Young women whose partners use condoms every time they have sex are 70% less likely to contract the human papillomavirus than women whose partners use condoms less than 5% of the time, according to a study published in the June 22 edition of the New England Journal of Medicine, the AP/Miami Herald reports (Johnson, AP/Miami Herald, 6/22). HPV is known to cause most cases of genital warts and cervical cancer (Emery, Reuters, 6/21). In the study, Rachel Winer, a researcher at the University of Washington's epidemiology department, and colleagues invited more than 24,000 undergraduate women ages 18 to 22 at UW to take part in the study (AP/Miami Herald, 6/22). Researchers enrolled 82 women at the school who reported first having sexual intercourse with a male partner within two weeks of enrolling in the study or during the study period. The participants underwent pelvic exams, Pap tests and HPV tests every four months and completed a Web-based diary of their sexual activities every two weeks (Rubin, USA Today, 6/22). Researchers followed the women for an average of 34 months. The study, after statistically adjusting for the number of new partners as well as the estimated number of previous partners of the male partner, finds that women whose partners used condoms during every instance of vaginal intercourse were 70% less likely to have contracted HPV than women whose partners used condoms less than 5% of the time. In addition, women whose partners used condoms more than half of the time were 50% less likely to contract HPV than women whose partners used condoms less than 5% of the time (Winer et al., NEJM, 6/22). None of the women who reported always using condoms with their partners developed HPV lesions during the study period, while 14 women who did not use condoms as regularly developed lesions (AP/Miami Herald, 6/22). The National Institute of Allergy and Infectious Diseases in part funded the study with a $685,000 grant (Altman, New York Times, 6/22).
Potential Policy Effect
Some experts said the study should bring strong data to the debate at FDA about whether to revise condom labels, the Chicago Tribune reports (Miller Rubin/Peres, Chicago Tribune, 6/22). FDA in November 2005 published a draft guidance document for latex condom manufacturers and opened a 90-day public comment period on the regulations. The document includes a proposal to require labels to state that condoms "greatly reduce, but do not eliminate," the risk of pregnancy and HIV infection when used correctly during sexual intercourse but provide "less protection" from other sexually transmitted infections, including HPV and herpes, because those STIs can be spread through skin-to-skin contact. However, the guidance also says that "using latex condoms every time you have sex may still give you some benefits against these [STIs]." FDA previously only has required condom labels to include a warning about allergic reactions to latex. The guidance document comes after Rep. Mark Souder (R-Ind.) and Sen. Tom Coburn (R-Okla.), then a former House member, in August 2003 wrote letters to HHS Acting Principal Deputy Inspector General Dara Corrigan questioning whether CDC and FDA were complying with a 2000 law aimed at providing increased and accurate HPV prevention education. Souder and Coburn have said FDA's proposed guidelines overstate condoms' effectiveness at preventing HPV transmission (Kaiser Daily HIV/AIDS Report, 11/11/05). Souder on Wednesday said that Winer's study shows that condoms have a "high failure rate" in preventing HPV transmission "by any standard." He added that the eight month study period is a "short period of time, so it's expected that the infection rate would only increase during a longer study period." However, Rep. Henry Waxman (D-Calif.), who last year cited the then-unpublished study in a letter to FDA calling on the agency not to revise the labeling, said, "This study provides important evidence for the effectiveness of condoms in reducing the risk of HPV transmission. The data further undermines the right-wing call for misleading labels on condoms claiming the opposite and reminds us that what matters in public health is science, not ideology" (Sedlar, CQ HealthBeat, 6/21).
Jennifer Wu, an ob-gyn at Lenox Hill Hospital in New York City, said, "Previous studies were unable to demonstrate that condoms protected against HPV transmission," adding that the studies might not have been definitive because of "[d]esign flaws and a lack of information about the frequency of condom use" (Ricks, Long Island Newsday, 6/22). Peter LaBarbera of the Illinois Family Institute said, "[T]his study shows that even partners who always use condoms show it is not a cure-all for HPV," adding, "I think [this study] has no bearing on whether abstinence is the best thing to teach kids." Laura Streicher, a gynecologist and assistant clinical professor at Northwestern University, said the study "reinforces" the medical community's advice that people should use condoms to reduce the transmission of STIs. Sarah Brown, director of the National Campaign to Prevent Teen Pregnancy, said, "For the people who feel that we should only be stressing [the] safest method, this supports their view, ... [b]ut for those who take the position that we live in the real world, they will feel that science has vindicated them" (Chicago Tribune, 6/22). Hunter Handsfield, former director of the Sexually Transmitted Diseases Program at Public Health -- Seattle & King County, said, "This study, from a political and social policy perspective, is probably the most important research in [STIs] in the last five years."
The UW study and other recent studies provide "[s]trong empirical evidence indicat[ing] that condom use considerably reduces the risk of transmission of most [STIs], including [HIV] infection," Markus Steiner and Willard Cates from the Institute for Family Health at Family Health International write in a related NEJM perspective piece, the Seattle Post-Intelligencer reports (Davidow, Seattle Post-Intelligencer, 6/22). However, the authors say that the "protection that condoms offer against a specific [STI] cannot be precisely quantified," so many people are beginning to understand that "neither abstinence until marriage and subsequent faithfulness nor consistent condom use alone is a practical preventive solution" for STI transmission. The authors write that people "must continue to be vigilant when promoting the use of condoms to avoid giving users the false sense of security; we should refer, for example, to 'safer sex' rather than 'safe sex.'" In addition, condom use should be promoted as part of the ABC prevention method -- which stands for abstinence, be faithful and use condoms -- to reduce the spread of STIs, including HIV, the authors write, adding that a "whole alphabet" of prevention methods will result in "effective (but not perfect) prevention programs." Steiner and Cates conclude, "Condoms are just one tool in the armamentarium against [STIs]; only by harnessing all the evidence based prevention tools" -- such as promoting abstinence as well as consistent condom use -- "can we move toward true sexual health" (Steiner/Cates, NEJM, 6/22).
NPR's "All Things Considered" on Wednesday reported on the study. The segment includes comments from Winer and Linda Klepacki, a sexual health analyst at Focus on the Family (Wilson, "All Things Considered," NPR, 6/21). The complete segment is available online in RealPlayer.
In addition, WAMU's "The Diane Rehm Show" on Thursday is scheduled to include a discussion about HPV, with comments from Douglas Lowy, chief of the Laboratory of Cellular Oncology at the National Cancer Institute's Center for Cancer Research; Cindy Pearson, executive director of the National Women's Health Network; Lee Savio Beers, assistant professor of pediatrics at Children's National Medical Center; and Peter Sprigg, vice president for policy at the Family Research Council (Rehm, "The Diane Rehm Show," WAMU, 6/22). The complete segment will be available online in RealPlayer following the broadcast.
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