| The following is a chronological bibliography of key studies on nonoxynol-9 (N-9) and prevention of sexually transmitted diseases (STDs). In all prospective studies where volunteer participants were at risk of HIV, participants were encouraged to use latex condoms consistently and correctly, the best protection for people at risk of STDs, and they were counseled about STD risks and ways to reduce their risks. Participants were frequently examined for STDs and were treated. | |
| Zekeng L, Feldblum PJ, Oliver RM, Kaptue L. Barrier contraceptive use and HIV infection among high-risk women in Cameroon. AIDS 1993; 7(5):725-31.
An observational study conducted among 273 female sex workers in Cameroon concluded that women who used N-9 or latex condoms consistently had a significant reduction in HIV infection rates -- the first time a study had reported epidemiological evidence that N-9 may protect against HIV. Half of the women reported using condoms for 63 percent or more of sexual acts, while half reported using spermicide for at least 67 percent of coital acts. Volunteer participants were advised to use non-spermicidal male lubricated condoms and a vaginal suppository containing 100 mg of N-9 each time they had sexual intercourse. The study, which lasted 12 months, was conducted by the National AIDS Control Service in Yaoundé and Family Health International. A later analysis of this data concluded that use of vaginal N-9 suppositories did not increase the incidence of genital ulcers. Previous research had suggested that frequent N-9 use can lead to genital irritation and ulceration. Ulcers could be a possible risk factor for HIV. (Weir SS, Roddy RE, Zekeng L, Feldblum PJ. Nonoxynol-9 use, genital ulcers, and HIV infection in a cohort of sex workers. Genitourin Med 1995; 71:78-81). Another examination of the data set concluded that male latex condoms offered significant protection against gonorrhea. (Weir SS, Feldblum PJ, Zekeng L, Roddy RE. The use of nonoxynol-9 for protection against cervical gonorrhea. Am J Public Health 1994; 84(6):910-14.) Feldblum PJ, Weir SS. The protective effect of nonoxynol-9 against HIV infection (letter). Am J Public Health 1994; 84(6):1032-34. Reanalysis of data collected among sex workers in Cameroon reaffirmed findings from the original observational study that N-9 use may offer some protection against HIV. The reanalysis, conducted by FHI, found that the more consistent the use of N-9, the lower HIV rates were. Researchers also found that the rate of HIV infection decreased as condom use increased. Kreiss J, Ngugi E, Holmes K, Ndinya-Achola J, Waiyaki P, Roberts PL, Ruminjo I, Sajabi R, Kimata J, Fleming TR, Anzala A, Holton D, Plummer F. Efficacy of nonoxynol 9 contraceptive sponge use in preventing heterosexual acquisition of HIV in Nairobi prostitutes. JAMA 1992; 268(4):477-82. A randomized controlled trial of N-9 contraceptive sponge use among sex workers in Nairobi, Kenya concluded that the N-9 sponge did not appear to protect against HIV. Women who used the N-9 sponge had a three-fold increase in incidence of genital ulcers, which has been considered a risk factor for acquisition of HIV, and a higher risk of vulvitis. However, N-9 users had a 60 percent reduced risk of gonorrhea, said the study's researchers from the University of Washington at Seattle, University of Nairobi, University of Manitoba, and Kenya Medical Research Institute. Seventy-four women were randomly assigned to use the N-9 polyurethane sponge. Women were asked to insert the sponge each day before having sex, to use one sponge for two to three sex partners, and to remove the last sponge six hours after last sexual intercourse. Sixty-four women were told to insert a placebo gylcerine vaginal suppository (later a water-based vaginal cream) once daily before intercourse with their first sex partner of the day. Niruthisard S, Roddy RE, Chutivongse S. Use of nonoxynol-9 and reduction in rate of gonococcal and chlamydial cervical infections. Lancet 1992; 339:1371-75. The effects of N-9 in preventing chlamydia and gonorrhea were examined in this 1990 randomized controlled trial, which was conducted in Bangkok, Thailand by FHI and Chulalongkorn University. Researchers compared infection rates among 186 women who used N-9 film and condoms with 157 women who used condoms and a placebo film. Volunteer participants were women who worked at massage parlors and had an average of two to three sexual partners per day. Researchers found that, overall, use of N-9 decreased the rate of gonococcal and chlamydial cervical infection by 25 percent. For women who used N-9 for more than 75 percent of sexual acts, the rate of infection declined by 40 percent. For women who used N-9 for fewer sexual acts, N-9 appeared to offer little protection from cervical infection. Condoms offered greater protection against gonorrhea and chlamydia than did N-9 alone. There was no difference in the development of genital ulcers or vaginal yeast infections in either group. N-9 users complained more frequently about genital irritation, including burning, itching, and soreness, although symptoms were not considered severe.
Women who used the N-9 sponge had lower rates of chlamydia (29 percent of sponge users and 51 percent of nonusers after seven weeks) and the incidence of gonorrhea was also lower among sponge users (8 percent in the N-9 group compared with 40 percent in the control group) in a randomized controlled trial in Bangkok, Thailand among 492 sex workers from massage parlors. Sponge users had a higher incidence of candidiasis than nonusers (12 percent versus 4 percent, respectively). Half of the volunteer participants were assigned to use the N-9 sponge while 246 were assigned to the control group. Women were asked to continue their regular family planning method, in most cases oral or injectable contraceptives, and encouraged to use condoms. The study was conducted by FHI and the Thai Ministry of Public Health. Louv WC, Austin H, Alexander WJ, Stagno S, Cheeks J. A clinical trial of nonoxynol-9 for preventing gonococcal and chlamydial infections. J Infect Dis 1988; 158:518-23. In this randomized controlled study of 818 women, researchers from the University of Alabama at Birmingham and Jefferson County Department of Health, Birmingham, evaluated the ability of N-9 to prevent gonorrhea and chlamydia. Study participants were clients at clinics that treat sexually transmitted diseases. One group of participants was asked to use a commercially available spermicide gel containing N-9, while the control group was asked to use a placebo. After six months, researchers concluded that women who used N-9 were less likely to develop gonorrhea or chlamydia than women in the placebo group. The more consistent was the N-9 use, the lower were the rates of cervical infection. A second study, published in the American Journal of Obstetrics and Gynecology in August 1990, evaluated spermicide use among the same group of women and found that women who used N-9 had a lower incidence of trichomoniasis and bacterial vaginosis than did women in a placebo group. There was no difference in the incidence of candidiasis. Kelaghan J, Rubin GL, Ory HW, Layde PM. Barrier-method contraceptives and pelvic inflammatory disease. JAMA 1982; 248(2):184-87. Researchers at the U.S. Centers for Disease Control and Prevention found that women who used barrier contraceptives (condoms, N-9 spermicides, diaphragms with N-9 spermicide) were less likely to develop pelvic inflammatory disease (PID) than women who used other contraceptives or no contraceptives. PID is a serious illness for women and can lead to infertility or death. Researchers analyzed the data from the Women's Health Study, a large multicenter case-controlled study conducted in the United States from 1976 to 1978. Researchers compared the contraceptive methods used by 645 women hospitalized for PID with the methods used by 2,509 women with no history of PID. Further reading Centers for Disease Control and Prevention. Update: barrier protection against HIV infection and other sexually transmitted diseases. MMWR 1993; 42(3): 589-91, 597. This paper summaries several scientific studies that have concluded that male latex condoms can effectively protect against HIV transmission. For couples who are serodiscordant (one is HIV-positive and the other is HIV-negative), using latex condoms consistently and correctly reduced the risk of HIV transmission. Latex condoms reduced the risk of gonorrhea, herpes simplex, genital ulcers and pelvic inflammatory disease. Latex condoms also provided a physical barrier against transmission of hepatitis B, chlamydia and gonorrhea. Feldblum PJ, Morrison CS, Roddy RE, Cates W Jr. The effectiveness of barrier methods of contraception in preventing the spread of HIV. AIDS 1995;(Suppl A): S85-S93. This article gives an overview of research on chemical and physical barrier methods and their ability to prevent sexually transmitted diseases, including in vitro and in vivo data on male condom use and spermicide use and information on irritation, consistency of use, and future research needs. Elias CJ, Coggins C, Atisook R, Bassett MT, Ettiegne-Traore V, Ghys PD, Jenkins-Woelk L, Thongkrajai E, VanDevanter NL. Women's Preferences Regarding the Formulation of the Over-the-Counter Vaginal Spermicides. Presentation at the XI International Conference on AIDS. July 7-12, 1996. Vancouver, Canada. A survey of 138 women in Cote d'Ivoire, Thailand, United States and Zimbabwe on their preferences for spermicide formulations (gel, suppository, film) found that women's preferences were influenced by such factors as lubricant or drying effect, effects on sexual pleasure and frequency of use. |
