Do condoms really protect against STDs?

Does promoting condom use lead to an increase in promiscuous sex?
Let me first point out that according to data published by the Guttmacher Institute (as well as the Youth Risk Surveillance Survey of 2003), over 50 percent of high school girls have begun having intercourse between the ages of 15 and 18. The Institute has also published well accepted data that shows that contraceptive education does not encourage sexual activity. Of interest is the fact that only 15 percent of Americans want abstinence-only education taught in classrooms, but four in 10 sex education teachers don’t teach about contraceptive methods or teach that it is ineffective. We still have the highest rate of teen pregnancy in the developed world! Lack of contraceptive education is certainly not helping.

Moreover, analysis on the use of condoms to reduce the risk of HIV in 174 studies (with over 100,000 participants) did not show that condom use increased unsafe sexual behavior. Most major health institutions now support an ABC approach for prevention of HIV and other STDs.  ABC stands for

• Abstinence
• Be faithful
• Use Condoms

For those who choose to be sexually active, there is medically sound reassurance that condom use can reduce the risk of STDs, but only when used consistently and correctly. Condoms, the “c” in this all important acronym can help attain safer sex.

Will the new HPV vaccine make condom use less important?
No. The vaccine that was recently approved by the FDA for HPV and cervical cancer protection (Gardasil, manufactured by Merck & Co.) specifically targets four types of HPV viruses, which cause 70 percent of cervical cancers and 90 percent of genital warts as well as pre-cancerous lesions of the cervix and vagina. This vaccine is effective in preventing cancers and active infections from these four types of HPV in women who have not yet been infected.  It doesn’t protect those who have already been infected with these viruses. Gardasil is therefore slated for use in adolescent girls and young women between the ages of 9 and 26.  The vaccine is given through three injections over a course of six months. Each shot costs $120.  Within one month of finishing the last injection, immunity is present. In essence, this is a “before you have sex” or “before you are infected” vaccine. It will probably be given (like the hepatitis vaccine) by pediatricians or by gynecologists who see adolescent girls and young women.

(Note: The new recommendation by the American College of Obstetricians and Gynecologists is that 13- to 15-year old girls have an initial ob-gyn visit to discuss their development, periods and future reproductive health issues. A pelvic exam is not felt to be necessary at this time ... but it certainly would be an appropriate time to discuss and provide immunization.)

Clearly a lot of issues need to be resolved about this new vaccine. How long is it protective? (So far data has shown efficacy continues for at least five years.) Will booster shots be necessary? Who will pay? Should we immunize young women who have already had sex but whose previous HPV status is unknown ? And let’s not forget that as good as this vaccine may be in preventing cervical cancer, there are other types of HPV infections that can potentially cause cancer. The vaccine will not protect against all the other STDs and, of course, is not a contraceptive.

Condoms remain an important tool in our ongoing efforts to achieve sexual and reproductive health. We now have additional evidence that when it comes to the horrifically prevalent and transmittable HPV, condom protection is effective.

Dr. Judith Reichman, the “Today” show's medical contributor on women's health, has practiced obstetrics and gynecology for more than 20 years. You will find many answers to your questions in her latest book, "Slow Your Clock Down: The Complete Guide to a Healthy, Younger You," which is now available in paperback. It is published by William Morrow, a division of HarperCollins.

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