Hogewoning, C., Bleeker, M., van den Brule, A. et al. . Condom use promotes regression of cervical intraepithelial neoplasia and clearance of human papillomavirus: a randomized clinical trial

Canadian Journal of Human Sexuality, The, Spring, 2003 by Alexander McKay

International Journal of Cancer, 107, 811-816.

Human papillomavirus (HPV) is among the most common sexually transmitted infections and women with persistent infections with certain types of HPV are at increased risk for cervical intraepithelial neoplasia (CIN), a precursor to the development of cervical cancer. Studies addressing the effectiveness of condom use in preventing HPV infection and HPV-related conditions have yielded inconsistent results. It has been suggested that continuous re-infection from one partner to another within a couple relationship may reduce the likelihood of each partner clearing the virus. To the extent that condom use potentially prevents transmission of HPV, particularly from males to females, it may play a role in preventing the development of CIN in women. The Hogewoning et al study was designed specifically to evaluate the effects of condom use on CIN regression and HPV clearance.

The study participants were women referred to a colposcopy clinic in the Netherlands between January 1995 and June 2002. Women were eligible for the study if they had an exclusive male sexual partner and had an abnormal cervical smear and/or CIN. Subjects were excluded from the study if they received surgical treatment for their cervical lesion or if they were regular condom users at baseline. The couples were randomly assigned to use condoms (n = 72) or to not use condoms (n = 76). Colposcopic and cervical smears were taken after 3, 6, and 12 months and subsequently every 6 months. For the condom group, the use of condoms was verbally verified at each visit.

The 2-year cumulative regression rate for CIN was 53% in the condom group verses 35% in the noncondom group and the 2-year rates of HPV clearance was 23% in the condom group verses 4% in the noncondom group. There was no significant relationship between age and HPV clearance. For women who were still HPV positive after 6 months, there were no differences in HPV clearance rates among those who used condoms longer than 6 months compared to those who used condoms for less than 6 months.

The authors suggest that a possible explanation for their findings is that condoms may interfere with the continuous transmission of HPV between partners. As a result, the HPV viral load may remain under a certain critical threshold, allowing the immune system to eliminate the virus. In conclusion, Hogewoning et al., note that although their study was relatively small,

   ... it demonstrates that intervention with
   condom use for at least 3 months can
   promote CIN regression and HPV
   clearance. Our results imply that condom use
   should be considered as an alternative
   strategy in the management of women with
   CIN and that the need for aggressive
   treatments may be reduced. Condom use
   should also be advised in pregnant women
   with CIN, in whom treatment is difficult.
   Whether condom use might be helpful in
   decreasing the number of latent HPV
   infections in HPV-positive cytologically
   normal women is currently under
   investigation (p. 816).