Condoms can reduce your risk of contracting sexually transmitted diseases, but just how effective are they? On “Today’s Woman,” we take a look at condoms. Dr. Judith Reichman, a “Today” contributor and gynecologist, was invited on the show to share the latest information on STDs and tips on how to prevent getting one.

Condoms have a fascinating history. In 1000 B.C., Egyptian men used a linen sheath for protection against disease. By the 1700s, condoms were made from animal intestines and described as “a cobweb against infection.”  In the 1800s, rubber became the condom material of choice. Natural rubber latex was introduced in the early 1900s, and by the 1950s lubricated condoms were widely marketed. Since then, we have seen the advent of polyurethane condoms. Currently, condoms have become thinner and strongerm and they come in various sizes, shapes, colors and, yes, even flavors. Clearly, we’ve come a long way from using Egyptian linen penis wraps for disease protection. But do modern condoms prevent the transmission of STDs? Here are a few common questions about them and the latest information on them.

Do condoms reduce the risk of STDs, including HIV?
Not always. Even though it makes sense that preventing direct skin-to-skin (or vaginal mucosa) contact during intercourse would prevent viruses, bacteria and sperm from passing between partners, warnings about condom effectiveness prevail. Condoms are certainly not foolproof when it comes to contraception. If 100 women and their partners use condoms for a year in what is described as “perfect use,” two will become pregnant. With “typical use” (not used consistently or correctly) 15 women will become pregnant. This “typical use” failure rate is rarely due to a faulty condom, but rather to faulty application or no application. (Note, condoms in the U.S. are electronically tested for holes and defects and serial lots are tested for strength.)

When it comes to STD information and labeling, condoms have come under social, religious, political and medical scrutiny. Absolute standards for STD protection have been strongly advocated and, of course, are correct: The best way to ensure 100 percent protection against STDs is for both partners to abstain from sexual intercourse until marriage and then to refrain from extramarital sex. But as we know, this has not been applicable or practical for many (if not a majority) of individuals both in the U.S. and the developing world. In 2001, a law was passed that required the Food and Drug Administration to reexamine condom labels to determine the “medical accuracy” of their description of condoms’ effectiveness in preventing human papillomavirus (HPV) infections as well as other STDs. Since then, there has subsequently been considerable effort to pressure the FDA to add a warning to condoms about their lack of protection.

But in the past six years, further studies have supplied evidence that should set the condom issue straight. Medical evidence now shows that consistent use of condoms reduces the risk of transmission in men and women of

• HIV (by 80 percent)
• Gonorrhea
• Chlamydia
• Herpes simplex virus

(Note: The prevention of the last three STDs has not been absolutely quantified, because no one is suggesting that a person known to have one of these treatable infections have regular intercourse with an unaffected partner, unless they use condoms and/or are appropriately treated. Condom protection against HIV has been studied, especially in countries where therapies are often unavailable or unaffordable.)

We now have a new study published in the New England Journal of Medicine that convincingly demonstrates that condom use also reduces the risk of HPV infection in women.

What was novel or important about this HPV study?
HPV transmission is extraordinarily common. Genital HPV has now been shown to occur at some point in up to 80 percent of sexually active young women within five years of  becoming sexually active. If the virus is not killed by a woman’s immune system (which is what usually happens), it goes on to cause pre-cancers and cancers in the cervix, vagina, vulva skin and anus, as well as benign but physically disturbing warts.

This three-year study followed 82 female university students who had previously never had intercourse with a male partner. For three years, they answered simple questions on their computer every two weeks about their sexual behavior (whether they used condoms, how often they had intercourse, whether their partners had had previous partners, and if there was skin-to-skin contact without condom use). They were also tested every four months for HPV and had a Pap test. The women whose partners always wore a condom during sex were 70 percent less likely to become infected with HPV than those whose partners used protection less than 5 percent of the time. And even women whose partners used condoms just more than half of the time had a 50 percent reduction in their development of HPV.

None of the women whose partners always used condoms developed pre-cancerous lesions (called cervical squamous intraepithelial lesions) during the three-year period.  But 14 women whose partners did not use condoms or used them inconsistently developed these lesions, which were detected on their Pap smears. The FDA is currently revising rules for claims that manufacturers can make on how well condoms prevent STDs and HPV, and this study may influence their final recommendations.

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