An Ounce of Prevention

Sexually transmitted diseases (STDs), including HIV infections, are a global health priority. There are more than 20 sexually transmitted bacterial and viral infections. Each causes substantial long- and short-term morbidity and, in the case of HIV, mortality for infected persons, for their sexual partners, and for children born to infected mothers (1). Sexually transmitted diseases are a causal factor in the pathogenesis of squamous-cell carcinoma of the genital tract, a leading preventable cause of tubal factor infertility and ectopic pregnancy; are associated with adverse outcomes of pregnancy; and amplify risk for acquisition and transmission of HIV.

Efforts to control STDs are best served by using a combined strategy aimed at identification and care for individuals with infection, and preventive measures for those at risk for infection. For many years, condoms have played a central role in efforts to prevent transmission or acquisition of STDs. However, during the past decade, people have challenged the utility of condoms for prevention of these diseases, mostly on the basis of ill-founded concerns that condom promotion might paradoxically encourage risky behaviors and because of the dearth of scientific proof that condoms are effective for prevention of STDs. To address the latter contention, the National Institutes of Health (NIH) convened an expert panel in June 2000 to critically review the published scientific evidence that condoms are effective for prevention of STDs. The panel's report (2) concluded that we have good evidence that condoms are effective for preventing HIV infection in women and men, and for preventing gonorrhea …