Condom use promotes regression of cervical intraepithelial neoplasia and clearance of human papillomavirus: A randomized clinical trial

Hogewoning et al.1 reported recently that condom use promotes regression of cervical intraepithelial neoplasia (CIN) lesions and clearance of human papillomavirus (HPV), according to their randomized clinical trial. CIN/cervical cancer is increasingly defined as an infectious disease associated with HPV,2 but under the influence of exogenous/endogenous carcinogenic agents, including tobacco-related carcinogens/mutagens (TRCM).3, 4, 5, 6, 7, 8, 9 Women are exposed to TRCM via their own smoking and inhaling sex partners' passive/environmental tobacco smoke.10, 11 Moreover, exposure of the cervical membrane to TRCM via semen/seminal fluid from smoking sex partners should not be overlooked.12 In the data of Hogewoning et al., smoking rates were lower in condom users than in the control group, and the odds ratio (95% CI) was estimated to be 0.35 (0.11–1.09). This was not statistically significant, however, which seems partly due to a low response rate (46%) and insufficient statistical power. Thus, the authors are requested to examine effects of own and sex partners' smoking, or execute multivariate analysis with adjustment for these parameters. They should at least discuss possible effects of smoking, environmental tobacco smoke and exposure via semen/seminal fluid. Finally, as the authors concluded, it seems plausible that condom use is beneficial not only for prevention of HPV and other infectious agents, including HIV and STD-associated pathogens, but also for blockade of TRCM exposure.5, 8, 12 A diaphragm-type contraceptive therefore may also favor CIN regression, HPV clearance and prevention of cervical cancer. Yours sincerely, Shinkan Tokudome, Sadao Suzuki, Hiromitsu Ichikawa, Akihiro Hosono, Kenji Maeda, Mitsuhiro Marumoto, Kazuyuki Arakawa, Hiroyuki Agawa, Reza Ghadimi