Conservative misinformation on the efficacy of condoms

[Jichard]

Many social conservatives (especially sociall conservative Christians) have made false claims regarding the efficacy of condoms in preventing STIs and pregnancy. These conservatives then spread this misinformation to other people, which can lead to very negative results (ex: the effect of the Catholic church's stance against condom use. It makes sense that these conservatives would spread this sort of misinformation, since they are often religiously opposed to contraception and the fornication they think it promotes. They therefore spread negative misinformation about condoms, so people will instead opt for things like abstinence. The recent history on this is rather bleak:

"Public Health Advocates Say Campaign to Disparage Condoms Threatens STD Prevention Efforts"
http://www.guttmacher.org/pubs/tgr/06/1/gr060101.html


"With God on Their Side: How Christian Fundamentalists Trampled Science, Policy, and Democracy in George W. Bush's White House"
http://search.proquest.com/docview/2...gsite=gscholar

"After an extensive review of all the scientific data on condoms, the NIH found "strong evidence" for the effectiveness of condoms in preventing HIV, as well as several other sexually transmitted diseases-facts that had already become common sense to most Americans. The scientific literature includes evidence that condoms and safe sex practices cut HIV rates in half among white gay men from 1988 to 1993, [results] hailed by many at the time as a public health coup, and that 98 to 100 percent of uninfected people in a long-term relationship with an HIV-positive partner avoided infection through consistent condom use.11 But Coburn, McIlhaney, and a group of doctors associated with Focus on the Family calling themselves the Physicians Consortium held a press conference to claim the opposite. They latched onto the inconclusive data about one common sexually transmitted virus, HPV- a lack of data that NIH insisted "should not be interpreted as proof of the adequacy or inadequacy of the condom to reduce the risk of STDs"- to condemn condoms once and for all. McIlhaney declared that the report "reveals that condoms are not a reliable defense against today's epidemic of sexually transmitted diseases."12 Coburn announced to reporters, "For decades, the federal government has spent hundreds of millions of dollars to promote an unsubstantiated claim that promiscuity can be safe. We all now know for a fact that that is a lie." For good measure, claiming that he was guilty of spreading lies about condom effectiveness, they called for the resignation of Jeffrey Koplan, then the director of the Centers for Disease Control (CDC).13 Within seven months, Koplan had resigned, and Bush had appointed Coburn, McIlhaney, and Shepherd Smith's wife and colleague Anita to his Presidential Advisory Council on HIV/AIDS."

Apparently this practice of spreading misinformation on the effectiveness of condoms has extended to this forum, amongst a number of other forums. It seems to be particularly prevalent amongst some Catholics and various conservative Christians.

Anyone ever notice that condom manufacturers never claim that they're for use as a contraceptive? They advertise their usefulness in the prevention of spreading disease.

Unfortunately, no one reads the tiny print. Great against GC/CT; good against HIV; crap shoot against syphilis; useless against HPV/herpes

As I said, I looked at failure rates - not prevalence/incidence.

If bungee cords had similar rates to condoms (21%), no one would ever jump - it would be a really stupid version of Russian Roulette - which is really stupid itself.

A 21% failure rate overall - that's about two out of every eight tries. Pretty sure bungee cords do better than that.

So I thought it'd be useful to deal with this dangerous misinformation, to prevent this information from being spread further.

[Darth Ovious]

So I take it you know that Teal is taking the info from the CDC?

http://www.cdc.gov/reproductivehealt...thods-2014.pdf

So what would you say is your objection to this info?

[Teallaura]

1999...




I was a DIS dealing with STD for 18 years. I told more than a few folks that yes, they really had GC or Syphilis or HIV despite the fact that they always used condoms. I know a good deal about condon efficacy, unlike a certain Internet jockey.

Oh, and citing a fifteen plus year old study is stupid.

[Sam]

1999...




I was a DIS dealing with STD for 18 years. I told more than a few folks that yes, they really had GC or Syphilis or HIV despite the fact that they always used condoms. I know a good deal about condon efficacy, unlike a certain Internet jockey.

Oh, and citing a fifteen plus year old study is stupid.

Your claim was that condoms are "useless" in preventing some infections, notably HPV. Current research does not support this claim, however.

Source: Editor's Choice: Condom Use and Human Papillomavirus in Men. J Infect Dis. first published online May 3, 2013 doi:10.1093/infdis/jit193

In the highest HPV exposure risk category (ie, men with no steady sex partners), those who reported always using condoms in the 6 months before study entry were about 50% less likely to become newly infected with any HPV types in the 12-month follow-up period, compared with men who never used condoms (adjusted hazard ratio [HR]

© Copyright Original Source

At least for some circumstances, condom use does reduce the prevalence of HPV infection and therefore is not useless towards that end.

[Teallaura]

In men, which screams 'what the heck? Women are tested far more frequently so why limit the study that way?

The internal validity poses an immediate question what on earth .are they reporting? 50% ? I'd have to pull it apart but that is a red flag,

And the biggest issue what strains? There has been limited evidence of effect but only partial on strains that tend to be symptomatic, if memory serve, 131 + strains and the best research way Showing nada against the Most important ones.

[Sam]

In men, which screams 'what the heck? Women are tested far more frequently so why limit the study that way?

The internal validity poses an immediate question what on earth .are they reporting? 50% ? I'd have to pull it apart but that is a red flag,

And the biggest issue what strains? There has been limited evidence of effect but only partial on strains that tend to be symptomatic, if memory serve, 131 + strains and the best research way Showing nada against the Most important ones.

At this point, you need to justify your claims with some citations. You agreed with Rogue that condom manufacturers weren't labeling condoms as contraceptives, which was false, and you're arguing that condoms do nothing against HPV, which is contradicted by evidence like what I cited above.

I'm interested in the literature suggesting that condoms are useless regarding HPV but you've got to actually cite the literature (or at least identify what's wrong with the literature that's been cited).

[klaus54]

• Edited by a Moderator •

[Teallaura]

At this point, you need to justify your claims with some citations. You agreed with Rogue that condom manufacturers weren't labeling condoms as contraceptives, which was false, and you're arguing that condoms do nothing against HPV, which is contradicted by evidence like what I cited above.

I'm interested in the literature suggesting that condoms are useless regarding HPV but you've got to actually cite the literature (or at least identify what's wrong with the literature that's been cited).

No, I don't 'got' to do anything - you aren't paying for my time and the silly (men only? Huh?) thing you cited doesn't do anything beyond maybe calling the word 'useless' into question. Since you pulled that thing and it obviously wasn't the first on the list - the 'men' part gives it away as it's an expensive way to do the thing - you've already seen that there's literature that doesn't support condom usage against HPV - and frankly, neither does the study you cited. At 50% there's an ethical question about recommending condoms over abstinence since condom efficacy is so low.

Rogue said manufacturers weren't PROMOTING condoms as contraceptives, which is true. He didn't say they weren't labelled as such or never referred to as such. Condom ads are almost all directed at STD when they give reasons for use (some do, some don't). I have no obligation to disprove something neither Rogue nor I said to begin with.

Restating the argument since you've decided to be pedantic (big surprise there): Condom efficacy against HPV is considerably lower than their efficacy against most diseases. Since much HPV spread is likely similar to herpes spread (which has similarly abysmal failure rates) this is probably a function of the condom's inability to cover sufficient surface area. A few studies have shown limited efficacy against certain strains of HPV but on the whole condoms are not considered adequate protection against HPV and are not considered protection at all against herpes.

As to the thing you cited, it only studied MEN - who, last I looked, don't get cervical cancer. I'd have to pull it apart - and I don't have time so I'm not gonna - but I already mentioned the red flags in just the abstract. It's probably a limited study - which is fine - but at such a low efficacy, I'd need to see the math to know exactly what they think the got. But if you wanna take a fifty/fifty shot against a cause of testicular cancer, that's up to you. I'd advise against. In this case, the 'better than nothing' argument is false - no sex would be far safer.

Based on the lit I have read - which is now getting long in the tooth, I concede - only one study showed any significant efficacy in women - and by 'significant' I mean outside the margin of error. It was pretty low. I never recommended condom usage for HPV prevention to patients and when I explained the relative differences in efficacy, I was always careful to mention that that one study was out there. Because cervical cancer is so hard to detect and ovarian even harder (the connection to HPV isn't as certain but is strongly suspected) it is UNETHICAL to recommend condom usage for protection against HPV to women. No study that I am aware of shows substantive condom efficacy against HPV.

Lastly, I notice you only picked on the one disease - and then only on the semantics. Really petty, Sam. People bet their lives on how well those little bits of latex can protect them - and far too many lose that bet.

[Sam]

No, I don't 'got' to do anything - you aren't paying for my time and the silly (men only? Huh?) thing you cited doesn't do anything beyond maybe calling the word 'useless' into question. Since you pulled that thing and it obviously wasn't the first on the list - the 'men' part gives it away as it's an expensive way to do the thing - you've already seen that there's literature that doesn't support condom usage against HPV - and frankly, neither does the study you cited. At 50% there's an ethical question about recommending condoms over abstinence since condom efficacy is so low.

Rogue said manufacturers weren't PROMOTING condoms as contraceptives, which is true. He didn't say they weren't labelled as such or never referred to as such. Condom ads are almost all directed at STD when they give reasons for use (some do, some don't). I have no obligation to disprove something neither Rogue nor I said to begin with.

Restating the argument since you've decided to be pedantic (big surprise there): Condom efficacy against HPV is considerably lower than their efficacy against most diseases. Since much HPV spread is likely similar to herpes spread (which has similarly abysmal failure rates) this is probably a function of the condom's inability to cover sufficient surface area. A few studies have shown limited efficacy against certain strains of HPV but on the whole condoms are not considered adequate protection against HPV and are not considered protection at all against herpes.

As to the thing you cited, it only studied MEN - who, last I looked, don't get cervical cancer. I'd have to pull it apart - and I don't have time so I'm not gonna - but I already mentioned the red flags in just the abstract. It's probably a limited study - which is fine - but at such a low efficacy, I'd need to see the math to know exactly what they think the got. But if you wanna take a fifty/fifty shot against a cause of testicular cancer, that's up to you. I'd advise against. In this case, the 'better than nothing' argument is false - no sex would be far safer.

Based on the lit I have read - which is now getting long in the tooth, I concede - only one study showed any significant efficacy in women - and by 'significant' I mean outside the margin of error. It was pretty low. I never recommended condom usage for HPV prevention to patients and when I explained the relative differences in efficacy, I was always careful to mention that that one study was out there. Because cervical cancer is so hard to detect and ovarian even harder (the connection to HPV isn't as certain but is strongly suspected) it is UNETHICAL to recommend condom usage for protection against HPV to women. No study that I am aware of shows substantive condom efficacy against HPV.

Lastly, I notice you only picked on the one disease - and then only on the semantics. Really petty, Sam. People bet their lives on how well those little bits of latex can protect them - and far too many lose that bet.

If you say that condoms are useless against HPV, you are spreading misinformation. Even if condoms were only 10% effective against the transmission of HPV, they would not be useless and, all else being equal, it would be wrong to say that they were.

When it comes to your criticisms of the study itself, you're not talking like an epidemiologist or, really, like anybody particularly interested in how infectious diseases spread. Even if men were only a vector of HPV, the transmission of HPV in men (especially sexually active men with no steady partner, which is where this study saw the most benefit of condom use) would be highly relevant to the study of HPV transmission in women. But since you're on that horse:

Source: Condom use in prevention of Human Papillomavirus infections and cervical neoplasia: systematic review of longitudinal studies. Lam JU et al. J Med Screen. 2014 Mar;21(1):38-50. doi: 10.1177/0969141314522454. Epub 2014 Jan 31.

RESULTS:
In total, 384 abstracts were retrieved. Eight studies reported in 10 articles met the inclusion criteria for the final review. Four studies showed a statistically significantly protective effect of consistent condom use on HPV infection and on regression of cervical neoplasia. In the remaining four studies, a protective effect was also observed for these outcomes, although it was not statistically significant.


CONCLUSIONS:
Consistent condom use appears to offer a relatively good protection from HPV infections and associated cervical neoplasia. Advice to use condoms might be used as an additional instrument to prevent unnecessary colposcopies and neoplasia treatments in cervical screening, and to reduce the risk of cervical cancer.

© Copyright Original Source

That's eight studies showing a protective effect regarding HPV transmission and cervical neoplasia with four of those studies reaching the bar of statistical significance. In short, not useless. FAR from being unethical to recommend condom usage to protect against HPV, it would unethical NOT to do so for at-risk individuals. Sure, tell them that abstinence gives them better odds but the job of any health worker is NOT to withhold relevant information of protective methods that have been demonstrated to reduce the risk of infection.

If you're going to complain about Jichard citing a 1999 study, please don't turn around and concede that your literature is likewise long in the tooth (without even the added benefit of actually citing that literature!). Certainly don't dismiss out of hand recentlike this and they promote their product neither by alluding to pregnancy prevention or STD/STI prevention. They're more about attractive people having a certain kind of fun. But since the context of that conversation was very clearly about the efficacy of condoms in preventing pregnancy and you were very clearly arguing that they are highly ineffective at doing so, you can certainly understand why Rogue's post and your post could be (best) understood in that context rather than a media critique of advertisement.

[Sam]

And, looking over in the other thread, Rogue said:

Anyone ever notice that condom manufacturers never claim that they're for use as a contraceptive? They advertise their usefulness in the prevention of spreading disease.

That's the post you agreed with and, so we're clear, it was directly in the context of condoms being ineffective contraceptives. Condom manufacturers do, in fact, claim condoms are for use as contraceptives. Rogue's claim was therefore false.

[Teallaura]

If you say that condoms are useless against HPV, you are spreading misinformation. Even if condoms were only 10% effective against the transmission of HPV, they would not be useless and, all else being equal, it would be wrong to say that they were.

When it comes to your criticisms of the study itself, you're not talking like an epidemiologist or, really, like anybody particularly interested in how infectious diseases spread. Even if men were only a vector of HPV, the transmission of HPV in men (especially sexually active men with no steady partner, which is where this study saw the most benefit of condom use) would be highly relevant to the study of HPV transmission in women. But since you're on that horse:

Source: Condom use in prevention of Human Papillomavirus infections and cervical neoplasia: systematic review of longitudinal studies. Lam JU et al. J Med Screen. 2014 Mar;21(1):38-50. doi: 10.1177/0969141314522454. Epub 2014 Jan 31.

RESULTS:
In total, 384 abstracts were retrieved. Eight studies reported in 10 articles met the inclusion criteria for the final review. Four studies showed a statistically significantly protective effect of consistent condom use on HPV infection and on regression of cervical neoplasia. In the remaining four studies, a protective effect was also observed for these outcomes, although it was not statistically significant.


CONCLUSIONS:
Consistent condom use appears to offer a relatively good protection from HPV infections and associated cervical neoplasia. Advice to use condoms might be used as an additional instrument to prevent unnecessary colposcopies and neoplasia treatments in cervical screening, and to reduce the risk of cervical cancer.

© Copyright Original Source

That's eight studies showing a protective effect regarding HPV transmission and cervical neoplasia with four of those studies reaching the bar of statistical significance. In short, not useless. FAR from being unethical to recommend condom usage to protect against HPV, it would unethical NOT to do so for at-risk individuals. Sure, tell them that abstinence gives them better odds but the job of any health worker is NOT to withhold relevant information of protective methods that have been demonstrated to reduce the risk of infection.

If you're going to complain about Jichard citing a 1999 study, please don't turn around and concede that your literature is likewise long in the tooth (without even the added benefit of actually citing that literature!). Certainly don't dismiss out of hand recentlike this and they promote their product neither by alluding to pregnancy prevention or STD/STI prevention. They're more about attractive people having a certain kind of fun. But since the context of that conversation was very clearly about the efficacy of condoms in preventing pregnancy and you were very clearly arguing that they are highly ineffective at doing so, you can certainly understand why Rogue's post and your post could be (best) understood in that context rather than a media critique of advertisement.

I wasted a lot of time answering so I'm leaving it. However, I'm also unsubscribing from this thread so I wouldn't blame you for not bothering to read it since I won't respond again.



A lit review that found only eight studies it could include - and only four of those showed 'significant' efficacy? Yeah, that has to be actually read and I already said I don't have time. Assuming they are okay, great - except it only deals with a few types of HPV. Should include the cervical cancer related strains - but it WON'T include all strains because they aren't all found on the cervix of infected women. So, you really haven't shown anything more than greater efficacy than previously shown on strains that infect the cervix.

What it doesn't show is that the efficacy is equivalent to the efficacy against GC/CT - and it won't. HPV is a different animal that plays by different rules. Based solely on that, I wouldn't recommend condoms for HPV protection since that still isn't shown to be the case. I would amend that they might provide more protection against cervical cancer than previously believed - but I'd never tell a woman that they provide significant protection because they don't.

Leaving that aside - READ the danged thread! I never argued about the efficacy of condoms against pregnancy - I cited the CDC which puts the failure rate at 21%. That's pretty pathetic given how large sperm are and I admit I don't get that - they work better against GC/CT than that. They aren't ineffective - but their failure rates compared to bungee cords are significantly higher. As for that analogy, it's Roy's. Jichard simply didn't understand what he was jumping into - he's undermining Roy's argument, not mine. This whole STD/condom thing is a sidetrack - which is why I'm not willing to invest time I don't have redoing research I no longer need professionally. Late on, I'll actually look into it - it would be nice if they helped against HPV better than they are known to so far - but I'm not doing that just because you got on your high horse about an argument you HAD NOT READ.

Hint: Roy believes his examples of death by misadventure are good comparisons to whether or not a woman bears responsibility for her consensual actions when they result in pregnancy. I argue that they are not. Jichard, ever so sweetly (note the dripping sarcasm), sided with me unintentionally by arguing that it is not a valid comparison - not realizing who he was contradicting.

You got hung up on the word 'useless'.

Unlike Jichard, I didn't cite an ancient study are refutation; 2005 was the first 'effective' study I recall seeing and to date, the only one I know is valid. I've seen some others of varying validity - nothing hideously bad but nothing that really showed strong evidence. Without hunting it down, I mentioned the one I knew I could trust and had the honesty to admit it was older. You turned up a fairly paltry lit review which doesn't exactly show strong evidence, either. If I were debating it instead of fending off the dogpile - and in a better humor - I'd spend the time hunting the lit but I frankly don't have time and am wasting too much answering you now.

Oh, and have the guts to admit you were wrong about the ads. Don't wuss around - I'd already said some don't use reasons. Quit making excuses - you just plain didn't read the thing correctly and you jumped down my throat wrongly on that point.

[rogue06]

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Sorry. Couldn't resist.

[Zymologist]

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Sorry. Couldn't resist.

"Vests are all about protection. Like a lifevest protects you from drowning, and bulletproof vests protect you from getting shot, and the sweatervest protects you from pretty girls."
--Demetri Martin

[Jichard]

So I take it you know that Teal is taking the info from the CDC?

http://www.cdc.gov/reproductivehealt...thods-2014.pdf

So what would you say is your objection to this info?

Please try not to misrepresent the CDC. Thanks.

In any event, I made it quite clear why Teal's claim was ridiculous. To repeat myself:

As I said, I looked at failure rates - not prevalence/incidence.

If bungee cords had similar rates to condoms (21%), no one would ever jump - it would be a really stupid version of Russian Roulette - which is really stupid itself.

False analogy.


First, you're comparing

failure rates for bungee cords, when bungee cords are used properly

to

failure rates for condoms, when condoms are used improperly

Of course, condoms, as with anything else (like bungee cords or televisions) will have a higher failure rate when used improperly. So if you want to do an accurate comparison, then you need to compare the devices when the devices are both used properly.


Second, your "21%" and "2 in 8" figures are off:

"Condom use errors and problems: a global view"
http://www.publish.csiro.au/?act=vie...id=SH11095.pdf

"However, condom effectiveness is compromised by user errors and lack of use.2 For example, the World Health Organisation reported that condoms have a 2% perfect use failure rate for pregnancy, but the typical failure rate is 15% (81)."

Please do better. Thanks.

[Jichard]

1999...

Yes, 1999. Your side has been misrepresenting the efficacy of condoms since even before them. It goes back to at least the Reagan administration.

I was a DIS dealing with STD for 18 years. I told more than a few folks that yes, they really had GC or Syphilis or HIV despite the fact that they always used condoms.

My goodness, are you saying you actually gave people health advice? Did you really tell people miinformation about the efficacy of condoms? If so, then your words are extremely dangerous.

I know a good deal about condon efficacy, unlike a certain Internet jockey.

And I know more about immunology, then some conservative Christian on the internet who misrepresents about the effectiveness on condoms.

Oh, and citing a fifteen plus year old study is stupid.

I didn't cite a fifteen year-old study. I cited two sources going over the history of social conservative distortions on topics like the efficacy on condoms.

When I cited studies, I cited studies renging from 2002 to about last year. You still have no honest response to these studies. I wonder why?

Anyone ever notice that condom manufacturers never claim that they're for use as a contraceptive? They advertise their usefulness in the prevention of spreading disease.

Unfortunately, no one reads the tiny print. Great against GC/CT; good against HIV; crap shoot against syphilis; useless against HPV/herpes

Ok, this is like the second time you've made false claims regarding the effectiveness of condoms. I'm beginning to suspect that you're not very informed on this subject. I get why you're making these false claims: you want to make condom use look as bad / unreliable as possible, so people will instead go for the alternatives you want. But is your goal really worth pursuing, if it involves misleading other people?

Anyway, I've seen some other conservative Christians (including some Catholics) make the same false claim as you: that condoms are useless against HPV. So I checked out the evidence on the subject a few months ago. And, what do you knw, you guys are wrong. For example:

"Condom Use and the Risk of Genital Human Papillomavirus Infection in Young Women"
http://www.nejm.org/doi/full/10.1056/nejmoa053284

"Among newly sexually active women, consistent condom use by their partners appears to reduce the risk of cervical and vulvovaginal HPV infection."

"Condom use in prevention of Human Papillomavirus infections and cervical neoplasia: systematic review of longitudinal studies"
http://msc.sagepub.com/content/21/1/38.full.pdf+html

"Consistent condom use appears to offer a relatively good protection from HPV infections and associated cervical neoplasia. Advice to use condoms might be used as an additional instrument to prevent unnecessary colposcopies and neoplasia treatments in cervical screening, and to reduce the risk of cervical cancer."

"Condom use promotes regression of cervical intraepithelial neoplasia and clearance of human papillomavirus: a randomized clinical trial"
http://onlinelibrary.wiley.com/doi/1.../ijc.11474/pdf

"Condom use promotes regression of CIN lesions and clearance of HPV."

"Consistent Condom Use Reduces the Genital Human Papillomavirus Burden Among High-Risk Men: The HPV Infection in Men Study"
http://hcpportalco20140430.pfizer.ed...en%20Study.pdf

"Condoms should be promoted in combination with HPV vaccination to prevent HPV infection in men."

Your claims about herpes are off-base as well, though I haven't previously seen conservative Christians claim that condoms were useless against HSV. Maybe that claim is a new innovation for your side of the debate, or maybe more people on your side know better than to make that sort of claim? Anyway, here's some introductory evidence showing that condoms are not "useless" when it comes to dealing with HSV:

"A Pooled Analysis of the Effect of Condoms in Preventing HSV-2 Acquisition"
http://www.researchgate.net/profile/...a12d000000.pdf

"To our knowledge, this is the largest analysis using prospective data to assess the effect of condom use in preventing HSV-2 acquisition. Although the magnitude of protection was not as large as has been observed with other STIs, we found that condoms offer moderate protection against HSV-2 acquisition in men and women"

"Case-Crossover Analysis of Condom Use and Herpes Simplex Virus Type 2 Acquisition"
http://journals.lww.com/stdjournal/F...Herpes.17.aspx

"This analysis suggests that condoms offer significant protection against HSV-2 transmission."

"Condom use and the prevention of genital herpes acquisition"
http://europepmc.org/abstract/med/11916494

"While many studies have examined the degree of protection offered through the use of condoms against HSV-2 acquisition, findings have been either difficult to interpret or inconsistent. However, the body of evidence supports the efficacy of condoms in preventing HSV-2 infection among women. More data are required for HSV-2 prevention in men. The infrequent use of condoms during pregnancy, coupled with the high incidence of complications associated with HSV-2 acquisition at this time, warrants efforts to improve condom use among male partners of pregnant women at risk of HSV-2 infection."

Hopefully you all will stop spreading misinformation and put people's health first. Because it's a really bad idea to tell people that condoms are useless against HPV, when that is actually not the case.

[Yay! I knew one day my training in immunology would pay off.]

It's quite telling the number of people on here who Amen'd your misrepresentions on the effectiveness of condoms. It just goes to illustrate my point regarding many socially conservative Christians: many of you don't really care what the facts are on the efficacy of condoms. You just want to distort the facts for your ideological ends.