Protection, Condom

Although condom use is a must it unfortunately does not protect you totally from genital warts. Condoms provide protection above the base of the penis but does not provide protection for your penile base (where there is no condom coverage), pubic area and scrotum area. Many patients have their original genital warts in those areas but the disease can spread to the penile shaft later.

According to CDC, While available scientific evidence suggests that the effect of condoms in preventing HPV infection is unknown; condom use has been associated with lower rates of the HPV-associated diseases of genital warts and cervical cancer.

"The available scientific evidence is not sufficient to recommend condoms as a primary prevention strategy for the prevention of genital HPV infection. There is evidence that indicates that the use of condoms may reduce the risk of cervical cancer."

Consistent Use of condom:
Condom must be use from beginning and foreplay of sex all the way to the end which is climax. I always tell my patients either you have dress on or condom on. This means condom must be used from beginning of sex act act till the end because even foreplay has its own  risk.

This is an important topic needs to be address, in years of my practice I frequently ask this typical

following question:

Did you use condom?
Surprisingly many patients had similar answer of “Almost”
I realized that there are 2 reasons that patient answer “ Almost”

1) Patient is embarrassed to tell that he/she did not use protection which may doctor assume he/she is very irresponsible.

2) Patient has false belief of protection means, protect against  transmission of semen.
Many people believe to have sex and when getting close to reach climax then use protection to play safe. This is a false belief in view of sexually transmitted diseases.
By this practice you may decrease the chance of pregnancy, but not HPV.
HPV gets transmitted by skin to skin contact in genital area.

Correct Use of condom:
It is important to use the condom correctly beside consistently
Genital ulcer diseases include genital herpes, syphilis, and chancroid. These diseases are transmitted primarily through “skin-to-skin” contact from sores/ulcers or infected skin that looks normal.

HPV infections are transmitted through contact with infected genital skin or mucosal surfaces/fluids. Genital ulcer diseases and HPV infection can occur in male or female genital areas that are, or are not, covered (protected by the condom).

Theoretical basis for protection. Protection against  HPV depends on the site of the HPV or warts  infection. Latex condoms may only protect against transmission when the infections are in genital are covered on that particular area. Thus, consistent and correct use of latex condoms would be expected to protect against transmission of HPV warts in some, but not all. Not all growth and site of HPV infection gets covered by condom.

Conclusion: Condom usage may help against HPV  but is not 100% with multiple reason to my clinical experience as follow:

1)Skin Coverage of condom
condom does not cover whole genital area , base of penile shaft is usually not covered. Pubic area has no condom coverage and we have seen numerous patient with HPV on their pubic area.

2) Transmission stage
Not necessarily you need to have an active visible growth in order to pass genital HPV warts. In other word you may assume that if you cover the warts with latex then you may not pass the pathogen which is not true. This might help but it is not safe nor 100% effective. For example: viral shedding may happen in HPV patients even though she does not have a visible warts.

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