Condom report questions STD protection

By Christy Feig
CNN Medical Unit

WASHINGTON -- A draft copy of a National Institutes of Health report on the effectiveness of condoms says science cannot yet confirm that condoms prevent the spread of most sexually transmitted diseases (STDs), other than HIV and the transmission of gonorrhea from woman to man.

The report, obtained by CNN Thursday, says "the absence of definitive conclusions ... should not be interpreted as proof of the adequacy or inadequacy of the condom to reduce the risk of STDs other than HIV transmission in men and women, and gonorrhea in men. To definitely answer the remaining questions about condom effectiveness for preventing STD infections will require well-designed and ethically sound clinical studies."

Sources in the AIDS community said there is no new information in this report and they are concerned the administration will use it to promote an abstinence-only agenda.

RESOURCES Message Board: AIDS prevention

"The risk of acquiring any disease spread through genital secretions ... can be effectively reduced through consistent and correct condom use," the sources said. "Obviously, a condom can't protect what it doesn't cover or touch. But it can protect against the infectious agents in genital secretions."

The sources contend that abstinence fails more often than condoms. "Abstinence, like a condom, is only effective when it is consistently used as a means of STD and HIV prevention," they said. "Young people should have access to both."

The report was created in a June government workshop of 28 panel members who considered the question: "What is the scientific evidence on the effectiveness of latex male condom use to prevent STD transmission during vaginal intercourse?"

The report estimates one in every five adults in America has an STD. There are approximately 15 million new sexually transmitted infections every year in the United States, many of which are undiagnosed.

Latex male condoms accounts for 97 percent of United States condom sales, according to the report.

The panel members examined evidence related to eight STDs: HIV, gonorrhea, chlamydia, syphilis, chancroid, trichomoniasis, genital herpes caused by herpes simplex viruses, and genital human papillomavirus infection.

The panel said there were some problems with the 138 peer-reviewed papers they reviewed for the report, including:

• Many studies lacked a sufficient number of subjects to have adequate statistical power to evaluate condom effectiveness.

• Many studies were done in special populations, such as commercial sex workers or STD clinic patients who are at far higher risk for infection than are other sexually active individuals, therefore limiting how the results can be generalized to other populations.

• Most studies did not use optimal interview methods to gather accurate information, especially with regard to sexual histories and condom usage.

• Many studies did not distinguish between correct and incorrect condom use.

• Slippage and breakage events were not quantified and some studies measured only if a condom was 'ever' used.

The panel said those limitations prevented accurate conclusions about condom effectiveness. The report said it is important to pursue "robust research" to really determine how effective condoms are at preventing disease.

The report was requested by former Rep. Tom Coburn. The June 12-13 workshop was sponsored by four federal agencies: the U.S. Agency for International Development, the Food and Drug Administration, the Centers for Disease Control and Prevention, and the National Institutes of Health.