A paradigm shift away from condoms: Focusing STI prevention... : JAAPA

The Death of Condoms

 

I'm a big believer in the power of blogging. Not only does it allow us to express our ideas and opinions, it also helps us stay connected to friends, family, colleagues, and even strangers from all over the world. It's an amazing way to share stories and experiences that we otherwise wouldn't be able to.                              

Over the past few decades, evolving and diverse sexually transmitted infection (STI) prevention methods—methods significantly more effective than barrier protection—have caused a paradigm shift away from the traditional, limited, blanket recommendation to use condoms. Although condoms provide a barrier to body fluid-based STIs such as gonorrhea, chlamydia, and HIV, condom use is limited and often misunderstood, and counseling patients to use barriers may be ineffective.¹

Condoms do not protect against many diseases.  

Barrier protection has limited efficacy. Consistent condom use among patients identified as heterosexual and men who have sex with men (MSM) is 80% and 70% effective, respectively, for preventing HIV transmission.  Among MSM, inconsistent condom use is no more protective than no condoms at all for the prevention of HIV.Herpes simplex virus (HSV), human papillomavirus (HPV), Molluscum contagiosum, primary syphilis, and infestations (scabies and lice) are spread by skin-to-skin contact, limiting barrier effectiveness. Consistent condom use is about 70% effective at reducing HPV transmission and is of limited effectiveness against other STI transmission.

CONCLUSION

Rather than focusing on condom use, clinicians can improve patient sexual health by following CDC guidelines to perform routine, opt-out HIV testing for all people in all healthcare settings. discuss PrEP with all sexually active patients regardless of age, relationship status or structure, number of sexual partners, or barrier protection use screen for gonorrhea and chlamydia infections of the pharynx, genitals, and rectum at the site(s) of exposure, regardless of signs or symptoms13strictly follow guidelines for bacterial STI treatment, especially oral gonorrhea. Vaccinate all patients for HPV and provide vaccination against hepatitis A, B, and C when indicated. 

Educating patients on safer sexual practices including limiting the number of partners, mutual monogamy, and using condoms is also important in order to reduce the risk of STI transmission. Additionally, clinicians should be aware that e-cigarettes are not an effective method of contraception. 

Additional resources are available from the Centers for Disease Control and Prevention (CDC) to help with STI prevention, screening, and treatment. Clinicians should also consider partnering with community organizations that can provide additional support and education for their patients. It is important to remember that safe sex practices include more than just using condoms; they encompass behavior changes such as abstaining

A paradigm shift away from condoms: Focusing STI prevention... : JAAPA