On the Teen Scene:
Preventing STDs

by Judith Levine Willis

You don't have to be a genius to figure out that the only sure way to avoid getting sexually transmitted diseases (STDs) is to not have sex.

But in today's age of AIDS, it's smart to also know ways to lower the risk of getting STDs, including HIV, the virus that causes AIDS.

Infection with HIV, which stands for human immunodeficiency virus, is spreading among teenagers. According to the Centers for Disease Control and Prevention (CDC), as of June 30, 1997, 2953 people had been diagnosed with HIV or AIDS when they were in their teens and 107,281 when in their twenties. Because it can be many years from the time a person becomes infected to when the person develops symptoms and is diagnosed with HIV infection, many people diagnosed in their 20s likely contracted HIV in their teens.

You may have heard that birth control can also help prevent AIDS and other STDs. This is only partly true. The whole story is that only one form of birth control currently on the market--latex condoms (thin rubber sheaths used to cover the penis)--is highly effective in reducing the transmission (spread) of HIV and many other STDs.

The Food and Drug Administration has approved the marketing of male condoms made of polyurethane for people allergic to latex. (See "Information on Labels") Reality Female Condom, another form of birth control made of polyurethane, may give limited protection against STDs, but it is not as effective as male latex condoms.)

So people who use other kinds of birth control, such as the pill, diaphragm, Norplant, Depo-Provera, cervical cap, or IUD, also need to use condoms to help prevent STDs.

Here's why: Latex condoms work against STDs by keeping blood, a man's semen, and a woman's vaginal fluids--all of which can carry bacteria and viruses--from passing from one person to another. For many years, scientists have known that male condoms (also called safes, rubbers, or prophylactics) can help prevent STDs transmitted by bacteria, such as syphilis and gonorrhea, because the bacteria can't get through the condom. More recently, researchers discovered that latex condoms can also reduce the risk of getting STDs caused by viruses, such as HIV, herpes, and hepatitis B, even though viruses are much smaller than bacteria or sperm.

After this discovery, FDA, which regulates condoms as medical devices, worked with manufacturers to develop labeling for latex condoms. The labeling tells consumers that although latex condoms cannot entirely eliminate the risk of STDs, when used properly and consistently they are highly effective in preventing STDs. FDA also provided a sample set of instructions and requested that all condoms include adequate instructions.

Make the Right Choice

Male condoms now sold in the United States are made either of latex (rubber), polyurethane or natural membrane (called "lambskin," but actually made of sheep intestine). Scientists found that natural skin condoms are not as effective as latex condoms in reducing the risk of STDs because natural skin condoms have naturally occurring tiny holes or pores that viruses may be able to get through. Only latex condoms labeled for protection against STDs should be used for disease protection, unless one of the partners is allergic to latex. In that case, a polyurethane condom can be used.

Some condoms have lubricants added and some have spermicide (a chemical that kills sperm) added. The package labeling tells whether either of these has been added to the condom.

Lubricants may help prevent condoms from breaking and may help prevent irritation. But lubricants do not give any added disease protection. If an unlubricated condom is used, a water-based lubricant (such as K-Y Jelly), available over-the-counter (without prescription) in drugstores, can be used but is not required for the proper use of the condom. Do not use petroleum-based jelly (such as Vaseline), baby oil, lotions, cooking oils, or cold creams because these products can weaken latex and cause the condom to tear easily.

Some condoms have added spermicide, an active chemical in spermicides, nonoxynol-9, kills sperm. But spermicides alone (as sold in creams and jellies over-the-counter in drugstores) and spermicides used with the diaphragm or cervical cap do not give adequate protection against HIV and other STDs. For the best disease protection, a latex condom should be used from start to finish every time a person has sex.

FDA requires condoms to be labeled with an expiration date. Condoms should be stored in a cool, dry place out of direct sunlight. Closets and drawers usually make good storage places. Because of possible exposure to extreme heat and cold, glove compartments of cars are not a good place to store condoms. For the same reason, condoms shouldn't be kept in a pocket, wallet or purse for more than a few hours at a time. Condoms should not be used after the expiration date, usually abbreviated EXP and followed by the date.

Condoms are available in almost all drugstores, many supermarkets, and other stores. They are also available from vending machines. When purchasing condoms from vending machines, as from any source, be sure they are latex, labeled for disease prevention, and are not past their expiration date. Don't buy a condom from a vending machine located where it may be exposed to extreme heat or cold or to direct sunlight.

How to Use a Condom

• Use a new condom for every act of vaginal, anal and oral (penis-mouth contact) sex. Do not unroll the condom before placing it on the penis.
• Put the condom on after the penis is erect and before any contact is made between the penis and any part of the partner's body.
• If the condom does not have a reservoir top, pinch the tip enough to leave a half-inch space for semen to collect. Always make sure to eliminate any air in the tip to help keep the condom from breaking.
• Holding the condom rim (and pinching a half inch space if necessary), place the condom on the top of the penis. Then, continuing to hold it by the rim, unroll it all the way to the base of the penis. If you are also using water-based lubricant, you can put more on the outside of the condom.
• If you feel the condom break, stop immediately, withdraw, and put on a new condom.
• After ejaculation and before the penis gets soft, grip the rim of the condom and carefully withdraw.
• To remove the condom, gently pull it off the penis, being careful that semen doesn't spill out.
• Wrap the condom in a tissue and throw it in the trash where others won't handle it. (Don't flush condoms down the toilet because they may cause sewer problems.) Afterwards, wash your hands with soap and water.

Latex condoms are the only form of contraception now available that human studies have shown to be highly effective in protecting against the transmission of HIV and other STDs. They give good disease protection for vaginal sex and should also reduce the risk of disease transmission in oral and anal sex. But latex condoms may not be 100 percent effective, and a lot depends on knowing the right way to buy, store and use them.

Judith Levine Willis is a member of FDA's Public Affairs Staff.

New Information on Labels

Information about whether a birth control product also helps protect against sexually transmitted diseases (STDs), including HIV infection, is emphasized on the labeling of these products, because a product that is highly effective in preventing pregnancy will not necessarily protect against sexually transmitted diseases.

Labels on birth control pills, implants such as Norplant, injectable contraceptives such as Depo-Provera, intrauterine devices (IUDs), and natural skin condoms will state that the products are intended to prevent pregnancy and do not protect against STDs, including HIV infection (which leads to AIDS). Labeling of natural skin condoms will also state that consumers should use a latex condom to help reduce risk of many STDs, including HIV infection.

Laboratory tests show that organisms as small as sperm and the HIV virus cannot pass through polyurethane condom. But the risks of STDs, including HIV infection, have not been well studied in actual use with polyurethane condoms. So unless one or both partners is allergic to latex, latex condoms should be used.

Labeling for latex condoms states that if used properly, latex condoms help reduce risk of HIV transmission and many other STDs. This statement, a modification from previous labeling, now appears on individual condom wrappers, on the box, and in consumer information.

Besides highlighting statements concerning sexually transmitted diseases and AIDS on the consumer packaging, manufacturers will add a similar statement to patient and physician leaflets provided with the products.

FDA may take action against any products that don't carry the new information.

FDA is currently reviewing whether similar action is necessary for the labeling of spermicide, cervical caps, and diaphragms.

Looking at a Condom Label

Like other drugs and medical devices, FDA requires condom packages to contain certain labeling information. When buying condoms, look on the package label to make sure the condoms are:

• made of latex
• labeled for disease prevention
• not past their expiration date (EXP followed by the date).

STD Facts

• Sexually transmitted diseases affect more than 12 million Americans each year, many of whom are teenagers or young adults.
• Using drugs and alcohol increases your chances of getting STDs because these substances can interfere with your judgment and your ability to use a condom properly.
• Intravenous drug use puts a person at higher risk for HIV and hepatitis B because IV drug users usually share needles.
• The more partners you have, the higher your chance of being exposed to HIV or other STDs. This is because it is difficult to know whether a person is infected, or has had sex with people who are more likely to be infected due to intravenous drug use or other risk factors.
• Sometimes, early in infection, there may be no symptoms, or symptoms may be confused with other illnesses.
• You cannot tell by looking at someone whether he or she is infected with HIV or another STD.

STDs can cause:

• pelvic inflammatory disease (PID), which can damage a woman's fallopian tubes and result in pelvic pain and sterility
• tubal pregnancies (where the fetus grows in the fallopian tube instead of the womb), sometimes fatal to the mother and always fatal to the fetus
• cancer of the cervix in women
• sterility--the inability to have children--in both men and women
• damage to major organs, such as the heart, kidney and brain, if STDs go untreated
• death, especially with HIV infection.

See a doctor if you have any of these STD symptoms:

• discharge from vagina, penis or rectum
• pain or burning during urination or intercourse
• pain in the abdomen (women), testicles (men), or buttocks and legs (both)
• blisters, open sores, warts, rash, or swelling in the genital or anal areas or mouth
• persistent flu-like symptoms--including fever, headache, aching muscles, or swollen glands--which may precede STD symptoms.

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