STDs Expert Forum
Condom Effectiveness
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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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Condom Effectiveness

I have a general question regarding condom effectiveness in preventing STD transmission.  There seems to be a lot of conflicting information out there and even the CDC has changed the language of its condom warnings in the last few years and that chnage seems to suggest that condoms are not as effective as originally believed.  And when the NIH released its "big" report in 2001 regarding the effectiveness of condoms, it seemed that every expert had a different take on what the report said and the report didn't really say anything concrete except with respect to HIV.

My question simply put is this: Is there anyway to quantify the risks of contracting an STD while having intercourse and using a condom?  All I hear seem to hear or read is that condoms reduce the risk or "greatly" reduce the risk but are not 100%.  I've even heard that condoms are really not that effective in preventing skin-to-skin STD's like HSV-2 or HPV.  So what is the approximate percentage or level of protection?  What does "reduce the risk" of transmitting an STD really mean?  I would like to have some idea of what the chances are of contracting an STD while using a condom before I make those kinds of decisions again.  

Now bringing it all back to me personally like everyone likes to do . . . I am a male that has had intercourse with three different partners in the last year and I have used a condom each time.  I don't believe that there has been any slippage or breakage (I did not observe any) so how much of a risk have I been taking?  I have not seen any bumps or sores in my genital areas though I have had what I would term minor bladder infections from time-to-time (maybe 3 occasions total) in the last year where I would feel the urge to urinate frequently.  It generally cleared up in a couple days.  Should I be tested for an STD?  Should I stop having sex until I find one partner and we are both tested?  

Thanks for taking the time to read this message and I appreciate any feedback.

- Andy
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First, the 2001 condom report was variably interpreted, depending in part on the political views of the person doing the interpreting.  It simply is not true that the report showed condoms are not effective against any STD.  "Absence of proof is not proof of absence":  that is, lack of data to show condoms were effective against HPV, for example, was not evidence that they aren't effective.

Second, studying condom efficacy is extremely difficult.  It depends on persons at risk remembering their exposures correctly, often over several partners for long prior periods (ethically, you can't ask someone to have sex with a known infected person to see how well a condom works).  Also, people at greatest risk use condoms more than other people do; so apparent condom "failures" often reflect the fact that the people studied are at particularly high risk.

Third, no safety device is 100% effective, and neither are condoms.  That doesn't mean they should not be recommended.  People die despite seat belts, having smoke alarms in their homes, or wearing helmets when biking.

Fourth, almost all condom failures result from improper use, breakage (which is not common), and so on--not because of "microscopic pores" or because STD bacterial and viruses can pass through intact latex or polyurethrane; they cannot.  Some skin-to-skin infections (herpes, HPV, syphilis) occur because the condom doesn't prevent penile skin contact above the condom.

Finally, despite the difficulties in research, since the 2001 condom report, many studies have documented the excellent efficacy of condoms against all STDs.  Most recently, an excellent, well-controlled study has shown that condoms are highly effective in preventing HPV, and other recent studies have confirmed condoms' efficacy against herpes.

Unfortunately, none of this permits definitive percentage assessments of condom effectiveness on the percentage basis you seek.  The general consensus is that properly used condoms (in place before ANY genital contact, no breakage, and withdrawal while still erect [before the penis softens] while holding the condom in place on the penis) are close to 100% effective in preventing the infections that are transmitted by secretions (gonorrhea, chlamydia, HIV, hepatitis viruses).  The best guesstimate from the available research is that they are probably ~90% protective against HPV or HSV.

Bottom line 1:  condoms are important, but they do not substitute for care in selection of partners and related aspects of sexual safety.  Bottom line 2:  I cannot judge how safe you are, because I don't know if you use condoms "properly", how and where you select your partners, and their likelihood of having STDs.

Good luck--  HHH, MD
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