Protection in detail

Use Protection or Say No to Your Partner

 (following information has been obtain from CDC in conjunction with our clinical experience)

The surest way to avoid transmission of STD is to abstain from sexual intercourse, or to be in a long-term mutually monogamous relationship with a partner who has been tested and you know is uninfected. And to make sure that person is not having sex with other person.

For persons whose sexual behaviors place them at risk for STDs, correct and consistent use of the male latex condom can reduce the risk of STD transmission. However, no protective method is 100 percent effective, and condom use cannot guarantee absolute protection against any STD.

Transmission of an STD cannot be prevented by washing the genitals, urinating, and/or douching after sex

How to use condom

Make sure that you leave room at the tip to collect the semen. Lubrication helps prevention of tears. If your condom is not lubricated by manufacture you could use water based lubrication such as K Y jelly. Do not use mineral or petroleum based lubrication. They could denature the latex and weaken it.

Polyurethane and lambskin condoms

Are not as effective as latex to provide protection against STDs . They might be used for pregnancy prevention ,however, not for the purpose of STDs which we are addressing.

Oral Sex and Condom: It is a must no matter how you view it. Oral sex is sex. You could get variety of sexually transmitted disease by unprotected oral sex. For example,NGU, Gonorrhea Herpes, syphilis etc

Anal Sex and Condom: It is the most important of all considering risk factor such as HIV. Lets assume that your partner got tested for every single possible STD! and it is free from all. You still will be exposed to bacteria in rectum such as E Coli. Never have vaginal sex after performing anal sex.

Outer course Sex and Condom: You should have condom on. It is a false belief that by not penetrating then you will not get STD. Genital to genital contact could give you many stds such as syphilis , Molluscum, herpes, Chancroid etc

Discharge Diseases, Including
Gonorrhea, Chlamydia, Trichomoniasis

(and NGU)

What is discharge? It is fluid leakage of genital which may contain bacteria, virus, parasits or cellular elements such as white blood cells.

Gonorrhea, Chlamydia, and trichomoniasis are termed discharge diseases because they are sexually transmitted by genital secretions, such as semen or vaginal fluids. HIV is also transmitted by genital secretions.

Epidemiologic studies that compare infection rates among condom users and nonusers provide evidence that latex condoms can protect against the transmission of chlamydia, gonorrhea and trichomoniasis. However, some other epidemiologic studies show little or no protection against these infections. Many of the available epidemiologic studies were not designed or conducted in ways that allow for accurate measurement of condom effectiveness against the discharge diseases. More research is needed to assess the degree of protection latex condoms provide for discharge diseases, other than HIV.

Why you could have risk of infection despite using condom?

For example, Chlamydia is .25 micromillimeter and each micromillimeter is 0.001 millimeter.They are so small that is not visible . Latex on laboratory is impermeable barrier to that ,however, you may get exposure when you remove your condom, if condom break, or prolong sex with exposure of leakage from ring of the condom toward urethral opening. However, we know if properly use condom then we decrease the chance of infection by Chlamydia.

Genital Ulcer Diseases and Human Papillomavirus

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 genital ulcer diseases and HPV depends on the site of the sore/ulcer or infection. Latex condoms can only protect against transmission when the ulcers or infections are in genital areas that are covered or protected by the condom. Thus, consistent and correct use of latex condoms would be expected to protect against transmission of genital ulcer diseases and HPV in some, but not all, instances."

Conclusion: Condom usage may help against genital ulcer disease but is not 100% with multiple reason to my clinical experience

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 herpes on their pubic area.

2) Transmission stage

Not necessarily you need to have an active visible sore in order to pass genital ulcer disease . In other word you may assume that if you cover the sore 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 shading happens in herpes patient even though she does not have a visible sore.

Sexually Transmitted Diseases, Including HIV

There are two primary ways that STDs can be transmitted. Human immunodeficiency virus (HIV), as well as gonorrhea, chlamydia, and trichomoniasis – the discharge diseases – are transmitted when infected semen or vaginal fluids contact mucosal surfaces (e.g., the male urethra, the vagina or cervix). In contrast, genital ulcer diseases – genital herpes, syphilis, and chancroid – and human papillomavirus are primarily transmitted through contact with infected skin or mucosal surfaces.

Theoretical basis for protection. Condoms can be expected to provide different levels of protection for various sexually transmitted diseases, depending on differences in how the diseases are transmitted. Because condoms block the discharge of semen or protect the male urethra against exposure to vaginal secretions, a greater level of protection is provided for the discharge diseases. A lesser degree of protection is provided for the genital ulcer diseases or HPV because these infections may be transmitted by exposure to areas, e.g., infected skin or mucosal surfaces, that are not covered or protected by the condom.

Dr. Arani's Tips to decrease your risk when having sex with a new partner besides using condom

Use following tips to further decrease your chance of getting STD's

we have been teaching following tips to our patient in our Medical Center with significant help to our patient.

1) Never have sex in dark room with your partner in very first time. Many people would try to hide some visible STD's by insisting of having sex in lower light.

2) Always ask your partner's open question regarding STDs, if she/he has got tested recently and ask if she or he ever had STDs

Be careful about answers such as following:

Answer # 1"I just had pap smear and everything is fine" This is a misunderstanding or false belief. Pap smear is for HPV or cancer prevention and routinely done by gynecologist, a normal pap smear does not mean person is free from STDs. Each STDs has its own particular test.

Answer # 2 " I had physical with my doctor and had blood test and everything is fine" This is misunderstanding again, physical exam blood test not necessarily contain STD test. It checks patient for routine such as cholesterol, kidney or liver function test etc.For example, It does not check for HIV unless you request for it.

3) I understand that you are not a doctor, however, you could use your own common sense. Look for any unusual sign on your genital partner. For example: wart, sore, rash, discharge or unusual smell.

If you have seen above signs then have an open discussion with your partner. You may stop there and ask for your partner to see his/her doctor first before engaging sex.

Remember Protection and prevention is always better than infection and treatment.

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