For the first time, scientists have proof that condoms
offer women impressive protection against the virus that
causes cervical cancer.
A three-year study of female college students
all virgins at the start found that women whose
partners always wore a condom during sex were 70 percent
less likely to become infected with the human papilloma
virus, or HPV, than those whose partners used protection
less than 5 percent of the time.
"That's pretty awesome. There aren't too many times when
you can have an intervention that would offer so much
protection," said Dr. Patricia Kloser, an infectious-disease
specialist at University of Medicine and Dentistry of
New Jersey who was not part of the study.
Condoms have been shown convincingly to prevent pregnancy
and AIDS. But conservatives
who want to see abstinence taught in schools have long
argued that condoms do not protect well against diseases
such as HPV, because men can spread the virus to women
from sores on their genitals outside the area covered
by a condom.
However, the researchers at the University of Washington
found that the chances of HPV being spread that way appear
to be small.
Human papilloma virus which can cause cervical
cancer, genital warts and vaginal, vulvar, anal and penile
cancers is the most common sexually transmitted
disease, infecting about 80 percent of young women within
five years of becoming sexually active. An estimated 630
million people worldwide are infected.
The virus is spread during sex from contact with the
sores, or lesions, that develop around infected cells.
Often, the virus is killed by the immune system, but
in some people HPV can take hold and cause lesions that
can turn cancerous years later. Cervical cancer strikes
about 10,520 American women and kills about 3,500 each
year. Worldwide, about 500,000 women develop cervical
cancer and nearly 300,000 die from it every year.
In the HPV study, published in Thursday's
New England Journal of Medicine, none of the women
who reported that their partners always used condoms developed
lesions during the three-year period. Fourteen women whose
partners used condoms less regularly got lesions.
Twelve of the 42 women who said their partners always
used condoms became infected. Rachel Winer, a researcher
in the university's epidemiology department, said it could
be that the couples did not use the condoms correctly
or had some sexual contact before putting on a condom.
Recent medical advances might someday render the condom
debate moot: Earlier this month, the government approved
the first vaccine against HPV, and public health officials
are urging that girls be routinely vaccinated before they
become sexually active.
The study comes as the Food and
Drug Administration is revising rules for the claims
that manufacturers can make on how well condoms prevent
sexually transmitted diseases.
Packages now must state: "If used properly, latex condoms
will help to reduce the risk of transmission of
HIV infection (AIDS) and many other sexually transmitted
diseases." But revisions were ordered by Congress in 2000
amid pressure from conservative groups demanding "medically
accurate" claims as to condoms' effectiveness.
Safe-sex advocates warn that changing the wording would
undermine public confidence in, and use of, condoms.
At the time, there was solid evidence only on how well
condoms prevent pregnancy, HIV and, in men, gonorrhea.
Recent research has produced strong evidence condoms protect
well against gonorrhea, chlamydia and herpes in both men
and women, said Dr. Ward Cates Jr., president of the Institute
for Family Health at Family Health International. This
study adds HPV to that list, he said.
"This will help clinicians to counsel their patients
about the effectiveness of condoms to reduce another of
the sexually transmitted infections if condoms
are used consistently and correctly," Cates said.
The researchers invited 24,000 female students ages 18
to 22 at the Seattle university to be in the study. Starting
in 2001, they followed 82 from before their first vaginal
intercourse, testing the women for HPV with swabs of the
cervix and other genital areas every four months. The
women kept online diaries detailing each act of intercourse,
including condom use and whether there was any genital
contact without a condom.
Winer said previous HPV studies either showed no protection
from condoms or were inconclusive. This one included only
virgins and collected more details, and the computer diaries
helped women be more honest about condom use than those
in studies where people are interviewed about their sexual
behavior, she said.
"This is about as ideal a study as you can get," said
Dr. Tom Fitch, a San Antonio pediatrician and board chairman
at the Medical Institute for Sexual Health, which stresses
abstinence and monogamy as the only sure ways to prevent
sexually transmitted infections.
Nevertheless, Fitch noted that some consistent condom
users still were infected with HPV. Fitch and Kloser also
suggested that the results in the real world say,
among poor, inner-city women might be different
from those with college women.
Fitch said several studies have shown that at most,
50 percent of people reported using a condom every time
they had sex.