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How Safe are Condoms at Preventing HPV and Herpes?
I read that HPV and Herpes can spread through skin to skin contact that is not covered by the condom, such as the scrotum or the groin area. My question is does a person have to have a break in his skin when making skin to skin contact with an infected person to become infected? Or is healthy skin that is "free of breaks" sufficient enough protection against herpes and HPV. If not, should a man seek contraception that covered the groin and scrotum area?
MEDICAL PROFESSIONAL
I should have included a comment on the actual effectiveness of condoms. For HPV, women who report 100% correct and consistent condom use have a 70% lower rate of genital HPV than women who use condoms half the time or less. (Half time use makes no difference.) But of course a 30% rate of still catching HPV means that even women who always use condoms with all new partners still have a substantial chance of getting infected. Although the data in men are not as precise, probably the risks are more or less the same.
The available data are less precise for HSV-2, but the ballpark figures are the same. The difference is that for HSV, unlike HPV, there are other effective prevention strategies: avoiding sex with known-infected partners outside committed relationships, and anti-herpes drugs by people who know they have HSV-2.
For both viruses, it is likely that the male condom is 90-95% effective in preventing infection for any single episode of sex. The reason "consistent and correct" condom use provides only ~70% protection is because of repeated exposure; even with 90-95% efficacy for each exposure, lots of events raises the odds of transmission.
The available data are less precise for HSV-2, but the ballpark figures are the same. The difference is that for HSV, unlike HPV, there are other effective prevention strategies: avoiding sex with known-infected partners outside committed relationships, and anti-herpes drugs by people who know they have HSV-2.
For both viruses, it is likely that the male condom is 90-95% effective in preventing infection for any single episode of sex. The reason "consistent and correct" condom use provides only ~70% protection is because of repeated exposure; even with 90-95% efficacy for each exposure, lots of events raises the odds of transmission.
A related discussion, How Effective are male condoms for girls in protecting hpv was started.
MEDICAL PROFESSIONAL
These are good questions. They have been addressed in passing in many other discussions, but this is an opportunity for me to put some comments about HPV transmission in a single place. Forgive the somewhat wordy reply.
In general, cornified (dry) skin is less susceptible to HPV than moist, thin tissues. For that reason, HSV and HPV are more readily transmitted from men to women than vice versa, and uncircumcized men get penile warts and herpes more often than those without foreskins -- in both cases because of the nature of the genital tissues exposed. For most tissue surfaces, especially those with cornified skin, simply laying HSV or HPV on the skin surface probably is not sufficient for transmission. The virus must be "massaged" into the skin; and microscopic trauma of the sort that probably is common during vaginal or anal sex probably facilitates transmission. This is why fleeting exposure, like brief genital contact without penetration, or touching of the scrotum to a partner's genital area during sex, usually does not result in transmission. It's also one of the main reasons that non-sexual transmission doesn't occur.
For these reasons, genital warts and the initial outbreak of genital herpes usually occur at the sites of maximum friction during sex: the glans and shaft of the penis, the vaginal opening, labia minor, and cervix in women, and the anus in persons who are the receptive partners in anal sex; and why warts are much less common on the scrotum, pubic area, or the labia major. There are many exceptions, but these are the general rules.
However, that doesn't mean the scrotum, groin, pubic area, etc don't get infected. They do. For HPV, it might not happen during sex, but perhaps mostly because an initial infection of, say, the penis or minor labia then spreads to wider areas -- either by itself or though mechanical means as we clean, scratch, or otherwise touch our genitals. For HSV, recurrent outbreaks can happen pretty much in the "boxer shorts" area. But that's a different mechanism, which happens because HSV sets up housekeeping in a nerve route, and the recurrent episodes occur where that particular nerve root serves the skin. HSV recurrences usually are on the penis, labia, anus, etc -- but recurrent outbreaks are not rare in places like a buttock, upper thigh, scrotum, or pubic area.
As far as barriers that cover wider areas than the penis itself, the female condom does that. However, that device has not won wide acceptance. But for the reasons above, the male condom provides substantial protection -- but for the same reasons, it isn't 100% protective.
But for HPV, I really don't think it matters much. It certainly is not worth the trouble, not to mention adverse effects on the sexual experience, to do things like apply plastic wrap to wider areas or, as some men on this forum have reported doing, having sex while wearing underwear or other clothing. As has been discussed many times on this forum, getting genital HPV is inevitable; it happens at least once to at least 80% of all sexually active people. Sexually active people should view HPV as a normal and expected consequence of human sexuality, and preventing all HPV infections simply will never be possible. Fortunately, the large majority of HPV infections never cause symptoms or disease and they clear up without treatment, with no health consequences. It makes sense to use (male) condoms for casual or new sexual encounters, and for younger women to get vaccinated against HPV, which prevents infection with the HPV types most likely to cause warts or cancer. (In the US, regulatory approval for men is expect this fall, after which men also can consider vaccination.) Aside from those steps, people should just relax, accept the fact of life that they'll have one or more genital HPV infections, and not worry about it.
Herpes is a little bit different in this regard. It's not quite as inevitable as HPV. But still most people are at risk for genital HSV at one time or another. Fortunately, here too, most infections are mild or even asymptomatic and don't have nearly as much impact on genital health or sexual health as is commonly believed.
Thanks again for the opportunity to write a blog-like answer. I hope it helps.
Regards-- HHH, MD
In general, cornified (dry) skin is less susceptible to HPV than moist, thin tissues. For that reason, HSV and HPV are more readily transmitted from men to women than vice versa, and uncircumcized men get penile warts and herpes more often than those without foreskins -- in both cases because of the nature of the genital tissues exposed. For most tissue surfaces, especially those with cornified skin, simply laying HSV or HPV on the skin surface probably is not sufficient for transmission. The virus must be "massaged" into the skin; and microscopic trauma of the sort that probably is common during vaginal or anal sex probably facilitates transmission. This is why fleeting exposure, like brief genital contact without penetration, or touching of the scrotum to a partner's genital area during sex, usually does not result in transmission. It's also one of the main reasons that non-sexual transmission doesn't occur.
For these reasons, genital warts and the initial outbreak of genital herpes usually occur at the sites of maximum friction during sex: the glans and shaft of the penis, the vaginal opening, labia minor, and cervix in women, and the anus in persons who are the receptive partners in anal sex; and why warts are much less common on the scrotum, pubic area, or the labia major. There are many exceptions, but these are the general rules.
However, that doesn't mean the scrotum, groin, pubic area, etc don't get infected. They do. For HPV, it might not happen during sex, but perhaps mostly because an initial infection of, say, the penis or minor labia then spreads to wider areas -- either by itself or though mechanical means as we clean, scratch, or otherwise touch our genitals. For HSV, recurrent outbreaks can happen pretty much in the "boxer shorts" area. But that's a different mechanism, which happens because HSV sets up housekeeping in a nerve route, and the recurrent episodes occur where that particular nerve root serves the skin. HSV recurrences usually are on the penis, labia, anus, etc -- but recurrent outbreaks are not rare in places like a buttock, upper thigh, scrotum, or pubic area.
As far as barriers that cover wider areas than the penis itself, the female condom does that. However, that device has not won wide acceptance. But for the reasons above, the male condom provides substantial protection -- but for the same reasons, it isn't 100% protective.
But for HPV, I really don't think it matters much. It certainly is not worth the trouble, not to mention adverse effects on the sexual experience, to do things like apply plastic wrap to wider areas or, as some men on this forum have reported doing, having sex while wearing underwear or other clothing. As has been discussed many times on this forum, getting genital HPV is inevitable; it happens at least once to at least 80% of all sexually active people. Sexually active people should view HPV as a normal and expected consequence of human sexuality, and preventing all HPV infections simply will never be possible. Fortunately, the large majority of HPV infections never cause symptoms or disease and they clear up without treatment, with no health consequences. It makes sense to use (male) condoms for casual or new sexual encounters, and for younger women to get vaccinated against HPV, which prevents infection with the HPV types most likely to cause warts or cancer. (In the US, regulatory approval for men is expect this fall, after which men also can consider vaccination.) Aside from those steps, people should just relax, accept the fact of life that they'll have one or more genital HPV infections, and not worry about it.
Herpes is a little bit different in this regard. It's not quite as inevitable as HPV. But still most people are at risk for genital HSV at one time or another. Fortunately, here too, most infections are mild or even asymptomatic and don't have nearly as much impact on genital health or sexual health as is commonly believed.
Thanks again for the opportunity to write a blog-like answer. I hope it helps.
Regards-- HHH, MD
You are reading content posted in the STDs Forum
Herpes spreads by oral, vaginal and anal sex.
Herpes sores blister, then burst, scab and heal.
STIs are the most common cause of genital sores.
Millions of people are diagnosed with STDs in the U.S. each year.
STDs can't be transmitted by casual contact, like hugging or touching.
Syphilis is an STD that is transmitted by oral, genital and anal sex.
