Condoms and STDs
With the increasing number of STDs (sexually transmitted diseases) and especially since the advent of AIDS in the early 1980s, condoms have been promoted as the means of having 'safe sex'.
Of engaging in sexual activity with no risk of getting an STD or of getting pregnant!
Isn't that what 'safe' means?
But do they REALLY provide 'safe sex'?
In the USA the term is now usually 'safer sex' as authorities and researchers acknowledge that condoms do NOT provide full protection against disease.
The Research
The most comprehensive analysis of all the available research (138 peer reviewed papers) on condom effectiveness was undertaken by the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Department of Health and Human Services in the USA following a request by Congress in 2001. They only analysed use of condoms by heterosexuals.
Scientific Evidence on Condom Effectiveness for Sexually Transmitted Disease (STD) Prevention
Full Report: This is a 49 page pdf document - it begins with a 2 page Executive Summary.
The Executive Summary says that:
* Use of the condom on all occasions "significantly reduced the risk of HIV infection in men and women".
* Use of the "male condom could reduce the risk of gonorrhea for men".
* There was "insufficient evidence from the epidemiological studies on these diseases to draw definite conclusions about whether condoms were effective in STDs caused by genital secretions (Chlamydia, gonorrhea in women etc)
* Genital ulcer diseases (herpes, syphilis): insufficient evidence to draw conclusions.
 More detailed findings:
The Report noted that the protection that condoms afford against STDs can be examined from three perspectives. 1) the condom itself.
2) The individual users.
3) The population of people where particular sexual behaviours are seen. (P 3)
The limitations of study designs were then discussed.
The Report then analysed each of these three factors (P 6-10).
The Diseases were then considered in detail:
"HIV infection, gonorrhea, chlamydial infection, (including PID caused by gonococcal and chlamydial infections), syphilis, chancroid, trichomoniasis, genital herpes caused by HSV 1 and 2, genital HPV infection and HPV diseases including genital warts, cervical dysplasia and cervical cancer." (P 11)
These are mostly in two categories - discharge of secretions and ulcerative (plus HPV).
Some of the findings:
* HIV:"consistent condom use decreased the risk of HIV/AIDS transmission by approximately 85%".
* Gonorrhea: reduction for men; not enough evidence for women.
* Chlamydia: "Other studies in men and women demonstrated either no or some protection and are inconclusive."
* Genital ulcer STDs (eg herpes): protective effect "would be expected to depend on the site of the sore/ulcer or infection and the ability of the condom to fully cover the lesion"! Not enough research evidence to make other conclusions.
* Syphilis: Some studies showed some protective effect - but the studies were held to be inadequate to accurately assess any protective effect.
* HPV: "There was no evidence that condom use reduced the risk of HPV infection".
The Centres for Disease Control and Prevention released a 6 page Summary of this Report.
They say: "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."
Indeed - condom use is hardly what one could call 'safe'!
Studies done since 2000
Some researchers have done further studies or analysed additional data in an effort to show that condoms are more effective:
Condoms for sexually transmissible infection prevention: politics versus science
Adrian MindelA and Shailendra SawleshwarkarA ,B
A Sexually Transmitted Infections Research Centre, Marian Villa, Westmead Hospital and University of Sydney, Westmead, NSW 2145, Australia.
Sexual Health Journal, 22 Feb 2008.
The authors analyse the situation following on from the US analysis done in 2008. They confirm that condoms provide [some] protection against HIV but acknowledge that "infections transmitted via skin and mucous membrane contact" have less protection. They then go on to the politics and discuss their views on abstinence education! Abstract only.
Effectiveness of condoms in preventing sexually transmitted infections
Bull World Health Organ. 2004 Jun;82(6):454-61
The authors write about additional studies: "These prospective studies, published since June 2000, show that condom use is associated with statistically significant protection of men and women against several other types of STIs, including chlamydial infection, gonorrhoea, herpes simplex virus type 2, and syphilis. Condoms may also be associated with protecting women against trichomoniasis" and conclude "Although condoms are not 100% effective, partial protection can substantially reduce the spread of STIs within populations."
What are young people being told?
"Chlamydia is transmitted by having vaginal, anal or oral sex without a condom, with someone who has the infection." ACT Health Fact Sheet
But you could get it even if you do use a condom!
"The best way to avoid getting chlamydia is to practice safe sex: that is to use a condom."
Queensland Health
"Safe Sex - Always practise safe sex by using a condom and lubricant with ALL your sexual partners when travelling overseas."
WA Population Health - overseas travel
"Have you heard that condoms are not completely effective against all STDs? Well, that's correct, but they are pretty damn good and certainly the best we have at the moment, short of abstinence!"
NT Health
A dose of reality?
"Condoms are the best form of protection against STD's."
STD's Ninemsn Health page.
At least they add "Protection against genital warts and herpes is most only moderate in cases that involve anatomical areas not covered by the condom."
'Safe sex'... then 'help prevent'
Ironically a lot of Australian services proclaim the message of 'safe sex' and then talk of using condoms to help prevent STIs... or reduce the risk.
The NSW 'Safe Sex - No Regrets' campaign says
"Safe sex is using condoms and water-based lubricants as well as a range of other things you can do during sex to help reduce the risk of catching or passing on STIs (sexually transmitted infections) or HIV.
Safe vaginal or anal sex - Condoms
"Condoms, used properly, are the most effective means of reducing the risk of getting or passing on an STI."
WA Health
"Safe sex is about preventing sexually transmitted infections (STIs) ..."
Queensland Health
Some groups are actually using the 'safer' word:
"Safer sex means sexual contact that does not involve any exchange of blood, semen or vaginal fluids." .... "We say safer sex rather than safe sex because sex can't be guaranteed 100% safe."
SA Child and Youth Health
How can we be really safe?
Following God's plan of abstinence before marriage and faithfulness within marriage between a man and a woman is the only way to be really 'safe'.
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