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Condoms Keep HIV at Bay; Jury's Still Out on STDs

But lack of evidence is not proof of failure, experts say

FRIDAY, July 20, 2001 (HealthDayNews) -- Condoms can keep people from getting AIDS, and they can keep men from getting gonorrhea, but there's no proof they prevent a myriad of other sexually transmitted infections in men or women, says a government report released today.

Condoms undoubtedly protect both men and women from HIV, the AIDS virus, says the report, which was based on an analysis of 138 studies on latex condom use and STD spread between male and female partners who had penile-vaginal sex.

But a lack of evidence and good research prevented similar conclusions about other diseases, says the National Institutes of Health (NIH) panel which released the report.

The panel says it found no proof that the contraceptives defend against chlamydia, genital herpes, trichomoniasis, genital ulcers, syphilis and human papilloma virus (HPV). HPV can cause cervical cancer. Trichomoniasis is caused by a single-celled organism; chlamydia and syphilis are caused by bacteria and can be treated with antibiotics. Herpes and HPV are caused by viruses.

However, the researchers hasten to say that just because the analysis of the studies found no definitive proof that condoms prevent an array of sexually transmitted diseases (STDs), that doesn't mean they don't. The report didn't come to any conclusions about how male latex condoms reduced the spread of these diseases in women.

"Because of limitations in study designs, there was insufficient evidence from the epidemiological studies on these diseases to draw definite conclusions" about condom use and these sexually transmitted diseases, the report says. Even so, it adds, "The absence of definitive conclusions reflected inadequacies of the evidence available and should not be interpreted as proof of the adequacy or inadequacy of the condom to reduce the risk of STDs."

Some 65 million Americans, or more than one in five, either have or have had an STD, the report says.

The report may undercut the popular perception that condoms are all that's required for "safe sex," and it could give ammunition to religious conservatives and other advocates of abstinence, say observers. Earlier this week, the U.S. Department of Health and Human Services announced $17 million in new grants to states to promote abstinence-only programs aimed at teens.

Dr. Willard Cates Jr., president of Family Health International of Research Triangle Park, N.C., a reproductive health research group, says the report "was actually really good news" about how well condoms work, since the study shows that they prevent transmission of HIV, the most serious STD, and gonorrhea, the most common sex infection next to chlamydia.

"All the other categories fall in between these, either in terms of ease of transmission or seriousness," says Cates, former director of the STD branch of the Centers for Disease Control and Prevention (CDC). As for the lack of evidence, Cates says, "It's crucial to emphasize that the absence of data does not mean that condoms don't work."

With that in mind, he says, "It's incumbent on public health officials to redouble their efforts and promote correct and consistent condom use."

Dr. David Kaplan, chief of adolescent medicine at Children's Hospital, in Denver, and chair of the American Academy of Pediatrics committee on adolescent medicine, says "It would be a horrendous mistake" for policy makers to discourage condom use. "Supporting abstinence is important, but at some point individuals become sexually active," he says.

The pediatricians' group and several other medical associations recommend that sexually active teens use condoms, though they support abstinence as a principle, as well.

Kaplan says because so few good studies have been done on the subject, it's hard to know why condoms wouldn't prevent infection. He says the fault usually lies with the wearer, not the condom itself, underscoring the need to teach people, and especially teens, how to use the contraceptives.

Teen condom use is up greatly in the last 20 years, the report says. Between 1991 and 1997, the share of 9th through 12th graders who said they used a condom during intercourse rose from 55 percent to 62 percent for boys and from 38 percent to 51 percent for girls.

The report came out of a workshop held last year by the NIH and other federal health-care agencies.

Condom use reduced the risk of HIV infection by 85 percent, and reduced female-to-male transmission of gonorrhea by between 49 percent and 100 percent, the report says.

What To Do

Condoms should be worn during intercourse and anytime there's genital contact, experts say. "The idea that condoms fail when used is a real rarity. However, they do fail when they're not used," Cates says.

To learn more about STDs, check the CDC, the Urology Channel, or the World Health Organization.

For more on barrier contraceptive methods such as condoms, try Family Health International.

SOURCES: Interviews with Willard Cates Jr., M.D., M.P.H., president, Family Health International, Research Triangle Park, N.C.; David Kaplan, M.D., professor of pediatrics, chief of adolescent medicine, University of Colorado, Children's Hospital, Denver; July 20, 2001, report, NIH
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