June 22, 2006
If you ask me, ABCNews blew the headline on this article:
Condoms Highly Effective Against HPV, Study Shows

College junior Kelsey Innis knows the facts about sexually transmitted diseases but finds that many students don't.

"There's an attitude of real fear out there that doesn't breed knowledge," said Innis, who is also a sexual health peer educator at the University of Texas in Austin.

Slowing the spread of one of the nation's most prevalent STDs among college students — the human papilloma virus, or HPV — requires knowing how the virus is prevented. That has been somewhat of a mystery — until now.

A new study in the New England Journal of Medicine reveals that consistent condom use can prevent the spread of HPV in up to 70 percent of cases, giving Innis and other health educators better proof that condoms can prevent HPV, helping to dispel any myths that they are not effective.

I find 'better proof that condoms can prevent HPV' interesting, because the actual study doesn't really say that at all:
Results The incidence of genital HPV infection was 37.8 per 100 patient-years at risk among women whose partners used condoms for all instances of intercourse during the eight months before testing, as compared with 89.3 per 100 patient-years at risk in women whose partners used condoms less than 5 percent of the time...

Conclusions Among newly sexually active women, consistent condom use by their partners appears to reduce the risk of cervical and vulvovaginal HPV infection.

What a bold conclusion: Codoms “appear” to reduce “the risk” of HPV infection.

It is interesting to read the methodology of the study. It is also interesting to see who they omitted from their analysis:

Analyses were restricted to women with at least one follow-up visit after they first had intercourse. Excluded from the study were 65 women who reported having had no vaginal intercourse, 3 women who did not record any information in their diaries regarding sexual behavior, and 60 women who reported having first had intercourse more than two weeks before enrollment.
These exclusions make perfect sense. The women who remained abstinent were not relevant to their study since they were only interested in how condoms prevent HPV transmission. (I think the transmission rate among the abstinent is already a known quantity.) Omitting those sexually active before the start of the study also helps rule out those who might already have contracted HPV.

But think about the results. I'm not sure exactly what 100 patient-years at risk really is (the study explains how they weighted sexual behavior in their analysis), but there were 90 incidents of genital HPV without the use of condoms, and almost 40 when they are always used. The way I read that, condoms do not stop the transmission of HPV, they merely reduce the risk by a little better than half.

Think about it this way: You have spend a very nice romantic evening with someone special and the chemistry is there. At the end of the evening the person says “Hey...I wanted to let you know that I have HPV*, but its ok...I have a condom,” and pulls one out of his/her pocket. What do you do? (*or HIV, syphilis, herpes or gonorrhea.)

I think your action really boils down to how much you believe ABC's headline and the rest of the 'safe sex' lobby. As for me, no way. I've read the study. I understand the risks.

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