Condoms are one of the best ways for sexually active people to avoid sexually transmitted diseases (STDs), but many worry that people are becoming more lax about protecting themselves. There are all kinds of myths swirling around about condoms — such as that they aren’t effective or that they kill the mood. And, thanks to anti-HIV medications, some people no longer see condom use as a matter of life or death.
The Centers for Disease Control and Prevention (CDC) recently announced that 2014 saw record highs in chlamydia, syphilis, and gonorrhea, which is a stark reminder that condoms protect against more than just HIV. So, even if you’re using medications to protect yourself from HIV, remember that syphilis is making a comeback, and can cause serious damage or even death when untreated, and that gonorrhea is rapidly evolving resistance to the last good drugs we have to treat it. Condoms are just as relevant as ever!
In 2014, the CDC announced it would start using the term “condomless sex” instead of “unprotected sex” to recognize that people could engage in condom-free sex, but still protect themselves from HIV by using Truvada, or pre-exposure prophylaxis (PrEP). Truvada is the first drug approved by the FDA to prevent HIV, and it can be taken by HIV-negative individuals to help their body ward off the virus before an infection can establish itself. The pill must be taken daily — using it inconsistently reduces its effectiveness.
And just how effective is PrEP, anyway? About as effective as condoms — but that doesn’t mean someone at risk for HIV should replace condoms with PrEP. In fact, combining PrEP with condoms reduces HIV risk even more dramatically. One study calculated that, among men who have sex with men (MSM) who have anal sex (which is more likely to transmit HIV than vaginal or oral sex), using only condoms every time was 70.5 percent effective in protecting against HIV; using only PrEP at least 90 percent of days was 73 percent effective; while using both condoms and PrEP correctly and consistently was 92 percent effective in protecting against HIV.
Some worry that PrEP is a threat to “condom culture,” which has been so successful in normalizing condom use. So far, the evidence is thin that MSM would ditch condoms entirely in favor of PrEP. One survey found that most MSM would not change their condom habits if they were using PrEP — though 30 percent reported they would use condoms less or not at all. On the other hand, participants in PrEP clinical trials did not change their behavior with respect to condoms. Luckily, the gay community is still pretty condom-savvy: Condom usage is higher among MSM than among heterosexual males (80 percent vs. 57 percent).
Before antibiotics, syphilis was the most dreaded STD out there, as it could lead to blindness, disfigurement, dementia, or even death. But by 2000 we saw a low of 2.1 cases of syphilis per 100,000 people, and the United States was poised to eliminate syphilis completely.
That good fortune didn’t last, and now we’re in the midst of a syphilis epidemic. In 2014, the rate increased to 6.3 cases per 100,000 — and Arizona had higher-than-average syphilis rates, with 8.7 cases per 100,000. Rates are highest among men in their twenties, with more than 30 cases per 100,000. And 83 percent of new syphilis cases are in MSM.
Furthermore, between 2013 and 2014, syphilis rates increased by 22.7 percent among women, which is bad news not only because the disease is dangerous to the infected person, but also because of how harmful syphilis is during pregnancy. The current rate of congenital syphilis, which occurs when the disease is transmitted to the baby during pregnancy, is the highest it’s been since 2001.
Having a syphilis infection can make someone more vulnerable to HIV. And that’s why prevention is key — get screened regularly, know your partners’ status, and use condoms or dental dams during vaginal, anal, or oral sex.
Gonorrhea can also be transmitted via vaginal, anal, or oral sex. Here, we’ll focus on oral sex, to debunk the common misconception that oral sex is safe sex — and therefore doesn’t require condoms or dental dams. Studies show that the vast majority of teenagers don’t use condoms for fellatio (oral contact with a penis), and another survey found that 71 percent of sexually active single adults, ages 18 to 35, reported never using condoms or dental dams for oral sex.
Such a lackadaisical approach is said to be typical in Japan, where 11 percent of males and 58 percent of females with genital gonorrhea infections also have gonorrhea infections in their throats. Anyone who performs oral sex, especially without protection, is vulnerable to STDs like gonorrhea. A 1973 study found that, among heterosexuals, 14 percent of men and 31 percent of women giving oral sex to a partner with genital gonorrhea acquired an oral infection. A more recent study found that cunnilingus (oral contact with female genitals) can transmit gonorrhea from a vagina to a partner giving oral sex. Furthermore, the available data suggest that mouth-to-penis gonorrhea transmission may be an underappreciated source of disease.
Oral gonorrhea infections are worrying because they rarely have symptoms and are more difficult to cure — which means they often go untreated, or treatment is more likely to fail, allowing the germs that cause gonorrhea to be transmitted with wild abandon. Also, the throat is a hotspot for antibiotic-resistance genes, and may be an incubator for emerging “superbug” strains of gonorrhea. The CDC has already declared antibiotic-resistant gonorrhea to be an urgent threat, and the lack of new drugs to replace the old ones means that we’re in danger of returning to the era of untreatable gonorrhea.
Yes, PrEP can reduce HIV risk, but it doesn’t protect users from other STDs, such as gonorrhea and syphilis — nor does it protect against pregnancy. Condoms are still the best way to protect yourself against most STDs! You can pick up condoms, or receive testing and treatment for STDs, at any Planned Parenthood health center.
Click here to check out other installments of our monthly STD Awareness series!