News Perspectives

Condom Labels Disputed

A conservative senator wants the U.S. Food and Drug Administration to require changes to the wording regarding effectiveness on condom labels, the Associated Press (AP) reported June 28. Condoms are very effective against HIV, the virus that causes AIDS, but the evidence is weaker regarding their use against other sexually transmitted diseases. Condoms reduce the risk of HIV infection by about 80 percent, AP reported. A recent U.S. government report said that for other infections studies cite prevention rates of 18 percent to 92 percent, depending on the disease.

What is the Doctor’s Reaction?

In case there is any confusion about whether to use condoms, one message should be clear: Condoms remain the best protection against sexually transmitted diseases for people who are sexually active. It’s important to emphasize this point given an ongoing debate in Congress over the label on condoms -- a debate that seems to be driven more by political issues than by health concerns.

While there’s some uncertainty about the effectiveness of condoms at preventing all sexually transmitted diseases, there’s no question that they are the best protection we have available -- short of complete abstinence. That’s the hitch for some social conservatives, who would like more emphasis on abstinence as the best way to prevent pregnancy and the spread of infection. To make the point, Republican Senator Tom Coburn is holding up the appointment of a new Food and Drug Administration commissioner until the agency approves condom labels that point out their shortcomings.

Expert panels that have supported condom use in general have also concluded that condoms can’t prevent 100 percent of sexually transmitted infections, and that they may work better at preventing some infections than others. For example, herpes and human papillomavirus can be spread from the skin on the scrotum and the base of the penis, which isn’t covered by a condom.

It’s also true that condoms aren’t the most effective form of birth control, especially when they are used alone. Perhaps most importantly, condoms work best only when they are used properly. For these reasons, it’s important that the labels and instructions on condoms be clear.

However, politicians and bureaucrats need to be careful about sending a mixed message that might discourage people from using condoms, or giving the impression that using a condom is no better that nothing at all. The value of abstinence shouldn’t be downplayed, but people who choose to be sexually active should understand that condoms remain our best available form of protection.

What Changes Can I Make Now?

People who want to lower their risk of sexually transmitted infection should keep in mind the following:

• Other than not having sex (abstinence), there is no way to prevent sexually transmitted diseases (STDs) 100 pecent of the time.
• On the other hand, condoms are the best protection against most STDs, including HIV
• Latex condoms appear much more effective at preventing certain infections than lambskin (natural) condoms.

While STDs can be carried and spread by people who have no symptoms or telltale signs, the risk of spreading an infection is highest when someone has an open sore or irritated skin surface.

Certain sexual practices seem to increase the risk of transmitting infections such as HIV. For example, anal intercourse appears more risky than oral sex, and certain things like kissing seems to have very little risk at all. That said, all types of sexual contact carry some degree of risk.

It also makes sense to choose your partners wisely, since some people are more likely to carry STDs that can be passed along sexually. For example, people who use intravenous drugs are more likely to carry HIV and hepatitis B infections.

If you are using condoms as birth control, remember that they are only about 85 percent effective. That means that if 100 couples use condoms for one year, about 15 of the women will become pregnant. Condoms are much better as birth control if they are combined with spermicidal jellies or foams.

What Can I Expect Looking to the Future?

For the near future, condoms and safe sex practices are likely to remain the main weapons against STDs. However, there’s ongoing research into antimicrobial gels and suppositories that might help to block the spread of certain diseases -- particularly HIV -- during vaginal intercourse. If and when they become available, these drugs will still need to be used along with condoms.