The Almighty Condom: Defeater of HPV?
— Posted by John (June 22, 2006 at 5:12 pm)
“Condoms Found to Block a Virus Harmful to Women,” headlines the New York Times article about a study on condoms and HPV (human papilloma virus) published today in the New England Journal of Medicine.
In many circles, the study is being touted as a boon for proponents of condom-based sex education and a setback for abstinence education supporters.
A closer look at the study, however, reveals that the tired old message of “Use condoms” is hardly an advisable strategy for HPV prevention.
Among the study’s findings:
The incidence of genital HPV infection was 37.8 per 100 patient-years at risk among women whose partners used condoms for all instances of intercourse during the eight months before testing, as compared with 89.3 per 100 patient-years at risk in women whose partners used condoms less than 5 percent of the time (adjusted hazard ratio, 0.3; 95 percent confidence interval, 0.1 to 0.6, adjusted for the number of new partners and the number of previous partners of the male partner).
Read that alarmingly high 100% condom use failure rate again in light of the New York Times headline. The study itself uses considerably less stronger language:
Conclusions Among newly sexually active women, consistent condom use by their partners appears to reduce the risk of cervical and vulvovaginal HPV infection [emphasis added].
The uncritical NYT article went on to say:
The study “provided a very clear answer” to the question of the protective benefits of condoms and papillomavirus infection, said Dr. [James] Allen of the American Social Health Association.
Earlier, the article quoted Dr. Allen as saying, “The findings are definitive.”
Apparently the reporter saw no need to ask Dr. Allen any follow-up questions. ‘Tis a pity, especially considering these caveats from the study’s authors:
Some limitations of the study should be noted. First, it is difficult to determine the optimal time frame for an assessment of risk factors for acquiring HPV infection. In retrospect, the 20-day lag period was relevant not only because it was the shortest observed interval between first intercourse and the detection of HPV infection in this study but also because it is within the range of time estimated for epithelial cells to mature and differentiate, cellular events that are required for HPV replication. Although an eight-month period was used because the majority of first infections associated with a first partner occurred within this time frame, not all partners are infectious, a partner’s infectivity may change, and infection could have occurred at any time within the eight-month period. If infection occurred early, for example, condom use for intercourse reported later in the interval would be unrelated to HPV status, and the true effect of condoms might be diluted.
Furthermore, incomplete reporting could have created a misclassification of the frequency of condom use, although such an effect probably would have been minimal, given the small percentage of days with missing data regarding sexual behavior. Incomplete follow-up and delayed or missed clinical visits were other potential sources of bias. For example, outcomes of short duration could be missed with less frequent follow-up, potentially leading to underestimates of the cumulative incidences of infection and lesions. However, when we compared women with average visit intervals of less than four months with those with intervals of four months or more, we observed similar rates of HPV infection (P=0.43). In a comparison of women who were eventually lost to follow-up with those who were not, similar rates of HPV infection were observed during the study (P=0.56).
Finally, although the newly sexually active women in our cohort reported a yearly median number of instances of intercourse (48) and a yearly median number of new partners (1) that were similar to those reported in a large national survey of a random sample of women of a similar age, our results may not be generalizable to populations of older women or women of lower socioeconomic status [emphasis added].
The study’s authors went on to note:
Given that HPV is transmissible through nonpenetrative sexual contact with both male and female partners and that imperfect condom use does occur, it is not surprising that some infections were still detected among women reporting consistent use.
Ay, there’s the rub. Human nature being what it is, not only does imperfect condom use occur, but surely it’s the norm–especially among teens. The more pertinent question is: Does “perfect condom use” occur?
My guess is rarely, if ever.
But these minor details weren’t considered by liberal bloggers who treated the news of the study as a death blow to abstinence education advocates.
At The Stranger, Dan Savage writes:
The religious f***tards opposed the recently-approved HPV vaccine because it removes one scary threat from their scare-based abstinence education programs: a highly contagious STI, for which there was no effective treatment, no cure, and which leads, in a small percentage of cases, to cervical cancer, sterility and death. Well, guess what? So do condoms…
The same cracked, misogynist logic that prompted the religious f***tards to oppose the HPV vaccine should prompt them to oppose the availability of condoms. They want sex—casual or not—to always and everywhere have the direst of consequences, from pregnancy to death, for both men and women, but especially for women.
In a post titled “Condoms Block HPV”, Jill at Feministe writes :
This a great news. Of course, condoms don’t prevent HPV 100% of the time because HPV is transmitted through skin-to-skin contact, and there are obviously some areas of the body where HPV might be present which aren’t covered by a condom during sex. But they’re damn effective if used correctly and consistently. Further, internal (or “female”) condoms cover a greater external area of the vulva, and might be a good option, especially if you know that your partner is infected [emphasis added].
Russian roulette, anyone? Anyone?
At Feministing, Samhita noted the study’s limited scope, but couldn’t help reverting to a familiar mantra:
Of course I just noticed that it says *newly* active sexual partners. Oh well. But you should use condoms anyway.
I guess old habits die hard.
***UPDATE 6/30/06, 11:10am:
Additional parsing of the study from an Illinois Right to Life Committee e-mail sent by IRLC executive director Bill Beckman:
Additional Concerns about the condom usage / HPV study
After reviewing the June 22, 2006 New England Journal of Medicine article covering the study on condom effectiveness in preventing HPV, I find that the study appears to have serious problems.
The key to my concerns is revealed in Table 1. That table presents the HPV infection rate based on various “risk factors”. As would be expected, the risk of infection goes up for women who have multiple sex partners or whose partners had previous or other sex partners. The same 122 cases of infection are also analyzed at various rates of condom usage.
Since there is no evidence of exclusion from the results of women who only had sex with one partner, who only had sex with them, these guaranteed successes (no risk of infection) are included in the results with the reduced infections attributed to condom usage. This situation could help explain why the infection rate is greater for 5-49% condom users than for under 5% condom users; namely, it just depends on what percentage of the no risk couples fall into which category of condom usage. If this conclusion about the study is correct, it seems the claimed results of 70% reduction in risk with 100% condom usage become totally bogus.
The IRLC press release above pointed out that 12 out of 42 women (28.5%) still got infected even with 100% condom usage, but these additional considerations make the study’s misrepresentation of condum protection that much worse.
I would also note that the study must have had participants who knew the purpose of the study, so that knowledge would seem to give them higher motivation to ensure use of a condom than in normal life. Even with that factor, only about 25% achieved 100% condom usage. Beyond that distortion, there was no attempt or ability to validate the accuracy of the journal reports filed by the women or provide any blind or double-blind protection to prevent participant or research bias from further distorting the study results.
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Michael-2 says:
Well, we keep getting this issue of condoms and viruses and the question of effectiveness.
A condoms is only used once and ironically condoms should be considered for only one-off chewing gum and bailing wire effectiveness against anything, including pregnancy and probably even more so for HIV and HPV. At least that is my attitude towards it. In other words if you are going to rely on condoms to prevent you from getting HIV from an infected person, especially and infected male, they will work once, twice, three times. True, this may look like a good system but statistics will ultimately prevail. From what I understand condoms have about an 80-85% user effectiveness against pregnancy, so why should the effectiveness against HIV or HPV be any higer or as high since pregnancy can occur only about 25% of the time anyway and HIV and HPV infection could occur anytime?
So ultimately one will probably get HIV if they do not make some change in their behavior.
Comment posted June 23rd, 2006 at 2:12 am
Pansy Moss says:
The natural flaws in latex are 700xs the size of an AIDS virus.
Comment posted June 23rd, 2006 at 6:27 am
Michael-2 says:
Pansy thanks, this is something that I heard about but did not know the factors. Of course, maybe rubber technology can improve but the situation will not be totally changed.
Where I like now in Abu Dhabi, United Arab Emirates, female contraceptives (barrier or hormonal) seem to be unavailable but condoms are at every fruit stand, grocer store, pharmacy, etc. I guess many think this is the answer to many problems.
Pansy, I read your earlier posts on your problems with NFP and since I promote and support NFP I hope you do not mind if I want to make a few tips to you:
I wonder if you are aware of the SPICE program of the couple-to-couple league?
If a couple does not have much of a courtship before starting their conjugal life, pure NFP is usually very, very difficult for them. This often has to be remediated.
Remember to beware of porn, visual for the husband and steamy trash romance stories for the wife while using NFP to avoid conception! And watch the alcohol; the next son could well be named Jack Daniels if you are not careful.
Sometimes a good, well meaning couple has a very disorder prayer life while trying NFP and this is a problem. Eucaristic Adoration helps many.
Many strong providentialists such as yourself worry about the morality of NFP, and I wonder if this is some obsession here by the dark powers. I guess on one’s spiritual sojourne there may be better higher such as pure abstinance or Quiver Fuller-type providentialism, but most of us are not at that plane. You and dear husband have earthy duties to each other and pitfalls are in the way, this is the fact of being human.
If trapped, many providentialists get sterilized, ironically enough!! There is something strangely wrong here. This situation can be avoided.
Comment posted June 23rd, 2006 at 8:17 am
Pansy Moss says:
Remember to beware of porn, visual for the husband and steamy trash romance stories for the wife while using NFP to avoid conception! And watch the alcohol; the next son could well be named Jack Daniels if you are not careful.
Many strong providentialists such as yourself worry about the morality of NFP, and I wonder if this is some obsession here by the dark powers. I guess on one’s spiritual sojourne there may be better higher such as pure abstinance or Quiver Fuller-type providentialism, but most of us are not at that plane. You and dear husband have earthy duties to each other and pitfalls are in the way, this is the fact of being human.
I have friends who are full blown providentialists, but I don’t necessarily agree with them in regards to my own life because I am not the type who would avoid conception for reasons like “oh, I just don’t want anymore children”. It would be because I truly feel a strong need to avoid. I do respect many of friends though because their lives seem happy and fulfilled. But I suppose that is why I enjoy their friendship period.
The Church allows for NFP in certain circumstances and so be it. If another couples uses NFP, and if they use it for more selfish reasons, then God will know. But I think NFP is window for other people to look at large Catholic families and say “oh that is just not necessary these days-there’s NFP”.
My problem is simply my charts are very, very difficult to read due to nursing. My NFP instructor gets baffled by my charts. We do not drink. Both my dh and I know alcoholics and my dh will not touch the stuff. I will have wine on a special occasion, he will not even do that. Pornography never appealed to me, even in my less Christian days. I have always been too much of a feminist for that. We lived off-grid for nearly the past two years among the Amish, so we didn’t even have TV.
I do have a problem in general with the concept that every ailment to a family can be remedied by simply not conceiving, and I think there are other ways to solve problems. If it is finances, a second job can help, for example. Again, my point is not to judge couples who use NFP. My point for me is that NFP has has not been the answer to my life’s problems but another frustration, and it is easier to attack the other problems simply by attacking the problems themselves as opposed to fixing them with not having children.
Yes, my prayer life could use more work. It ebbs and flows. Sometimes it is very strong, and others it is very weak. But to me, my goal in fixing my prayer life is to strengthen my relationship with God, not to fix my NFP life. It is just not that important to me.
Comment posted June 23rd, 2006 at 9:06 am
John says:
Pansy said: “The natural flaws in latex are 700xs the size of an AIDS virus.”
Pansy,
To be sure, the voids that occur in the manufacturing process of condoms can be much larger than the AIDS virus. 700x, though, is a higher figure than any I’ve come across.
The figure I’ve seen cited most often is that these voids can be up to 50 times larger than the AIDS virus.
According to the NEJM study that is the subject of this post, condoms are even less effective at preventing against the male-to-female transmission of HPV (a similarly small virus) than they are at preventing the transmission of HIV.
Comment posted June 23rd, 2006 at 9:39 am
Pansy Moss says:
Yeah, sorry, I think I meant 70xs.
Pfoof, 1 extra zero. Does it really matter? (j/k)
Actually, I was totally joking in the last sentence, but when I think about it, if I were putting my own life or my child’s life into my hands, I don’t think I would go with those odds. 50xs larger is pretty big. Would you even buy sunscreen with exposed patches of the same equivalence?
Comment posted June 23rd, 2006 at 11:03 am
John says:
Pansy said: “Would you even buy sunscreen with exposed patches of the same equivalence?”
Pansy,
Nope.
Comment posted June 23rd, 2006 at 11:06 am
Pansy Moss says:
Michael,
I have to tell you when I initially read your comment and you referred to drinking and porn, I literally had no idea what the heck you were talking about or alluding to. It just finally dawned on me that what you are getting it is struggling with NFP is due to a lack of self discipline in abstaining. That is not the problem at all. The fact is, I have been co-sleeping with babies for at least the past 7 years, believe me, abstaining is not a problem. And with all due respect, I think lack of self control to abstain is almost a straw man argument. It is the same argument as to why priests should marry.
I didn’t want to do this as I thought it might be TMI, but here is an example of my type of headache. This baby I am carrying I conceived on Day 31 (my cycles are 33 days). Granted, NFP is not the rhythm method, and I should have known from the symptoms, but nursing and weaning causes days and days of small amounts cervical mucus. But besides that, I thought I got it “right” that month, because I had very strong symptoms of ovulation around day 14 or so (I am not looking at my chart, but the normal days when ovulation would occur). I had the symptoms, we abstained for the requisite days until the symptoms left +3, and plus some more to be sure. I was so sure I ovulated earlier, I thought I was safe. I had no idea I was pregnant until one day I noticed I was tired, then another day I noticed that although I was I was losing weight through diet and exercise, my arms were getting cut up, my gut started to get larger. I took a test in total denial. I had the hardest time convincing the doctors of my due date because they would not believe that I knew I conceived on day 31 until they did an ultrasound.
Anyway, this is pretty typical of what my life with NFP has been like. I find it puts me in the strange paranoid mind set of constantly obsessing about my fertility. In all fairness, we ecological breastfeed which is very effective for us for years at a time, so it is difficult to go right into NFP when there was little concern at all. It’s not about overscrupulousness, or some impending evil making abstaining hard, or that I think the Pope was out of his mind when he wrote Humanae Vitae. I just have no faith in it. I envy couples who do. The only way in all honesty I feel NFP would work is just to permanently abstain, but that really isn’t NFP, is it? The point of NFP is to not have to abstain for the rest of your fertile life. I think for some couples, the idea of avoiding a child is important enough for them to abstain for very lengthy periods of time. I have seen it in the NFP board and been in the discussions about nursing and NFP. Women saying that they abstain for months at a time when breastfeeding. I am just not that driven.;)
Comment posted June 23rd, 2006 at 12:02 pm
Michael-2 says:
OK Pansy, I got your story straight. I certainly have no advice to give you about improving fertility monitoring; all I know is that there is the SM, Creighton, Billings regular, etc and they are all similar but not identical. Maybe diet means something, I do not know. I am a man and all I can say is things I read about.
Seems like women in the 3rd world have far less and fewer problems with this than people in the developed world. Maybe they have no hang-ups about the detail of what “thick mucous” means or things like that. I would imagine that if the entire child bearing age female alumni of Yale or Harvard where suddenly have to count on NFP for fertility control pandamonium and terror would break out; whereas the mass of women in remote places who work in fields, sweatshops, and other simple dutes in Latin America, Asia, and Africa would take this and use it without a hint of uncertainty.
I had some discussions with such women trained on the simple Billings method. To them fertility monitoring is fairly simple, the only problem is, surprise-surprise, handling the men.
Comment posted June 23rd, 2006 at 12:38 pm
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