on population, reproductive health & ethics

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Edmonton Journal (Canada), July 30, 2004

Condoms really do work against bacterial diseases: Study challenges notion that abstinence is the only option

Condoms significantly reduce a woman's risk of venereal diseases and infertility, according to the first long-term study of its kind.

While scientifically proven to reduce the chance of getting AIDS, condoms' ability to guard against more common sexually transmitted diseases, although strongly suspected, hadn't been formally demonstrated until now.

A three-year, multi-centre study involving more than 680 American women reveals that women who insist their sexual partners always wear a condom are half as likely to get a recurring case of pelvic inflammatory disease, and 60 per cent less likely to become infertile.

The study, published in the August issue of the American Journal of Public Health, confirms strong suspicions that condoms can help prevent common venereal infections, such as gonorrhea, chlamydia and pelvic inflammatory disease.

The findings are bound to be controversial in the U.S., where critics say a previous lack of research was seized upon by the Republican administration of President George W. Bush to justify a socially conservative public health policy advising abstinence.

"It's the best study out there that has backed this collective wisdom that condoms were effective" in fighting sexually transmitted diseases, said lead author Dr. Roberta B. Ness, an internist and chair of epidemiology at the University of Pittsburgh School of Medicine. "It's really the beginning of closing the information gap."

Her study followed 684 women age 14 to 37, who arrived at 13 U.S. medical centres beginning in March 1996 with symptoms of pelvic inflammatory disease -- or PID. Over the next three years, the women were periodically interviewed about their sexual behaviour to see which of them came down with the illness again, and why.

The study found a "clear association between regular condom use and a reduced risk not only for recurrent PID, but also related complications," such as chronic pelvic pain and infertility.

Women whose sexual partners didn't always use condoms were as vulnerable to PID as those whose partners never used them, which the researchers speculate may be because partners with a more casual attitude to condom use tended not to be monogamous, Ness said.

Her work counters a 1997 report by the Institute of Medicine, the main scientific advisory panel to the president, called the Hidden Epidemic: Confronting Sexually Transmitted Disease, which surveyed existing research before concluding that while condoms reduce cases of HIV, there was insufficient evidence for their effectiveness in fighting bacterial STDs.

The 1997 report instantly became a political football: public health activists denounced it, while the Bush administration continues to cite it as the scientific basis for a credo known as ABC, which stands for "Abstinence, Being Faithful, and Condom Use," in descending order of importance.

"The subtext is that the only good and scientifically valid way to protect against (venereal) diseases is through abstinence," said Ness. "They've used it to suggest there isn't a complete science to support condoms. So this report really fills in a gap where the data was missing."

PID is caused when chlamydia or gonorrhea bacteria infecting the cervix migrate into the upper genital tract. About eight per cent of U.S. women will get PID during their reproductive life, and as many as one in five women who become infertile can trace the cause to PID. A single episode boosts a woman's chance of becoming infertile as high as 15 per cent, said Ness.

In Canada, between 1984 and 1994, 2.3 per cent of women had a severe enough case of PID that they were hospitalized. Over the same period -- the latest for which figures are available -- the number of Canadians contracting the disease fell by 51 per cent for reasons that remain unclear.

Canadian hospitals spend at least $34 million a year to treat women with PID, according to the Canadian Institute for Health Information.

The study is an important one that will "absolutely ... provoke more debate" in Canada as well as the U.S. around the merits of condom use, said Bhagirath Singh, an immunologist and scientific director of the Institute of Infection and Immunity, based in London, Ont., one of the federally funded Canadian Institutes of Health Research.

Ness's results were "not rocket science," he added. "But the social implications (of the research) are going to become interesting. It's a splitting hair kind of debate, but condoms clearly, clearly are good public health policy, and I think that message comes across loud and clear."

<< Edmonton Journal -- 7/30/04 >>

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