Scientific Evidence on Condom Effectiveness for Sexually Transmitted Disease (STD) Prevention
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The Problem and the Process
Primary prevention of STD infection is an important health priority. Unfortunately there are no STD vaccines, except for hepatitis B vaccine, and topical microbicides to prevent STDs are not available. Beyond mutual lifelong monogamy among uninfected couples, condom-use is the only method for reducing the risk of HIV infection and STDs available to sexually active individuals.
Recently, a number of Federal agencies sponsored a workshop to answer the following question: "What is the scientific evidence on the effectiveness of latex male condom-use to prevent STD transmission during vaginal intercourse?"
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Conclusions on STDs Transmitted by Genital Secretions
The published data documenting effectiveness of the male condom were strongest for HIV. The Panel concluded that, based on a meta-analysis of published studies “always” users of the male condom significantly reduced the risk of HIV infection in men and women. These data provided strong evidence for the effectiveness of condoms in preventing HIV transmission in both men and women who engage in vaginal intercourse.
The Panel also concluded that the consistency of findings across four epidemiological studies of gonorrhea indicated that the latex male condom could reduce the risk of gonorrhea for men.
The strongest evidence for potential effectiveness of condoms on other STDs transmitted by genital secretions (i.e. gonorrhea in women, chlamydial infection and trichomoniasis) was the laboratory-based studies on the properties of the male latex condom and the strength of the evidence for condom use reducing the risk of HIV transmission in men and women and gonorrhea in men. The Panel concluded, however, that because of limitations in study designs there was insufficient evidence from the epidemiological studies on these diseases to draw definite conclusions about the effectiveness of the latex male condom in reducing the transmission of these diseases.
SEE THE TABLE ON PAGE 7
(Pay partrcular attention to the part about
Condom used, No break, No visibly detectable holes, but still passes virus 6 x 10-6 ml × .023 0.00000004 -- j)
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Conclusions
Condom use in the U.S. has increased over the past 20 years. Recent studies conducted in the U.S. show condom breakage rates during use to be in the range of 0.4% to 2.3%, with comparable rates for slippage. Use factors such as experience, condom size, and use of lubricant can affect condom slippage and breakage.
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Conclusions
The methodological strength of the studies on condoms to reduce the risk of HIV/AIDS transmission far exceeds that for other STDs. There is demonstrated exposure to HIV/AIDS through sexual intercourse with a regular partner (with an absence of other HIV/AIDS risk factors). Longitudinal studies of HIV- sexual partners of HIV+ infected cases allow for the estimation of HIV/AIDS incidence among condom users and condom non-users. From the two incidence estimates, consistent condom use decreased the risk of HIV/AIDS transmission by approximately 85%. These data provide strong evidence for the effectiveness of condoms for reducing sexually transmitted HIV.
