Do condoms prevent Human Papillomavirus (HPV) transmission?

Do Condoms Prevent HPV Transmission?

Condoms provide partial but incomplete protection against HPV transmission—they can lower the risk of genital warts and HPV-related disease progression, but cannot fully prevent HPV infection because the virus can infect areas not covered by a condom. 1

Evidence for Partial Protection

Genital HPV Transmission

• The CDC explicitly states that correct and consistent male condom use can lower the chances of giving or getting genital warts, but such use is not fully protective because HPV can infect areas that are not covered by a condom 1
• Multiple guidelines acknowledge that little evidence exists to suggest that condoms reduce the risk for HPV infection itself 1
• One prospective study among newly sexually active college women demonstrated a 70% reduction in HPV infection when partners used condoms consistently and correctly 1

Disease Outcomes vs. Infection

• While condoms may not prevent HPV infection, research suggests they may protect against genital warts, cervical intraepithelial neoplasia (CIN II or III), and invasive cervical cancer 2
• Condom use has been associated with higher rates of regression of cervical intraepithelial neoplasia and clearance of cervical HPV infection in women, and regression of HPV-associated penile lesions in men 3
• Available data are inconsistent and not specific enough to provide precise estimates that protected oral sex by condoms decreases transmission of HPV 1

Why Condoms Are Not Fully Protective

Anatomical Limitations

• HPV transmission can occur through any genital contact, not just penetrative intercourse 4
• The virus can infect skin and mucosal areas not covered by condoms, including the vulva, scrotum, perineum, and perianal region 1, 5
• Having just one sexual partner often results in infection because HPV is so common and transmissible 4

Transmission Characteristics

• Genital warts can be transmitted even when no visible signs of warts are present and even after warts are treated 5
• The presence or absence of symptoms is irrelevant to transmission risk 5
• Within an ongoing sexual relationship, both partners are usually already infected by the time one person is diagnosed 5

Clinical Recommendations

For Patients with Genital Warts

• Patients should inform current or new sexual partners that they have genital warts, as they can be transmitted to others 1, 5
• Patients should refrain from sexual activity until warts are gone or removed, though it is not known how long a person remains contagious after treatment 1, 5
• Both sex partners should be screened for other STDs if one has genital warts 1, 5

For General HPV Prevention

• HIV-infected persons should use latex condoms during every act of sexual intercourse to reduce risk for exposure to sexually transmitted pathogens, although limited evidence exists to demonstrate that condoms reduce the risk for HPV infection 1
• Abstaining from sexual activity (refraining from any genital contact) is the surest way to prevent genital HPV infection 1
• For those who choose to be sexually active, a monogamous relationship with an uninfected partner is the strategy most likely to prevent future genital HPV infections 1

Common Pitfalls to Avoid

• Do not falsely reassure patients that condoms provide complete protection against HPV—they reduce but do not eliminate risk 1, 5
• Do not assume asymptomatic warts are non-infectious—transmission occurs regardless of symptoms 5
• Do not use HPV testing to screen men or partners of women with HPV—no clinically validated HPV test exists for men 5
• Do not assume HPV diagnosis indicates recent sexual infidelity—HPV can remain dormant and reactivate years after initial infection 5, 6

Additional Prevention Strategies

• The quadrivalent HPV vaccine (Gardasil) can prevent infection with HPV types that cause 90% of genital warts (types 6 and 11) and is recommended for males and females aged 9-26 years 1, 6
• Women should continue regular Pap test screening as recommended, regardless of vaccination or genital wart history 1