Myron S. Cohen, MD

Disclosures

August 21, 2001

Question

Given the current controversy, are there really grounds for concern over the efficacy or otherwise of condoms in preventing HIV and other sexually transmitted diseases? How reliable is the evidence that underpins current prevention recommendations?

Response from Myron S. Cohen, MD

The ability of condoms to reduce the transmission of sexually transmitted diseases (STDs), including HIV, is sadly confused by the religious and political cacophony that surrounds their use. There is no doubt that male latex condoms can reduce the transmission of STDs. The only question is the magnitude of benefit.[1,2,3]

A comprehensive review document regarding the effectiveness of condoms, cosponsored by the National Institutes of Health, the Centers for Disease Control and Prevention, the Food and Drug Administration, and the US Agency for International Development, was published in July 2001.[4] Condoms appear to greatly reduce the transmission of HIV if they are used regularly and properly.[1,2] Condoms also reduce the transmission of most other STD pathogens, but the degree of protection afforded to men and women may vary widely, depending on the pathogen.[1] For example, condoms appear to protect men more than women from acquisition of pathogens that cause urethritis,[1] whereas women are better protected than men from acquisition of HSV-2.[3]

There is virtually no evidence to support the idea that knowledge or availability of condoms reduces rates of abstinence, or inspires promiscuity or riskier sexual behaviors. Condoms are clearly not perfect. They can be misused or (more rarely) fail or break. The benefits of condoms may not extend to protection from all STD pathogens, nor has their usage to prevent transmission of all STD pathogens been studied. However, the ability of condoms to prevent transmission of HIV is well established, and condoms must remain a first line of defense in any HIV prevention campaign.

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