Consistent condom use associated with regression of CIN and clearance of HPV in Dutch studies

Consistent condom use can hasten the regression of lesions in the cervix and on the penis caused by the genital wart virus, and can speed up the time it takes the body to clear infection with the wart virus, according to two Dutch studies published in the December 2003 edition of the International Journal of Cancer.

The ability of properly used condoms to prevent the transmission of HIV and bacterial sexually transmitted infections including gonorrhoea, syphilis and chlamydia is well recognised. However, as human papilloma virus (HPV), which causes genital and anal warts, can be spread by touch, condoms were not always recognised as an effective prophylaxis against infection.

Indeed, religious conservatives in the US Congress are currently trying to force condom manufacturers in the USA to include a warning on condom packages that condoms are unable to prevent HPV infection. The inability of condoms to prevent HPV infection has also been stressed by abstinence-only sex educators in the US, who only mention condoms in relation to their (very low) failure rate.

These Dutch studies, however, show that condoms can have some effect against HPV.

The first study involved a total of 123 women with pre-cancerous lesions in their cervix, cervical intraepithelial neoplasia (CIN), which is caused by certain subtypes of HPV. The women were randomised to consistently use condoms with their regular male sexual partner or not to use condoms. CIN in the women in the condom group showed a two-year cumulative regression rate of 53% compared to 35% in women who did not use condoms (p=0.03). Furthermore, HPV infection was cleared by 23% of women who used condoms, compared to only 4% of women not using condoms (p=0.02).

The second study involved the male partners of women with CIN who had penile warts. A total of 57 men were randomised to use condoms consistently for three months, and 43 men were randomised into a non-condom-use arm. Condom use shortened the time to regression of flat penile lesions (7.4 months condom group versus 13.9 non-condom arm, hazard ratio 2.1).

The investigators speculate that the use of condoms prevented continued transmission of HPV between partners, leading to lower HPV viral load, preventing reinfection with HPV, and promoting quicker clearance of the virus.

Infection with HPV has been linked to elevated levels of anal cancer in HIV-positive gay men and cervical cancer in HIV-positive women, even in the HAART era. The fact that consistent condom use was linked with regression of lesions and pre-cancerous lesions and clearance of HPV could provide additional reasons for consistent condom use by HIV-positive individuals who also have HPV infection.

Human papilloma virus - overview

Genital warts - factsheet

Condoms - factsheet

Editorial attacks shift away from condoms in HIV prevention - news story