Condom use has seen a reckless decline, despite a rising epidemic of sexually transmitted infections (STIs) and decreasing reproductive rights in the United States. Public health officials recently issued a warning about a syphilis outbreak in Houston, with cases increasing by 57% from 2019 to 2022. This outbreak mirrors the national trend of rising STIs such as chlamydia, gonorrhea, and syphilis. In 2021 alone, over 2.5 million cases of these infections were reported.
Dr. Allen Ghareeb, a maternal-fetal medicine fellow, attributes the increase in STIs to several factors. The COVID-19 pandemic deterred people from seeking routine care, including sexual and reproductive health check-ups. Since many STIs can be asymptomatic, the lack of routine check-ups worsened the situation. Additionally, the stigma and shame associated with getting tested or having an STI further contributed to the rise in infections.
Surprisingly, condom use has also declined, despite the increasing STI rates and regressing reproductive rights. Dr. Ghareeb expressed concern about this trend, stating, “Over the last couple of years, obviously, a lot of the attention in reproductive health care has been diverted to other issues, but I think we need to refocus some efforts on those safe sex practices.” A survey conducted by the Department of Health and Human Services revealed that men’s condom use declined from 75% in 2011 to 42% in 2021.
Gigi Engle, a certified sex educator, believes there are multiple reasons behind the decline in condom use. Inadequate sex education in schools, particularly in states with abortion bans, may be a contributing factor. The Guttmacher Institute found that adolescents between 2015 and 2019 were less likely to receive comprehensive sex education compared to their counterparts in 1995. There is also a pervasive myth that condoms reduce sensation for cis-men, leading them to pressure their partners to forgo condom use. Other contraceptive options, such as intrauterine devices and oral contraceptives, may also be responsible for the decline.
The rise of pre-exposure prophylaxis (PrEP) for HIV prevention among men who have sex with men could also be to blame for the decrease in condom use. While PrEP reduces the risk of HIV transmission, it does not protect against other STIs. Despite the availability and effectiveness of PrEP, it is crucial to remember that it does not provide complete protection.
Various social and economic conditions, such as poverty, stigma, lack of medical insurance, unstable housing, and limited access to free condoms, make it challenging for individuals to protect themselves from STIs.
Condoms have a long history as a barrier method to prevent STIs. Dating back to the 17th century, condoms were made from animal guts and were used to prevent infections. Later, during the mid-1800s, condoms made from rubber became the most common form of birth control. However, their popularity declined with the introduction of the combined oral contraceptive pill and made a comeback during the HIV and AIDS crisis.
The rise in STIs, especially syphilis, among heterosexual couples is concerning due to the potential grave consequences on fertility and pregnancy. STIs like chlamydia and gonorrhea, which often go unnoticed due to lack of symptoms, can lead to infertility and other complications. Newer STIs, such as MGen, as well as antibiotic-resistant infections, are also on the rise.
The decline in condom use amidst an STI epidemic and decreasing reproductive rights is alarming. It highlights the need for comprehensive sex education, access to affordable contraception, and destigmatizing discussions surrounding sexual health. Preventing the spread of STIs is crucial for individual and public health, and efforts should be made to promote safe sex practices.