For
more information:
CDC’s National Prevention Information Network
(800) 458-5231 or
www.cdcnpin.org
CDC
National STD/HIV Hotline
(800) 227-8922 or (800) 342-2437
En Espanol (800) 344-7432
www.cdc.gov/std
Click
here for PDF version
Fact Sheet
for Public Health Personnel:
Male
Latex Condoms
and Sexually Transmitted Diseases
In June 2000, the National
Institutes of Health (NIH), in collaboration with the Centers for Disease
Control and Prevention (CDC), the Food and Drug Administration (FDA),
and the United States Agency for International Development (USAID),
convened a workshop to evaluate the published evidence establishing
the effectiveness of latex male condoms in preventing STDs, including
HIV. A summary report from that workshop was completed in July 2001
(http://www.niaid.nih.gov/
dmid/stds/condomreport.pdf). This fact sheet is based on the NIH
workshop report and additional studies that were not reviewed in that
report or were published subsequent to the workshop. Most epidemiologic
studies comparing rates of STD transmission between condom users and
non-users focus on penile-vaginal intercourse.
Recommendations concerning
the male latex condom and the prevention of sexually transmitted diseases
(STDs), including human immunodeficiency virus (HIV), are based on information
about how different STDs are transmitted, the physical properties of
condoms, the anatomic coverage or protection that condoms provide, and
epidemiologic studies of condom use and STD risk.
The surest way to
avoid transmission of sexually transmitted diseases is to abstain from
sexual intercourse, or to be in a long-term mutually monogamous relationship
with a partner who has been tested and you know is uninfected.
For persons whose
sexual behaviors place them at risk for STDs, correct and consistent
use of the male latex condom can reduce the risk of STD transmission.
However, no protective method is 100 percent effective, and condom use
cannot guarantee absolute protection against any STD. Furthermore, condoms
lubricated with spermicides are no more effective than other lubricated
condoms in protecting against the transmission of HIV and other STDs.
In order to achieve the protective effect of condoms, they must be used
correctly and consistently. Incorrect use can lead to condom slippage
or breakage, thus diminishing their protective effect. Inconsistent
use, e.g., failure to use condoms with every act of intercourse, can
lead to STD transmission because transmission can occur with a single
act of intercourse.
While condom use has been associated with a lower risk of cervical cancer,
the use of condoms should not be a substitute for routine screening
with Pap smears to detect and prevent cervical cancer.
Sexually
Transmitted Diseases, Including HIV
Sexually
transmitted diseases, including HIV
Latex condoms, when used consistently and correctly, are highly
effective in preventing transmission of HIV, the virus that
causes AIDS. In addition, correct and consistent use of latex
condoms can reduce the risk of other sexually transmitted
diseases (STDs), including discharge and genital ulcer diseases.
While the effect of condoms in preventing human papillomavirus
(HPV) infection is unknown, condom use has been associated
with a lower rate of cervical cancer, an HPV-associated disease.
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There are two primary ways
that STDs can be transmitted. Human immunodeficiency virus (HIV), as
well as gonorrhea, chlamydia, and trichomoniasis – the discharge
diseases – are transmitted when infected semen or vaginal fluids
contact mucosal surfaces (e.g., the male urethra, the vagina or cervix).
In contrast, genital ulcer diseases – genital herpes, syphilis,
and chancroid – and human papillomavirus are primarily transmitted
through contact with infected skin or mucosal surfaces.
Laboratory studies
have demonstrated that latex condoms provide an essentially impermeable
barrier to particles the size of STD pathogens.
Theoretical basis
for protection. Condoms can be expected to provide different
levels of protection for various sexually transmitted diseases, depending
on differences in how the diseases are transmitted. Because condoms
block the discharge of semen or protect the male urethra against exposure
to vaginal secretions, a greater level of protection is provided for
the discharge diseases. A lesser degree of protection is provided for
the genital ulcer diseases or HPV because these infections may be transmitted
by exposure to areas, e.g., infected skin or mucosal surfaces, that
are not covered or protected by the condom.
Epidemiologic studies
seek to measure the protective effect of condoms by comparing
rates of STDs between condom users and nonusers in real-life settings.
Developing such measures of condom effectiveness is challenging. Because
these studies involve private behaviors that investigators cannot observe
directly, it is difficult to determine accurately whether an individual
is a condom user or whether condoms are used consistently and correctly.
Likewise, it can be difficult to determine the level of exposure to
STDs among study participants. These problems are often compounded in
studies that employ a “retrospective” design, e.g., studies
that measure behaviors and risks in the past.
As a result, observed measures
of condom effectiveness may be inaccurate. Most epidemiologic studies
of STDs, other than HIV, are characterized by these methodological limitations,
and thus, the results across them vary widely--ranging from demonstrating
no protection to demonstrating substantial protection associated with
condom use. This inconclusiveness of epidemiologic data about condom
effectiveness indicates that more research is needed--not that latex
condoms do not work. For HIV infection, unlike other STDs, a number
of carefully conducted studies, employing more rigorous methods and
measures, have demonstrated that consistent condom use is a highly effective
means of preventing HIV transmission.
Another type of epidemiologic
study involves examination of STD rates in populations rather than individuals.
Such studies have demonstrated that when condom use increases within
population groups, rates of STDs decline in these groups. Other studies
have examined the relationship between condom use and the complications
of sexually transmitted infections. For example, condom use has been
associated with a decreased risk of cervical cancer – an HPV associated
disease.
The following includes specific
information for HIV, discharge diseases, genital ulcer diseases and
human papillomavirus, including information on laboratory studies, the
theoretical basis for protection and epidemiologic studies.
HIV
/ AIDS
HIV,
the virus that causes AIDS
Latex condoms, when used consistently and correctly, are highly
effective in preventing the sexual transmission of HIV, the
virus that causes AIDS. |
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AIDS is, by far, the most
deadly sexually transmitted disease, and considerably more scientific
evidence exists regarding condom effectiveness for prevention of HIV
infection than for other STDs. The body of research on the effectiveness
of latex condoms in preventing sexual transmission of HIV is both comprehensive
and conclusive. In fact, the ability of latex condoms to prevent transmission
of HIV has been scientifically established in “real-life”
studies of sexually active couples as well as in laboratory studies.
Laboratory studies
have demonstrated that latex condoms provide an essentially impermeable
barrier to particles the size of STD pathogens.
Theoretical basis
for protection. Latex condoms cover the penis and provide an
effective barrier to exposure to secretions such as semen and vaginal
fluids, blocking the pathway of sexual transmission of HIV infection.
Epidemiologic studies
that are conducted in real-life settings, where one partner is infected
with HIV and the other partner is not, demonstrate conclusively that
the consistent use of latex condoms provides a high degree of protection.
Discharge
Diseases, Including
Gonorrhea, Chlamydia, and Trichomoniasis
Discharge
diseases, other than HIV
Latex condoms, when used consistently and correctly, can reduce
the risk of transmission of gonorrhea, chlamydia, and trichomoniasis. |
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Gonorrhea, chlamydia, and
trichomoniasis are termed discharge diseases because they are sexually
transmitted by genital secretions, such as semen or vaginal fluids.
HIV is also transmitted by genital secretions.
Laboratory studies
have demonstrated that latex condoms provide an essentially impermeable
barrier to particles the size of STD pathogens.
Theoretical basis
for protection. The physical properties of latex condoms protect
against discharge diseases such as gonorrhea, chlamydia, and trichomoniasis,
by providing a barrier to the genital secretions that transmit STD-causing
organisms.
Epidemiologic studies
that compare infection rates among condom users and nonusers provide
evidence that latex condoms can protect against the transmission of
chlamydia, gonorrhea and trichomoniasis. However, some other epidemiologic
studies show little or no protection against these infections. Many
of the available epidemiologic studies were not designed or conducted
in ways that allow for accurate measurement of condom effectiveness
against the discharge diseases. More research is needed to assess the
degree of protection latex condoms provide for discharge diseases, other
than HIV.
Genital
Ulcer Diseases and Human Papillomavirus
Genital
ulcer diseases and HPV infections
Genital ulcer diseases and HPV infections can occur in both
male or female genital areas that are covered or protected
by a latex condom, as well as in areas that are not covered.
Correct and consistent use of latex condoms can reduce the
risk of genital herpes, syphilis, and chancroid only when
the infected area or site of potential exposure is protected.
While the effect of condoms in preventing human papillomavirus
infection is unknown, condom use has been associated with
a lower rate of cervical cancer, an HPV-associated disease.
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Genital ulcer diseases include
genital herpes, syphilis, and chancroid. These diseases are transmitted
primarily through “skin-to-skin” contact from sores/ulcers
or infected skin that looks normal. HPV infections are transmitted through
contact with infected genital skin or mucosal surfaces/fluids. Genital
ulcer diseases and HPV infection can occur in male or female genital
areas that are, or are not, covered (protected by the condom).
Laboratory studies
have demonstrated that latex condoms provide an essentially impermeable
barrier to particles the size of STD pathogens.
Theoretical basis
for protection. Protection against genital ulcer diseases and
HPV depends on the site of the sore/ulcer or infection. Latex condoms
can only protect against transmission when the ulcers or infections
are in genital areas that are covered or protected by the condom. Thus,
consistent and correct use of latex condoms would be expected to protect
against transmission of genital ulcer diseases and HPV in some, but
not all, instances.
Epidemiologic studies
that compare infection rates among condom users and nonusers
provide evidence that latex condoms can protect against the transmission
of syphilis and genital herpes. However, some other epidemiologic studies
show little or no protection. Many of the available epidemiologic studies
were not designed or conducted in ways that allow for accurate measurement
of condom effectiveness against the genital ulcer diseases. No conclusive
studies have specifically addressed the transmission of chancroid and
condom use, although several studies have documented a reduced risk
of genital ulcers in settings where chancroid is a leading cause of
genital ulcers. More research is needed to assess the degree of protection
latex condoms provide for the genital ulcer diseases.
While some epidemiologic
studies have demonstrated lower rates of HPV infection among condom
users, most have not. It is particularly difficult to study the relationship
between condom use and HPV infection because HPV infection is often
intermittently detectable and because it is difficult to assess the
frequency of either existing or new infections. Many of the available
epidemiologic studies were not designed or conducted in ways that allow
for accurate measurement of condom effectiveness against HPV infection.
A number of studies, however,
do show an association between condom use and a reduced risk of HPV-associated
diseases, including genital warts, cervical dysplasia and cervical cancer.
The reason for lower rates of cervical cancer among condom users observed
in some studies is unknown. HPV infection is believed to be required,
but not by itself sufficient, for cervical cancer to occur. Co-infections
with other STDs may be a factor in increasing the likelihood that HPV
infection will lead to cervical cancer. More research is needed to assess
the degree of protection latex condoms provide for both HPV infection
and HPV-associated disease, such as cervical cancer.
January 23, 2003
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