STDs Expert Forum
Are Condoms Effective?
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The STD Forum is intended only for questions and support pertaining to sexually transmitted diseases other than HIV/AIDS, including chlamydia, gonorrhea, syphilis, human papillomavirus, genital warts, trichomonas, other vaginal infections, nongonoccal urethritis (NGU), cervicitis, molluscum contagiosum, chancroid, and pelvic inflammatory disease (PID). All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.

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Are Condoms Effective?

I recently heard that condoms aren't very effective in preventing STDs other than HIV.  I know that you could still get herpes or crabs even if you use a condom (on areas that aren't protected), but I can't see how you could get gonorrhea or chlamydia, which infect the urethra.  The urethra seems pretty well blocked.  How could the germs transmit either way?  However, I looked at the warning labels more carefully, and it does say "might" reduce the risk of spreading STDs besides HIV, whereas it says condoms are very effective at preventing HIV.

In short, can I rely on condoms for protection against gonorrhea and chlamydia if I use them consistently and correctly?  I know that no method is 100% safe, but how safe are condoms?  I read somewhere that a man has a 20% chance of getting gonorrhea with unprotected sex with an infected partner--what are the odds with a condom?

Thanks
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Thanks for the opportunity to address an issue important to all users of the STD and HIV prevention forums.

You are correct on three counts:  First, there is confusing information about condoms on the web and elsewhere.  Second, yes, properly used condoms are probably just about 100% protective against gonorrhea, chalmydia, and HIV, for exactly the reason you state.  Secretions and organisms cannot pass through intact latex. Third, also for the reason you recognize, condoms are less reliable against infections transmitted by skin-to-skin contact, but still offer at least fair to good protection against syphilis, herpes, and HPV.  (But probably not against crab lice).

The confusion comes largely from the difference in biological efficacy -- that is, the effectiveness of condoms as barriers -- and "use effectiveness", which takes into account that not all people use condoms correctly all the time, and that condoms sometimes break.  For example, properly used condoms probably are clost to 100% effective as contraceptives, yet couples who rely on condoms as their only birth control method have about a 90% reduction in pregnancy compared with couples who use no contraception.  That's 100% biological efficacy and 90% use effectiveness, taking into account that there might be brief penetration before the condom is in place, that condoms can break, and that people just forget some of the times that they didn't use a condom whey they should have.

The single research study that looked carefully at female to male gonorrhea transmission rates indeed showed a 20% chance of infection for each episode of vaginal sex with an infected woman.  Even taking use effectiveness into account, this suggests a 2% chance with condom -- but if properly used, the risk probably is about zero.  (But remember than gonorrhea sometimes is acquired through fellatio, for which most people don't use condoms.)

Bottom line:  As you suggest yourself, if you are careful to use condoms properly, you will indeed protect yourself with almost 100% reliability against those STDs that are transmitted by secretions, with somewhat lesser (but still good) protection against most skin-to-skin STD transmission.

Regards--  HHH, MD
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