Preventing STDs: The proper use of the condom
with Dr Walter Chin
February 16, 2003
Sexually transmitted diseases (STDs) are important and preventable causes of morbidity, mortality, disability, and are associated with lost productivity and substantial health care costs.
The STDs include HIV/AIDS infection, gonorrhoea, chlamydia, syphilis, chancroid, trichomonas, genital herpes caused by the herpes simplex virus type 1 or type 2 (HSV 1 and 2), human papilloma virus (HPV) infection and HPV diseases including genital warts, cervical dysplasia and cervical cancer. The health repercussions of STDs, particularly undiagnosed infections, can be serious. Asymptomatic infections, which can result in unknown transmission of STDs, are important factors in perpetuating STD/HIV infections.
The sexually transmitted infections can cause adverse pregnancy outcomes including miscarriage, still birth, intrauterine growth retardation, and perinatal (mother to child) infections. Some STDs are associated with infertility among women and one, the human papilloma virus, can cause cervical cancer among women. In addition, studies have shown that STDs promote HIV transmission by increasing HIV infectiousness and HIV susceptibility. Syphilis in the advanced stages has severe deleterious effects on the heart and nervous system.
In addition to these, hepatitis B, a serious liver infection, can be transmitted in the same way as the HIV. Hence, infection can occur through sexual transmission, infected needles, blood transfusions, or from mother to child. In sexual transmission, infection can occur if there is unprotected vaginal, anal or oral sex with an infected partner whose blood, saliva, semen or vaginal secretions enter the body of an uninfected person.
The STDs fall into two categories: those with discharges and those with ulcers. The diseases with discharges include HIV infection, gonorrhoea, chlamydial infection and trichmoniasis. The infectious agents of these diseases are present in genital secretions (ie, semen and vaginal fluid). In genital ulcer diseases (genital herpes, syphilis, and chancroid), the infectious agents are present in sores or ulcers. HPV infection does not fall in either category; this virus is probably transmitted via contact with infected cells in the presence or absence of fluid or tissue exchange.
Not all STDs respond to treatment. The curable diseases include four bacterial infections (gonorrhoea, chlamydial infection, syphilis, and chancroid) and the one parasitic infection (trichomoniasis). Appropriate treatment cures these infections. In contrast, the viral infections (HSV, HIV, and HPV) either persist for life (HSV and HIV) or are cleared spontaneously (ap- proximately 90 per cent of HPV infections). However, HSV and HIV infections may be controlled or ameliorated with anti-viral therapies.
During sexual intercourse STDs are transmitted from infected males to uninfected females via exposure of the cervix and vagina to semen, and from infected females to uninfected males via exposure of the male urethra to female genital secretions.
STDs can be prevented. This is even more important for those STDs, especially HIV/AIDS, that are not curable. Current prevention/risk reduction strategies include, abstinence, monogamy with an uninfected partner, use of condoms and engaging in sexual activity that does not result in the transfer of bodily fluids or cell-to-cell transmission. There are no vaccines (with the exception of hepatitis B vaccine) for the prevention of STDs.
The condom is a most effective way to prevent pregnancy and sexually transmitted diseases. The male condom is a sheath worn over a man's erect penis to catch sperm and keep them from entering the woman's vagina.
Most male condoms are made from natural rubber latex, a milky fluid produced by the rubber tree. When used consistently and without slippage or breakage, male condoms will contain pre-ejaculate emissions as well as semen following ejaculation, thus protecting the female reproductive tract. Condoms also prevent exposure of the penis to vaginal secretions.
There are three kinds of condoms.
There is the male latex condom. Latex condoms are the most effective against pregnancy and disease, and are the only condoms that prevent the transmission of HIV. These condoms are available over-the-counter in various sizes, colours, and textures; some types are also pre-coated with spermicide (an agent which kills sperms). Size is important, as if a condom is too tight, it is more likely to break, and if it is too slack, it is likely to slip off. It is essential that condoms are used properly. When using a condom, the package should be opened carefully.
The air should be gently pressed out of the tip of the condom before it is put on, as trapped air may lead to bursting of the condom when ejaculation occurs.
It should then be carefully rolled on to the erect penis before intercourse.
Proper lubrication can reduce the risk of the condom tearing. If the condom is not lubricated and lubrication is necessary, a water-based lubricant, such as K-Y jelly, should be used. It is important to note that petroleum or mineral-based lubricants, such as petroleum jelly or baby oil can weaken latex condoms causing them to break. For a condom to be fully effective, it must stay on the penis during sexual intercourse, and it must not break. However, condoms do slip or break during use. If the condom does break, the woman should insert some spermicidal cream immediately.
After intercourse, the rim of the condom should be held and the penis pulled out slowly from the vagina, before the erection subsides. Condoms should never be reused. As body heat will cause latex to deteriorate, it is not advisable to keep condoms in a wallet.
The second kind of condom is the 'natural condom,' which is made of natural (animal) skins. These are effective as a contraceptive, but have pores large enough for viruses and bacteria to pass through, and are therefore not adequate protection from HIV transmission or STDs.
The third kind of condom is the female condom. It is less effective than the male condom in preventing pregnancy, and similarly less effective in protecting against STDs. Female condoms (the vaginal pouch) are cylinders of polyurethane with plastic rings attached at either end. One end is closed. This end is inserted into the vagina until it covers the cervix; the other, open end, remains outside the vagina.
It is important to ensure that the polyurethane sheet covers the wall of the vagina. Intercourse should be halted if the penis slips between the pouch and the wall of the vagina, or if the outer ring is pushed inside the vagina. To be effective, the female condom must be put in before the penis is inserted into the vagina. The female condom is lubricated and packaged with extra lubricant.
Condoms are not associated with any serious side effects. Some men complain that condoms interfere with sensation, and some women dislike the feeling of the rubber against their vaginal walls or find the friction irritating. Condom use has no effect on future fertility. For those who may be allergic to latex, plastic (polyurethane) condoms are an alternative, although they are not as reliable as the latex ones.
Condoms are 97 to 98 per cent effective in preventing pregnancy and provide the best protection against sexually transmitted diseases. Studies, in which one partner is HIV positive, have shown that none of the uninfected partners acquired HIV after the use of condoms for an average of 20 months after vaginal or anal intercourse. In couples who did not use condoms or used them inconsistently, 10 per cent and 15 per cent respectively of the healthy partners became infected.
The clear message is that condoms used properly and consistently can prevent pregnancy, HIV infection and other sexually transmitted diseases.