Condom use promotes regression of human papilloma virus-associated penile lesions in male sexual partners of women with cervical intraepithelial neoplasia. He found that annual HIV incidence in non-users was 1. However in the year , researchers from London's City University presented a study 27 , 28 of gay male couples who had been randomised to use either standard or thicker condoms for anal sex and additional water-based lubricant. In a study of an ineffective candidate vaccine against HSV-2, Anna Wald and colleagues 32 found that women using condoms less than a quarter of the time were For this reason and because HIV seroconversion even in high-risk populations is a relatively uncommon event, prospective cohort studies have to be large and can be quite costly. A clinical trial of a thicker versus a standard condom for gay men. However, we now have enough evidence to demonstrate that condoms offer at least some and in some cases excellent protection against most STIs. To cite one of the 12 studies in more detail, 18 researchers looked at Italian serodiscordant couples in which the male partner was HIV positive. For persons whose sexual behaviors place them at risk for STDs, correct and consistent use of the male latex condom can reduce the risk of STD transmission.
This may be because the figures for vaginal sex are simply extrapolated to anal sex; it may also be because, in gay men at least, a lot of HIV transmission happens in casual situations where the HIV serostatus of partners cannot be assessed, and so the degree of HIV exposure risk are difficult to quantify. When it comes to STIs other than HIV, most epidemiologic studies of these are characterised by methodological limitations, and thus, the results across them vary widely - ranging from demonstrating no protection to demonstrating substantial protection. The same paradox applies in studies of anal sex — see the next section. Bulletin of the World Health Organization To take one study from Rakai, Uganda: In a subsequent re-analysis of the same data, 33 the researchers found that a higher level of condom use was protective for both sexes. For instance, a Dutch study 26 of gay men, one-third of them HIV-positive, found that the overall failure rate during male-to-male anal sex was 3. Nonetheless, a number of carefully conducted studies have demonstrated that consistent condom use is a highly effective means of preventing HIV transmission. Penis length was also associated with condom breakage, yet girth was not. Family Planning Perspectives, A clinical trial of a thicker versus a standard condom for gay men. Knowing how well they protect against other STIs is important for sexual health in general and may be particularly important for people with HIV, who may be more vulnerable to the effects of certain STIs. For all these reasons, measuring the efficacy of condoms or indeed other established prevention methods and strategies such as serosorting can be challenging. A study that measures HIV incidence in condom users and non-users will be confounded, for instance, if one group has substantially fewer sexual partners than the other. In further analysis, the investigators looked to see if the use of condoms reduced the risk of developing pre-cancerous cell changes in the cervix. The only later data we have relating HIV incidence among gay men to condom use come from retrospective studies of gay men diagnosed with HIV who were asked about their condom use. Effectiveness of condoms in preventing HIV transmission. The rate of new HIV diagnosis among men who attempted always to use condoms was 1. The time has come for common ground on preventing sexual transmission of HIV. Again, this is probably because men who never used condoms were likely to include monogamous men and ones who had less anal sex. Use of additional inappropriate lubricant oil-based or saliva was also associated with condom breakage. However, no protective method is percent effective, and condom use cannot guarantee absolute protection against any STD. These can be done in individuals whose characteristics are known and can be controlled for, and if the relationship truly is monogamous then infections by acute STIs and from outsiders can be ruled out. The best estimate we have is that using condoms more than three-quarters of the time halves the chance of acquiring HSV-2, and may reduce the chances of genital infection with the cold sore virus HSV-1 too. However, in , the World Health Organization WHO , benefiting from new study evidence, issued its own review 29 in which it was able at least to hazard a guess at condom efficacy against all STIs except human papillomavirus HPV , the genital wart virus. The fact that consistent condom use was linked with regression of lesions and pre-cancerous lesions and clearance of HPV could provide additional reasons for consistent condom use by HIV-positive individuals who also have HPV infection. Does anal sex need stronger condoms?
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