In July 2001, a National Institutes of Health (NIH) study panel in the United States issued its report on condom effectiveness in preventing sexually transmitted infections, including HIV/AIDS.1 Family Health International distributed this concise list of typical questions and answers about the report to health providers and scientists worldwide, to help explain key findings.
Q: What were the report's major findings?
A: The NIH report concluded that correct and consistent use of male latex condoms effectively reduces transmission of HIV/AIDS in women and men, and gonorrhea in men; and prevents pregnancy. The report also found that evidence is insufficient to determine the effectiveness of condoms in preventing the six other sexually transmitted infections (STIs) it reviewed.
Q: What did the panel say about these six other STIs?
A: The panel concluded that epidemiological evidence is currently insufficient to provide an accurate assessment of the effectiveness of condoms in preventing spread of gonorrhea in women, or chlamydial infection, syphilis, chancroid, trichomoniasis, genital herpes, and genital human papillomavirus (HPV) infection in women and men. "Because of limitations in study designs," the report says, "there was insufficient evidence from the epidemiological studies on these diseases to draw definite conclusions" about the effectiveness of condoms. How-ever, it noted that "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 these other infections.
Q: What is FHI's professional opinion about the study's implications?
A: "The data clearly show that condoms prevent HIV/AIDS, which is the most deadly STI, and gonorrhea, the most easily transmitted infection," says Willard Cates, Jr., MD, MPH, president of FHI. "We believe the male latex condom is also highly effective in preventing pregnancy, when used correctly and consistently. These are three excellent reasons for actively promoting the use of male latex condoms. Also, lack of research data on some STIs does not mean condoms are ineffective against these diseases. When used correctly and consistently, we should expect male latex condoms to be highly effective in preventing the risk of the other discharge diseases – gonorrhea in women, chlamydia and trichomoniasis. Condoms should also be effective, but not necessarily highly effective, in reducing the risk of genital ulcer diseases – genital herpes, syphilis, chancroid – and HPV infection. However, the study concluded that 'condom use might afford some reduction in risk of HPV-associated diseases, including genital warts in men and cervical neoplasia [cancer] in women.'"
Q: Was any significant recent research not included in the panel's report?
A: Yes. In a study published June 27, 2001 in the Journal of the American Medical Association, scientists concluded that condom use during more than 25 percent of coital acts was associated with protection against genital herpes transmission to susceptible women. Other encouraging recent studies that are nearing publication include research in Peru that found consistent condom use protected sex workers against gonorrhea and, to a lesser extent, against chlamydia. And more recent follow-up data have become available from an important study that led the panel to conclude that consistent condom use protects men against gonorrhea. The more recent findings also suggest substantial protection against chlamydia.
Q: How was the panel selected, and how did it reach its conclusions?
A: Cosponsored by the National Institutes of Health, the Centers for Disease Control and Prevention, the U.S. Food and Drug Administration, and the U.S. Agency for International Development, a 28-member panel of scientists and other experts analyzed more than 138 peer-reviewed studies on the properties and user patterns of the male latex condom during penile-vaginal intercourse.
Q: Precisely what risk reduction was found for gonorrhea and HIV/AIDS?
A: Meta-analysis of several studies showed an 87 percent decrease in risk of HIV transmission among consistent condom users versus non-users. However, three of the best-designed studies showed that HIV infection rates were less than 1 percent per year among consistent condom users. These data provide compelling evidence that consistent use of the latex male condom is a highly effective method for preventing HIV transmission, the report says. Studies also show a 49 percent to 100 percent reduction in risk of gonorrhea among men reporting condom use compared with non-users.
Q: What are the long-term health consequences from STIs?
A: In addition to death and other serious illnesses associated with HIV/AIDS, many of the other STIs can cause infertility, problems with pregnancy, and transmission from a mother to her infant. Long-term infection with certain types of HPV can cause cervical cancer if not diagnosed (through annual Pap smears) and treated. In addition, most STIs increase substantially the likelihood of transmitting HIV infection. While most STIs can be treated successfully, no vaccine is currently available to prevent infection by organisms that cause STIs, except for hepatitis B.
Reference
- Workshop summary: scientific evidence on condom effectiveness for sexually transmitted disease prevention. National Institute of Allergy and Infectious Diseases, National Institutes of Health, Department of Health and Human Services, 2001. Available: http://www.niaid.nih.gov/dmid/stds/condomreport.pdf, October 18, 2001.
