John Cardinal O'Connor
WARNING: The subject matter in this post deals candidly with sexually transmitted infections and diseases and their modes of transmission. Minors and persons easily upset by the nature of such discussion are advised to skip over this post.
In Part II of this series (Part I here. Part II here. Part IV here.) we examined the disconnect between ACT-UP’s rhetoric on condoms and the published reports in The New York Times during the two years prior to ACT-UP’s desecration of Saint Patrick’s Cathedral. In this article, we’ll consider some epidemiological data from the Centers for Disease Control and Prevention (CDC), and see if perhaps the rhetoric is supported by the data.
The graphs below come from CDC’s Sexually Transmitted Diseases Surveillance, 2008, with the exception of the HIV data, which is also CDC data available here. For purposes of classification, I have divided these diseases into two groups: A & B. This division is entirely my own and not a CDC classification scheme.
GROUP A DISEASES
Number of AIDS cases, AIDS deaths, and people living with AIDS, 1985-2004, United States (CDC, n.d.a)
Chlamydia
Genital Warts (HPV) Initial Visits to Doctor's Office
Herpes Simplex Virus
Trichomoniasis and Other Vaginitis
.
.
GROUP B DISEASES
Chancroid
Syphilis
Gonorrhea
.
.
Explaining the Data
In making sense out of these data, they have been divided into two groups based upon some shared characteristics.
Group A data all show the incidence of disease trending steadily upward. These diseases also share another common characteristic. They all possess the capacity to remain ‘silent’, or asymptomatic in a large percentage of their victims.
HIV Less than half of infected people develop a conversion reaction with its flu-like symptoms.
Trichomonas Though curable with drugs, up to 1/3 of women are asymptomatic carriers.
Human Papilloma Virus (Genital Warts) 60% chance of infection with one contact. Up to 1/3 women remain asymptomatic.
Genital Herpes 80%-90% of people fail to recognize symptoms or have no symptoms at all. They may still shed the virus.
Chlamydia 70%-80% of women have no symptoms. 25%-50% of men have no symptoms.
HPV and Herpes are contact transmission infections. Any exposed skin on the penis not covered by the condom, or on the labia contacting exposed penile skin with condom use, can become infected with a single act of intercourse. These diseases are also spread by oral-genital transmission.
The prevalence line in the HIV graph indicates the number of people living with HIV. As is evident, the rate continues to soar.
The question needs to be asked, with the explosion in condom usage and sales over the past 25 years, why the steady rise in these STI’s? Chlamydia experts believe that the rise in the graph is the result of a combination of better testing methods and mandatory reporting that didn’t come about until the late 1990’s. While that’s understandable, the basal level of infection was not always this high in the population.
Indeed, the graphs all indicate that prior to 1968, the disease rates, even in diseases that had mandatory reporting were extremely low. The graphs tell the sad story of the sexual revolution that really got going with the widespread availability of the pill in the late 1960’s.
This soaring rate of STI’s and STD’s can be explained by the condom bible. Consider an excerpt from the following book available to be read online:
The book Contraceptive Technology is the most authoritative source of information on all methods of birth control in the world today. This two-inch thick book is often referred to as the “family planner’s bible,” and is revised every few years in order to include updated information. The latest edition was published in 2004, and it is considered by family planners to be the “last word” on all matters contraceptive…
According to Contraceptive Technology, the condom’s user effectiveness rate is 85 percent [9]. This means that, under real-world conditions, a woman whose sexual partners use condoms for every act of sexual intercourse has a 15 percent chance of becoming pregnant in a year.
Figure 2 shows the chances of pregnancy for a woman whose sexual partners faithfully use condoms for 83 average annual instances of sexual intercourse.[10]
Keep in mind that these are the lowest rates that can generally be expected, since they assume 100% condom usage.
Figure 2
Probability of Pregnancy Over Time for Women Whose Sexual Partners Always Use Condoms
1 year 15 percent
2 years 28 percent
3 years 39 percent
4 years 48 percent
5 years 56 percent
10 years 80 percent
It must be stressed that these are probabilities for pregnancy, which can only occur one week per month. Slippage and breakage happen the other three weeks out of the month as well.
How then do we explain the data in Group B? Why the decline?
These diseases manifest immediately, and in the case of gonorrhea and chancroid, painfully. People seek medical treatment immediately, as all three of these diseases are curable with antibiotics. Not so for the viral diseases in Group A. There are no silent infections in Group B to enable transmission between a series of unsuspecting partners. Note too that the infections in gonorrhea and chancroid declined precipitously only at the outset of the HIV pandemic in the mid-late 1980’s. That’s when public health officers required names of partners in order to go out into the community and dry up the reservoir of pathogens. The same for syphilis.
In Group A, because the infections remain asymptomatic in so many for so long, the diseases are able to be transmitted unchecked. Unlike the pathogens in Group B, it’s next to impossible to dry up the reservoir of Trichomonas and Chlamydia because they lurk silently for months to years. The viral diseases HIV and Herpes cannot be eliminated, only held in check. To a good extent, HPV resolves spontaneously in most people, but not before being transmitted.
If condoms were so effective and could be rightly credited for the declines seen in group B, then we would have seen declines in Group A pathogens, minimally Chlamydia and Trichomonas, as well.
Some might argue that there is simply an increase in the number of young people having sex without condoms. Certainly some of these increases in Group A can rightly be attributed to this. Even stipulating this point does not diminish the 15% condom failure rate detailed above, nor does it obviate the fact that condoms do not cover the entire penis, hence not protecting against the spread of HPV and Herpes. The false sense of security leads people to engage in more frequent sex, often with several partners either at once or serially, leading to a greater probability of disease transmission through skin contact, oral sex, or catastrophic condom failure.
Finally, there is CDC’s own Fact Sheet on the Male Latex Condom for Public Health Personnel.
“Latex condoms, when used consistently and correctly, are highly effective in preventing the sexual transmission of HIV, the virus that causes AIDS. In addition, consistent and correct use of latex condoms reduces the risk of other sexually transmitted diseases (STDs), including diseases transmitted by genital secretions, and to a lesser degree, genital ulcer diseases. Condom use may reduce the risk for genital human papillomavirus (HPV) infection and HPV-associated diseases, e.g., genital warts and cervical cancer.”
Finally consider this statement from the fact sheet:
“The most reliable ways to avoid transmission of sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV), are to abstain from sexual activity or to be in a long-term mutually monogamous relationship with an uninfected partner.”
That’s as close a vindication of Cardinal O’Connor and the Bishops are likely to get from CDC. It seems very much like a variant expression of traditional morality, which is abstinence before and fidelity in marriage.
CDC gives no guarantees beyond that, and very little encouragement in the way of condom safety.
Next Wednesday: The efficacy of abstinence programs.
I’d be interested too to see the efficacy of condoms for oral and anal sex versus vaginal sex. Most advocates of condoms refuse to acknowledge the dangers of anal sex.
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When I was going through my FertilityCare training I learned that the condoms that planned parenthood hands out are the least effective in preventing pregnancy on the market. Guess they have to fuel the abortion mill somehow…
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Interesting analysis. I noticed in particular the high incidence of syphilis in the 40’s. Was this simply because the military was screening for it as part of drafting men? I have heard the claim that this particular disease has always been in the population for centuries. (Scars from syphilis can be detected in the bones of humans.) I am not sure that the failure rate of condoms necessarily can be determined by using the rate of pregnancy. Failure in the case of diseases would also relate to proper use. Surveys of young people, i.e. college-age, show that they will often engage in unprotected oral sex before proceeding to protected vaginal sex. Obviously this practice would not limit the spread of disease.