Condoms and HPV

Changing the Tide

HPV has long been "the Achilles heel" of the safer sex movement, says Cynthia Dailard, a senior public policy associate at the Guttmacher Institute. For years, research had not conclusively shown that risk of HPV infection can be reduced with condom use. HPV is highly contagious and is spread through skin-to-skin contact. Condoms cover some — but not all — of the area where skin-to-skin contact occurs during intercourse. Abstinence-only advocates have used this fact to claim that condoms are ineffective.

This new research, however, has the potential to change the tide.

"In theory, this study should put to rest the long-standing question of condoms' ability to protect women from HPV," says Dailard. "That's great news for women. But only time will tell how it will play out."

Just the Facts

Over a period of four and a half years, Rachel Winer, an epidemiologist at the University of Washington, and her colleagues followed 82 newly sexually active college women, tracking their condom use and HPV status. The women kept online journals of their sexual activity and visited the gynecologist every four months for testing. The study found

• Women who used condoms 100 percent of the time were 70 percent less likely to contract HPV than women who used condoms only five percent of the time.



• Women who used condoms more than half the time were still 50 percent less likely to develop HPV than women who never or rarely used them.

These results remained true even after researchers adjusted for the number of sexual partners a woman and her partner had. Two earlier studies from 2003 did show that the use of condoms helped clear existing HPV infections from the body and diminished abnormal cell growth on the cervix or penis that was caused by HPV. But these two studies were not designed to show whether condoms reduced the risk of infection. That's why Winer's study is so important.

Winer warns that condoms can't prevent the spread of all HPV — including the strains associated with cervical cancer — but that condoms provide a "significant protective benefit" to those who use them consistently and correctly. The protective benefit of condom use is vital for women who are eligible for the HPV vaccine. The HPV vaccine protects against four strains of HPV — two of which are associated with more than 70 percent of cervical cancer cases — but there are more than 30 types of genital HPV. Together, the HPV vaccine and condom use can dramatically decrease the rate of HPV infection.

The study has been roundly applauded by scientists because it proves what many had believed all along: condoms can help prevent the spread of HPV.

"I think within the field people are glad there are some actual hard data to show the actual protective benefit of condoms," says Winer. "From a policy perspective, people can use this information, along with the [HPV] vaccine and a comprehensive public health campaign, to spread the message that condoms reduce the risk of HPV. I don't want to comment on the political effects of the study because I'm a scientist."

The Abstinence-Only Response

But that's not the public health message abstinence-only advocates have proffered over the years. In fact, many used the lack of concrete research on HPV and condoms in the past to proclaim that condoms provide little protection from STIs in general. This misinformation was used as another of their arguments for women and men to refrain from sex until marriage.

So what do abstinence-only advocates say now, in light of Winer's study? So far, the only clear response has been to diminish the importance of the findings. Focus on the Family's sexual health analyst, Linda Klepacki, claimed in a press release that the study is small and must be replicated before she can draw any conclusions. In the absence of such data, she states, Focus on the Family will continue to support "risk elimination rather than risk reduction" and to encourage people to remain sexually abstinent until marriage and faithful within marriage.

All the abstinence-only advocates contacted by Planned Parenthood were unavailable or declined to comment.

There is evidence, however, that the abstinence-only approach is hurting some teens' sexual health. According to the landmark National Longitudinal Study on Adolescent Health (AdHealth), teens who take virginity pledges have the same STI rate as non-pledgers, even though pledgers wait longer to have sex. Researchers surmised that when pledgers do have sex, they are more likely to be secretive about it within their community and to avoid using condoms.

Up Next

Abstinence-only advocates have lobbied for "black box" labeling on condoms that would warn users that condoms don't protect them from HPV. Indeed, Sen. Tom Coburn (R-OK), who first introduced legislation on condom labeling in the late 1990s, attempted to use the issue to block the nomination of Lester Crawford to head the U.S. Food and Drug Administration (FDA) in June 2005. In February of this year, Planned Parenthood submitted comments to the FDA and urged the agency to make sure that science, not ideology, be the standard for any changes made to condom labels. "It is critical that condom labels reflect science, not scare tactics," said Karen Pearl, former interim president of PPFA.

Condom labeling is still under FDA review. Dailard says public health advocates are currently contacting the FDA to "make sure individuals there have a clear understanding of the research."

The Good News

Regardless of the political outcome, this new research is good news for women, roughly 80 percent of whom are expected to be diagnosed with some type of HPV by the time they are 50.

"From a public health standpoint, this study gives people, in particular women, more assurance that condoms are indeed effective in protecting from some HPV and cervical cancer," says Dailard. The results of the study are clear: Men and women need to use condoms regularly — each and every time — to reduce the risk of developing STIs, including HPV. Condom use is also recommended even if people receive the new HPV vaccine, because while the vaccine will protect against the types of HPV that cause 70 percent of the cases of cervical cancer, it will not protect the other types that cause it.

© 2006 Planned Parenthood Federation of America, Inc. All rights reserved.