the infection involves any and all genital surfaces--penis, vulva, etc.  And yes, you could well have a high risk infection that could be transmitted to a partner despite condom use.

Condoms are less effective against HPV than herpes. The best research shows 70% reduction in risk of aquiring HPV in female college students who use condoms 100% of the time.  Those who use condoms 55-99% of the time had a 50% reduction in HPV risk.  At less than 55% use, there was no protection.  The bottom line is that 100% consistent condom use will help protect against HPV, and it reinforces the advice that all sexually active people outside permanent, monogamous relationships should use condoms.  But in the long run, most people can still expect to catch HPV, mostly with the high risk types.  You should look on this as a normal event, not much different than carrying staph or strep on our skin.

As an epidemiologist, you undoubtedly know how to search the medical literature.  Look for recent papers by Anna Wald and her colleagues on HSV and condoms, and Rachel Winer and colleages for the masterful research study on HPV and condoms.

Regards--  HHH, MD

[H. Hunter Handsfield, M.D.]

I forgot to comment on the HIV part of your question.  An intact, properly used condom is 100% protective, or close to it.  There are volumes of medical liturature on the topic.

[IBCurious]

Dr. Handsfield, no need to respond further.  Thank you for answering my questions in such depth.  By the way, I am not an epidemiologist...you were the subject of my reference.  Thanks again.