Dr. Caron's Response:

February 14-21 is National Condom Week - so I'd like to focus today's column on several questions I have received about condoms from college students around the country - whether you go to college in Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana or elsewhere, I'd like you to take a moment to think about the issues related to condom use. Let me start off by saying: Vows of abstinence break far more often than condoms. Having said that, I would like to point out that the simple truth is that, for sexually active couples, condoms are the best means we have of preventing HIV/AIDS and other sexually transmitted infections (STIs). For a couple who is committed to having sexual intercourse and who have any concern regarding any of the STIs, latex condoms are the best means of preventing infection. Abstinence and a mutually faithful monogamous relationship with an uninfected partner, few would argue, are even more effective; but if sexual intercourse is going to occur, whatever the reasons behind the decision, condoms are the best approach to preventing an infection.

For condoms to work, they must be used correctly and consistently. The following instructions will help ensure effective use:

Use latex condoms every time you have sexual intercourse; this is the key to any kind of successful contraception.
Do not put a condomless penis into a vagina or anus. Even if a man has great "control" there is always the possibility of accidents.
Leave about a half-inch of space at the condom tip, and roll the condom all the way down to the base of the penis.
Soon after ejaculation, the penis should be withdrawn. Make sure someone holds the base of the condom firmly against the penis as it is withdrawn.
Do not re-use condoms.
Keep condoms in a cool, dry and convenient place.
If you and your partner are uncomfortable with condom use, consider the following:

Communication is crucial. It may seem "unromantic," but planning your contraception/STI protection strategy before you are sexually entangled is essential. Sex is too important to be left up to your genitals. Giving or getting a disease or worrying about pregnancy is about as unromantic as you can get. Explore your feelings together; share your knowledge. Consider visiting your local health center for information - together. Neither partner should be forced to use a form of birth control he or she is truly unhappy with. But the issue of protection must be dealt with - by both of you.
Don't forget your sense of humor and playfulness. Condoms can actually provide lots of laughs; laughter and sex go well together. Fancy condoms - lubricated, ribbed, flavored, colored (have you seen the black "tuxedo condoms" for formal affairs?) - are popular for their entertainment value. Let yourself be entertained.
Stand your ground. Unless you want to be pregnant and are sure your partner is free of STIs, you need protection during sex. If your partner says "no" to using a condom, you can just tell them: "None of my other partners have minded. What's wrong with you?" If your partner cares about you, he'll want to use a condom. if he really is against wearing a condom, she can wear one - the female condom offers great protection from pregnancy and infection as well.

Dr. Caron's Response:

Yes. Genital herpes infection is caused by exposure to the herpes simplex virus type 1 (HSV-1) or herpes simplex virus type 2 (HSV-2) through sexual contact. HSV-1 initially was associated with oral infection (cold sores and fever blisters around the mouth) and HSV-2 with genital infection (blisters on the penis or vulva). Over the past 30 years, however, the increased popularity of oral sex has led to transferring HSV-1 from the mouth to genitals. The two viruses are not different clinically, as both cause the same painful symptoms. A 2-12 day incubation period follows transmission of the virus. There is no cure, but there is treatment to speed the healing of the painful blisters. It should be noted that outbreaks of genital herpes caused by HSV-1 are usually less recurrent, produce less viral shedding, and in general are less of a problem for the person (and their partners). An estimated 50 million people are presently infected with genital herpes caused by HSV-2 in the U.S. - if you ad din the percentage of those with genital herpes du to HSV-1, the percentage is number is even larger. You should know that the virus can be easily spread by even a quick, casual kiss and thus it should not be assumed that a person with oral herpes got it from performing oral sex. By the way, not all mouth ulcers are caused by the herpes virus; they can also be caused by bacteria, allergic reactions, or autoimmune (canker sores) responses. However, "fever blisters" and most cold sores are herpes.

Dr. Caron's Response:

Genital warts are caused by the human papilloma virus (HPV). It is the most common sexually transmitted viral disease in the U.S., with over 5 million new cases annually. The warts usually appear on the genitals a few months after exposure to an infected partner. They are not painful, but some strains have been associated with a higher incidence of cervical cancer. HPV is extremely contagious, so it is in your best interest to wait until the small warts have been treated to proceed with genital contact. As you realize, a male condom is not going to cover the mound where the warts are located; and if you use a female condom, the rim may offer some protection from coming in contact with his mound, but it cannot be guaranteed to keep the area covered during sexual intercourse.
Although the cream he is using is effective in removing the warts, it works slowly and may take months - and the warts are still contagious. In addition, contact with him is not advised while he is using the cream that is designed to burn off the warts; direct contact of this cream with your genitals would not be pleasant. I am glad to know he is being referred to a specialist ­ someone who works specifically with sexually transmitted diseases ­ who can verify that these are genital warts and remove them more quickly. Genital warts can be removed by laser surgery, cryotherapy (freezing), cauterization (burning), or surgical excision. Once they are treated and the skin has healed, your friend should plan regular follow-up visits and also check himself regularly ­ since recurrence is not uncommon. As his sexual partner, you should proceed with caution once all signs of the warts are gone.

Dr. Caron's Response:

This is a great question. Some people who have contracted a sexually transmitted infection may notice such signs as an unusual discharge, odor, burning/pain in the genitals or with urination, or they may see an unusual lump, bump, or blister. Other people who have contracted an infection may not notice any signs or symptoms. In fact, many of the sexually transmitted infections can be carried by someone without any signs or symptoms - at least not in the early days or weeks after exposure. That's why it is recommended that all people who are sexually involved get regular checkups. It is unwise to try to diagnose and treat the condition yourself.

The best way to find out if you have contracted an infection is to have a medical exam performed - preferably by someone who specializes in sexually transmitted diseases/infections and is up-to-date on the latest signs, symptoms, diagnostic techniques and treatments. The tests are pretty simple and straightforward - including such things as a urine culture, a swab of the cervix, a blood test, a visual exam of the areas thought to be involved (vagina, penis, anus, throat). There will also be a chance to talk about your concerns, and good information will be provided on treatment (if needed), as well as how to lower your risks of future infections. If you have concerns that you or your partner could be infected with something, get it checked out.

Dr. Caron's Response:

Genital warts are determined by visible inspection. HPV (human papilloma virus) causes genital warts, which is a very common virus, infecting about 1 out of every 4 sexually active people. The warts typically appear on the genitals as soft, pink, painless single or multiple growths resembling a small cauliflower. In men, they may appear on the penis, foreskin, and scrotum, and within the urethra. In women, they may be found on the vulva, in the vagina, and on the cervix. The warts begin to appear 1-3 months after contact and are diagnosed visibly at a health clinic specializing in sexually transmitted infections. They may be removed by freezing, burning, dehydration with an electrical needle, or surgery. Although such treatments may remove the warts, please be aware that they do not rid the body of the virus - so there may be recurrences.

Dr. Caron's Response:

This is a very serious situation. Have you tried to find out why your partner won't be tested? Is it fear? Shame? Denial? Is she/he afraid to know that they may be infected? Are there issues of who gave this disease to who? Is there an issue of faithfulness? Maybe your partner has no symptoms - do they realize some people show no signs when infected? Why is your partner willing to risk being infected (and the potential damage to the reproductive organs) and also willing to risk passing it back to you if you continue to be sexually involved? If your partner won't be tested, how can you continue in a sexual relationship? Why is your partner willing to risk disease and possibly infecting others (you and future partners)? I can only imagine how this has impacted your relationship. While you cannot force your partner to be tested, you can decide if you want to continue to participate in this relationship. You need to seriously think about this relationship and stand firm on your desire to take care of yourself.

Dr. Caron's Response:

Let me start off by saying there are nearly 15 million new cases of STDs each year in the United States and most (two-thirds) of those occurring among those younger than 25. Some researchers have estimated that, among sexually active college students, about one in three will contract an STD by the time they graduate. I also want to point out that the U.S. has the highest rate of STDs in the industrialized world - it is 50 to 100 times higher than other industrialized nations... WHY? Many people point to a lack of prevention efforts (i.e., lack of education about the diseases and low condom use). Not long ago, I heard a person from the Centers for Disease Control speak at a conference on this very issue. They said that an analogy for how the U.S. is dealing with this issue would be that they are screaming "FIRE!" and everyone is just sitting around ignoring them. It is an epidemic. Just think about the estimates of the number of cases: Chlamydia, with 3million new cases a year, is as common as the common cold. Trichomoniasis: 5 million new cases; Gonorrhea: 650,000 new cases; HPV which causes genital warts: 5.5 million new cases a year; Genital herpes: 1 million new cases; Hepatitis B: 100,000new cases a year; and Syphilis: 20,000 new cases a year. I should also point out that HIV is a very real and active problem on college campuses.

I am very concerned that things are only going to get worse before they can get better due to our current administration's "war on condoms" - which is trying to convince people that condoms do not work. Take for example what happened to the Centers for Disease Control website: A fact sheet on condoms was removed and, eventually, replaced by one that emphasized that condoms may not work. How could this happen in America - that such misinformation could be allowed to spread - despite cries from credible health organizations who know that condoms are our best defense against diseases? Until we take our collective heads out of the sand and really take a look at the seriousness of the issue, I don't see much hope for lowering the rates. By the way, such misinformation about condoms will lead to not only an increase in disease, but also an increase in pregnancy. Only when we are willing to educate young people about the seriousness of these infections, and encourage all people who are sexually active to use latex condoms every time, will we see a reduction in the numbers.

Dr. Caron's Response:

Well, first of all, plenty of people get STIs. Each year, there are more reported cases of sexually transmitted infections than the common cold. Basically, anyone having body contact with someone who is already carrying an STI can get one. An estimated 10 to 15 million Americans contract some STI every year. As a group, STIs are the most commonly reported communicable infections in the nation. The statistics on STIs are probably understated for two reasons: (1) Many people don't show symptoms of an infection and go undetected, and (2) many don't seek treatment due to embarrassment and/or fear. But even though the statistics available are limited, they are still alarming because they are evidence of an epidemic no one wants to acknowledge. The current situation in the United States is such that it is as if someone is standing in the middle of the room screaming FIRE, and we are all sitting around pretending everything is fine. Scary.