Can You Get an STD Even If You Use Barrier Protection?

Introduction

How safe am I from STD with barrier protection?  

This article is written in hope to educate public on safe sex practices, what are the limitation despite barrier protection and how we can mitigate the risk against STDs.

Role of Barrier Protection

Barrier protection such as condoms or dental dams when used appropriately is effective in reducing the transmission of STDs. Barrier options act as a physical screen against infected body fluid, open wounds and sores. This prevents infection from entering to the skin or mucous membrane that is in contact with. They are widely available, low cost and relatively straight forward to be used. Furthermore, barrier protection prevents unwanted pregnancy.

Having said that, barrier protection also has its limitation. It only protects against the area that is being covered. The surrounding genitalia, pubis region can still be exposed. 

Risk of STDs with Barrier Protection

As the name suggested, barrier protection allows a direct coverage/ protection against passing of pathogens between two surfaces. In the context of intercourse, the usage of barrier protection reduces the risk of transmission of pathogens from a person to another. Nonetheless, barrier protection only safeguard against the surface area that it is able to cover. Yet, the surrounding area such as the inner thigh, pubis, scrotum, vulva remains exposed during intercourse. This is where the limitation of barrier protection lies and it is still possible to acquire STDs in the context of using barrier protection

To add things further, barrier protection can fail if the condom slips; condom breaks during intercourse, or inappropriate usage of barrier protection. One of the reasons that condom may fail without one realizing includes use of certain lubricants, concurrent spermicide, chemical/ perfumes or even antibiotic topical that can weaken the material of the barrier protection resulting in inability to prevent infection. 

Types of STDs transmissible even with barrier protection

Sexually related Infections that can be transmitted directly through skin/mucous contact include:

Herpes Simplex Virus (HSV)

This is a very common highly contagious viral infection that presents with intermittent outbreak of painful and itchy blisters and sores over the mucosal region of the mouth, and genital region.  There are two types of HSV: HSV type 1 and HSV type 2. While HSV type 1 is generally associated with mouth cold sores and HSV type 2 is associated with genital cold sores, due to various sexual orientation, the type of HSV no longer exclusively determines the location that is being affected. It is transmitted through direct skin-to-mucous  contact, or contact to affected body fluid. A person becomes infected lifelong once contracted by the virus. Thankfully, there are antiviral medications to manage the outbreaks and reduce the risk of spreading the infection to others.

Human Papillomavirus HPV (Genital Warts)

Genital warts are fleshy growth that can be single or clustered and appear cauliflower-like in the genital and mucosal area. The lesions are due to direct skin-to-skin contact with an infected person with HPV. There are over 150 strains of HPV in the world, with HPV type 6 and 11 responsible to genital warts. Often, many of us are carriers of HPV without any symptoms, yet able to transmit HPV and cause genital warts in others. There is no cure for HPV virus. In some, the virus may clear off overtime spontaneously by innate immune system. If the host immunity is weak, one can have persistent HPV infection. Genital warts can be treated with cream, liquid nitrogen, cauterization or surgical excision. HPV vaccination is effective in age-eligible group in preventing genital warts. 

Syphilis

Syphilis is caused by spirochaetes known as Treponema pallidum. This is a serious health condition due to its long-term health complications. While Syphilis is transmissible through body fluid and blood products, it is also spreadable through direct skin contact of the chancre (sore). Chancre is syphilitic skin lesion that is solitary and painless. One may mistake it as a pimple or an ulcer. It is commonly missed when it appears outside the genital region such as the pubis, groin, outer vulva, the lips or the mouth area. Chancre does resolve on its own, giving a false impression that one has recovered when in actual fact the infection continues in the affected individuals. Untreated syphilis can result in cardiovascular and neurological irreversible comorbidities and is spreadable to other sexual partners and unborn infants. Syphilis is a treatable condition.

Molluscum Contagiosum

Molluscum contagiosum is a viral skin infection that results from poxvirus. While it is not a life-threatening condition, it is highly contagious and spread easily upon skin-to-skin contact. It is characterized by discrete small, elevated firm skin-colored spots with a classical dimpling/ depression at the center of the lesion. It may disappear on its own, but in a person who has weaker immune system, the lesion tends to remain or even spreads to other parts of the body. When the lesions are present, there is a chance of passing the lesion to another person/ sexual contact. Leaving the lesions also increases the risk of scarring to the skin. Treatment for Mollusca include liquid nitrogen, topical cream, or electro cauterization to destroy the virus.

Scabies

This is a concerning skin mite infestation due to transfer and burrowing of Sarcoptes scabiei mite from an infected person via direct skin-to-skin contact. Scabies result in severe skin itch, and is commonly mistaken as other inflammatory skin conditions such as eczema or fungal infection. While direct contact is the main mode of transmission, it can also be passable during sexual intercourse, or sharing of affected cloths and bedding. Scabies can be treated with topical permethrin or malathion. For successful treatment, sexual partner(s) and household members should be treated concurrently as well.

In the event of failed barrier protection, STDs can spread!

Situations where barrier protection fails

• Inappropriate storage of condom: Keeping condom in hot, high temperature and high humidity area may result in degradation of the latex
• Using expired condom: Condom that has expired is likely to have a poorer quality latex/ material, leading to inability to protect one against infection and pregnancy
• Concurrent use of lubricants: Oil-based lubricants can weaken latex condom, resulting in ineffective protection against STD and pregnancy
• Reusing condom: Condoms are generally for single use.  It is unhygienic and may not serve its purpose upon repeat use
• Antibiotic cream: Antibiotic cream and gel such as clindamycin or metronidazole can weaken the rubber in the condom

In such situations, stop intercourse, consider using a new barrier protection if possible. Consider seeking medical attention for additional emergency contraception advice and speak to your doctor on STD checkup.

Role of STD testing

Regular STD testing remains the crux of a good sexual health, even in those who are using barrier protection regularly and correctly. While barrier protection significantly reduces risk of STD, it does not completely eliminate the risk of STDs.

• STD testing is the safety net to screen for infections that are insidious or have minimal symptoms. 
• STD testing allows one to have a peace of mind that one is healthy (or not) and prevent unknowingly passing infection to our partner(s).
• STD testing should also be offered if there is evidence of condom not being used appropriately.

What should I do for STD screening?

There are different STD tests that are available but everybody's risk of exposure to STD differs, it is prudent to speak to your healthcare profession on your medical and social history and allow your doctor to guide you on the tests suitable for you.

At DB Clinic, our doctors provide confidential sexual health consultations and STD screening tailored to individual exposure risks and clinical needs. You may contact our clinic for more information on available sexual health services and testing options.

Salient Take-home message

• Barrier protection when used appropriately is effective in reducing the risk of certain STDs.
• As barrier protection in not foolproof in STDs prevention, regular proactive sexual health checkup remains good practice and acts as an imperative second defense layer in safeguarding a person's reproductive health. Don't let your health chance and do take action now!

References:

1. Marfatia YS, Pandya I, Mehta K. Condoms: Past, present, and future. Indian J Sex Transm Dis AIDS. 2015 Jul-Dec;36(2):133-9. doi: 10.4103/0253-7184.167135.
2. Bosarge, P.M. (2006). Effectiveness of Barrier Methods for Sexually Transmitted Infection Prevention. In: Nelson, A.L., Woodward, J., Wysocki, S. (eds) Sexually Transmitted Diseases. Current Clinical Practice. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-59745-040-9_15
3. d'Oro LC, Parazzini F, Naldi L, La Vecchia C. Barrier methods of contraception, spermicides, and sexually transmitted diseases: a review. Genitourin Med. 1994 Dec;70(6):410-7.
4. Centers for Disease Control and Prevention (CDC). Update: barrier protection against HIV infection and other sexually transmitted diseases. MMWR Morb Mortal Wkly Rep. 1993 Aug 6;42(30):589-91, 597.