The Bowdoin Orient

This protection is not absolute, however. Condoms, of course, can only protect the skin that they cover against infection. Studies of the protective efficacy of condoms against HPV, like all "real-life" studies of sexually transmitted infection (STI) prevention, often and unavoidably include significant methodological problems. These methodological shortcomings have not allowed researchers to conclude definitively that this protection is absolute.

These shortcomings, and the fact that condoms cannot prevent the spread of HPV to or from genital areas they literally do not cover, have made some conclude that condoms cannot, in fact, be said to protect against the spread of HPV. The "Abstinence Only" campaigners, in particular, have argued that abstinence is the only "proven" protection against HPV, and that because of the relationship between HPV and cervical cancer, the choice facing young adults has really become one of "Virginity or Death," as Katha Pollit put it at last week's Common Hour. Similarly, commentators at the conservative think tank the Heritage Foundation, like to refer to HPV as "the deadly HPV" ?even though more than 99 percent of people who contract the virus never die from it.

HPV is by far the most prevalent STI. The numbers involved are truly staggering. It is estimated that 75 percent of sexually active people contract HPV at one time or another, and that at any given point in time, 20 million Americans have genital HPV infections that can be transmitted to others. Every year, over 5.5 million people become infected. Very fortunately, however, the great majority of HPV infections are overcome by our immune systems and resolve themselves without further complications.

Four of the over 30 sexually transmissible strains of the virus, though, cause cellular changes which can lead to cancer. In particular, cervical cancer is virtually always associated with untreated HPV Type 16 or Type 18. These are called "the high risk" sub-types, and they are "high risk" not because they always or even often cause cervical cancer, but because almost all cervical cancers can be traced back to them. To be perfectly clear: even the great majority of women with high-risk HPV on their cervices will never develop cervical cancer.

Cancer of the cervix occurs in nearly 16,000 women each year, and causes some 5,000 deaths in the U.S. annually. These are, of course, very significant numbers. They are also several orders of a magnitude smaller than the HPV numbers cited above. Cancer of the cervix is one of the most treatable and preventable cancers. Micro-invasive carcinoma of the cervix is nearly always curable surgically. It has a long pre-clinical phase, which permits early detection. In fact, regular screening Pap smears very effectively pick up early, pre-cancerous changes, and treatment at these early stages is curative.

More than half of women newly diagnosed with invasive cervical cancer have never had a Pap smear, and another ten percent have not had one in the previous five years. Cervical cancer may indeed be an HPV-related "STD," but it is most importantly a disease of medical neglect.

Back to condoms! The studies reviewed by the National Institute of Health and compiled by the CDC in a January, 2004 report, conclude that regular use of condoms is associated with lower rates of HPV-associated diseases AND cervical cancer (for the complete report, please see http://www.cdc.gov/std/HPV/2004HPV%20Report.pdf at the CDC's web site.)

These same studies show that condoms offer very effective protection against the spread of HIV, an STI that has claimed almost 500,000 American lives over the past 20 years, and which threatens to kill untold tens of millions more around the world. Condoms also offer very effective protection against chlamydia, an STI which infects over three million people in this country each year. And, finally, condoms also offer reasonably effective protection (about 85 percent) against unwanted pregnancies. From a public health standpoint, it is simply criminal to discourage condom use.

Total abstinence does presumably offer nearly 100 percent protection against STIs and unplanned pregnancies. And for some people, abstinence remains the best choice. For others, however, it is not, and those individuals need useful, scientific information to make their own best choices.

If that choice is safer sex, they need condoms! And we have plenty to hand out at the Health Center?and plenty of appointments for Pap tests, too.

Be well!

Jeff Benson, MD
Dudley Coe Health Center