The Condom- Do Condoms Make Sex Safer

The Condom: For years you've heard people say, "Use a condom every time you have sex." You may think that condoms make sex safe, but research shows that's not the case. Condoms used to prevent pregnancy fail in about 14% of couples during the first year of use.1 Even if used always, condoms just reduce your risk of getting a sexually transmitted infection (STI); they don't eliminate it.

The truth is, even if you use a condom every time you have sex, you're still at risk for both pregnancy and STIs. How serious is your risk? Keep reading.

Each year, there are about 19 million new infections; half of these are in people under 25.2 Many of these STIs have no cure. Untreated STIs can cause infertility, cancer and even death.

Oral Sex & Condoms To date, there is no evidence that consistent use of condoms during oral sex reduces your chance of getting most STIs, including HIV. While one study shows decreased risk of gonorrhea with consistent condom use during oral sex,3 another shows increased risk of HIV.4

Anal Sex & Condoms To date, there is no evidence that consistent condom use reduces your chance of getting most STIs during anal sex. However, there is some evidence that consistent use of condoms for anal sex may cut your chance of getting HIV by up to half.5

HPV (Human Papillomavirus) If you use condoms every time you have vaginal sex, you can cut your chance of getting HPV by up to half.6,7,8,9 HPV is a very common STI in the US. About half of all sexually active 18- to 22-year-old women are infected with it.10 Most people with HPV have no symptoms. If present, symptoms include genital warts. HPV can cause cervical, penile or anal cancer.11 In women, cervical cancer causes about the same number of deaths as HIV/AIDS every year.12,13

Genital Herpes If you use condoms every time you have vaginal sex, you can cut your chance of getting genital herpes in half.14,15 Genital herpes infects 1 out of 6 teens and adults.16 Once you're infected, you have it for life. If you don't stay on medication, sores can keep coming back. Even if you have no symptoms, you can still spread the infection to others. People with herpes are also at greater risk for becoming infected with HIV.17

Chlamydia and Gonorrhea If you use condoms every time you have vaginal sex, you can cut your chance of getting chlamydia or gonorrhea in half.18,19 Chlamydia is the most commonly reported STI. Most people with chlamydia or gonorrhea have no symptoms. Even without symptoms you can pass on these infections. If left untreated, both chlamydia and gonorrhea can cause long-term pelvic pain and pelvic inflammatory disease (PID). PID may interfere with your ability to get or stay pregnant.20

HIV/AIDS If you use condoms every time you have vaginal sex, you can cut your chance of getting HIV by 85%.4,21 That might sound pretty good, but that still leaves you at risk for infection. Every year, 40,000 Americans get an HIV infection. HIV/AIDS has killed nearly half a million Americans?and the number is growing.22

Do People Use Condoms All the Time? Only about two-thirds of sexually active 15- to 19-year-old males report having used condoms at their last sexual contact. And, as males get older, fewer use condoms every time they have sex.23 Even among couples where one partner has HIV, less than half use condoms every time they have sex.24,25,26,27,28 And not everyone who uses condoms uses them correctly. And, even if they are used correctly, they sometimes break or slip off.29

The Bottom Line Condoms don't make sex safe, just less risky. Although condoms can reduce your risk for some STIs, they don't eliminate it. You can still get an STI or get pregnant.

To completely reduce your risk for some STIs, you should avoid sexual activity (oral, vaginal or anal sex) until you are faithful to one partner. If you've already had sex, see a doctor about getting checked for STIs.

Waiting to have sex until you are in a faithful, lifelong relationship (such as marriage) is the only certain way to avoid being infected sexually.

References:

1 Trussell J. The essentials of contraception: efficacy, safety, and personal considerations. In: Hatcher RA, Trussell J, Stewart F, et al, eds. Contraceptive Technology. 18th rev. ed. New York, NY: Ardent Media; 2004:221-240.

2 Weinstock H, Berman S, Cates W Jr. Sexually transmitted diseases among American youth: incidence and prevalence estimates, 2000. Perspect Sex Reprod Health; 2004;36(1):6-10.

3 Wong ML, Chan RK. A prospective study of pharyngeal gonorrhoea and inconsistent condom use for oral sex among female brothel-based sex workers in Singapore. Int J STD AIDS. 1999;10(9):595-599.

4 Celentano DD, Sifakis F, Hylton J, et al. Race/ethnic differences in HIV prevalence and risks among adolescent and young adult men who have sex with men. Journal of Urban Health: Bulletin of New York Academy of Medicine 2005;82(4):610-21.

5 Saracco A, Musicco M, Nicolosi A, et al. Man-to-woman sexual transmission of HIV: longitudinal study of 343 steady partners of infected men. J Acquir Immune Defic Syndr 1993;6(5):497-502.

6 Vaccarella S, Franceschi S, Herrero R, Munoz N, et al. Sexual behavior, condom use, and human papillomavirus: pooled analysis of the IARC human papillomavirus prevalence surveys. Cancer Epidemiol Biomarkers Prev. 2006 Feb;15(2):326-33.   7 National Institute of Allergy and Infectious Diseases, National Institutes of Health. Workshop Summary: Scientific Evidence on Condom Effectiveness for Sexually Transmitted Disease (STD) Prevention. 2001. Available at http://www.niaid.nih.gov/dmid/stds/condomreport.pdf. Accessed on November 21, 2006.

8 Manhart LE, Koutsky LA. Do condoms prevent genital HPV infection, external genital warts, or cervical neoplasia? A meta-analysis. Sex Transm Dis. 2002;29(11):725-735.

9 Winer RL, Hughes JP, Feng Q, et al. Condom use and the risk of genital human papillomavirus infection in young women. N Engl J Med. 2006;354(25):2645-2654

10 Peyton CL, Gravitt PE, Hunt WC, et al. Determinants of genital human papillomavirus detection in a US population. J Infect Dis. 2001;183(11):1554-1564. Available at: http://www.journals.uchicago.edu/JID/journal/issues/v183n11/000941/000941.html. Accessed December 31, 2006.

11 Koutsky LA, Kiviat NB. Genital human papillomavirus. In: Holmes KK, Mardh PA, Sparling PF, et al., eds. Sexually Transmitted Diseases. 3rd ed. New York, NY: McGraw Hill, Co; 1999:347-359. 12 American Cancer Society. Cervical cancer overview. How many women get cancer of the cervix? Available at: http://www.cancer.org/docroot/CRI/content/CRI_2_2_1X_How_many_women_get_cancer_of_the_cervix_8.asp?sitearea= Accessed November 17, 2006.

13 Centers for Disease Control and Prevention. HIV/AIDS Surveillance Report, 2005. Vol. 17. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2006. Also available at: http://www.cdc.gov/hiv/topics/surveillance/resources/reports/.

14 Shlay JC, McClung MW, Patnaik JL, Douglas JM Jr. Comparison of sexually transmitted disease prevalence by reported level of condom use among patients attending an urban sexually transmitted disease clinic. Sex Transm Dis. 2004;31(3):154-160.

15 Wald A, Langenberg AG, Krantz E, et al. The relationship between condom use and herpes simplex virus acquisition. Ann Intern Med. 2005;143(10):707-713.

16 Xu F, Sternberg MR, Kottiri BJ et al. Trends in herpes simplex virus type 1 and type 2 seroprevalence in the United States. JAMA. 2006 Aug 23;296(8):964-73.

17 Corey L, Wald A, Celum CL, et al. The effects of herpes simplex virus-2 on HIV-1 acquisition and transmission: a review of two overlapping epidemics. J Acquir Immune Defic Syndr. 2004 Apr 15;35(5):435-45.

18 Ahmed S, Lutalo T, Wawer M, et al. HIV incidence and sexually transmitted disease prevalence associated with condom use: a population study in Rakai, Uganda. AIDS. 2001;15(16):2171-2179. Available at: http://www.aidsonline.com/pt/r/aid/pdfhandler.00002030-200111090-00013.pdf;jsessionid=Df45SnM7gkk38EFpMUFXzzHyP2uihj5eU4cX3Cl7zEEENny13OaW!1389088241!-949856145!9001!-1. Accessed November 27, 2006.

19 Baeten JM, Nyange PM, Richardson BA, et al. Hormonal contraception and risk of sexually transmitted disease acquisition: results from a prospective study. Am J Obstet Gynecol. 2001;185(2):380-385.

20 Westrom L, Eschenbach D. Pelvic inflammatory disease. In: Holmes KK, et al, eds. Sexually Transmitted Diseases. 3rd ed. New York: McGraw-Hill; 1999:783-809.

21 Weller S, Davis K. Condom effectiveness in reducing heterosexual HIV transmission. Cochrane Database Syst Rev. 2002;(1):CD003255. 22 Centers for Disease Control and Prevention. HIV/AIDS Surveillance Report, 2005. Vol. 17. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2006. Available online at: http://www.cdc.gov/hiv/topics/surveillance/resources/reports/.

23 Centers for Disease Control and Prevention. National Center for Health Statistics. 2005. Mosher WD, Chandra A, Jones J. Sexual behavior and selected health measures: Men and women 15--44 years of age, United States, 2002 . Advance data from vital and health statistics; no 362. Hyattsville, MD. Available online at: http://www.cdc.gov/nchs/data/ad/ad362.pdf

24 Davis KR, Weller SC. The effectiveness of condoms in reducing heterosexual transmission of HIV. Fam Plann Perspect. 1999; 31:272-279.

25 Weller S, Davis K. Condom effectivenesds in reducing heterosexual HIV transmission. Cochrane Database Syst Rev. 2002; 1:CD003255.

26 Weller SC. A meta-analysis of condom effectiveness in reducing sexually transmitted HIV. Soc Sci Med.1993; 369:1635-1644.

27 Pinkerton SD, Abramson PR. Effectiveness of condoms in preventing HIV transmission. Soc Sci Med.1997;44: 1303-1312.

28 Panozzo L, Battegay M, Friedl A, Vernazza PL; Swiss Cohort Study. High risk behaviour and fertility desires among heterosexual HIV-positive patients with a serodiscordant partner--two challenging issues. Swiss Med Wkly. 2003 Feb 22;133(7-8):124-7.

29 Crosby RA, Diclemente RJ, Wingood GM, et al. Correlates of condom failure among adolescent males: an exploratory study. Prev Med. 2005 Nov-Dec; 41(5-6):873-6. Epub 2005 Oct 27.