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N-9 not for women at high risk of HIV infection.

Spermicides containing nonoxynol-9 (N-9) increase the risk of HIV infection when used frequently by women at high risk of infection, but they remain a moderately effective contraceptive option for women at low risk of infection, technical experts convened by the World Health Organization (WHO) and the U.S.-based CONRAD Program have concluded. (1)

After reviewing research results about N-9's safety and effectiveness against HIV and other sexually transmitted infections (STIs), the group also agreed that:

* N-9 offers no protection against STIs such as gonorrhea and chlamydial infection.

* Condoms lubricated with N-9 should no longer be promoted because there is no evidence that they are more effective in preventing pregnancy or infection than condoms lubricated with silicone. However, it is better to use a condom lubricated with N-9 than none at all.

* N-9 should not be used rectally. (2)

In May 2002, the U.S. Centers for Disease Control and Prevention (CDC) published similar recommendations, advising family planning providers to inform women at risk of HIV and other STIs that N-9 spermicides do not protect against these infections. (3)

The WHO and CDC recommendations are based, in part, on an analysis of 10 randomized clinical trials of the effectiveness of N-9 against HIV or other STIs, involving almost 5,000 women, that included trials conducted by the Joint United Nations Programme on HIV/AIDS (UNAIDS) and FHI. (4) The analysis, recently published in two parts in the Cochrane Library, confirmed that there was no evidence that N-9 protects against STIs. (The Cochrane Library publishes evidenced-based systematic reviews to provide high-quality information on medical topics.)

Whether N-9 adds contraceptive protection to barrier methods other than condoms is still unknown, although spermicide use with the diaphragm is recommended. Researchers from FHI and Christchurch School of Medicine in New Zealand recently published a Cochrane Review of randomized controlled trials comparing the contraceptive effectiveness, safety, and acceptability of diaphragms with and without spermicide. They were unable to draw any conclusions because they identified only one eligible study, and even that study lacked statistical power. Calling for further research, the review authors wrote that their analysis "provides no evidence to change the commonly recommended practice of using the diaphragm with spermicide." (5)

REFERENCES

(1.) World Health Organization(WHO), CONRAD. Safety of Nonoxynol-9 When Used for Contraception: Report from WHO/CONRAD Technical Consultation, October 2001. Geneva, Switzerland: WHO and CONRAD, 2002. Available: http://www.who.int/reproductive-health/rtis/nonoxymal9.htlm

(2.) World Health Organization.

(3.) U.S. Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2002. MMWR 2002;51(RR-6):1-77. Available: http://www.cdc.gov/mmwr/PDF/RR/RRS106.pdf; Nonoxynol-9 spermicide use--United States 1999. MMWR 2002;51 (18):389-92. Available: http://www.cdc.gov/mmwr/PDF/wk/mm5118.pdf

(4.) Wilkinson D, Ramjee G, Tholandi M, et al. Nonoxynol-9 for preventing vaginal acquisition of HIV infection by women from men (Cochrane Review). In The Cochrane Library, Issue I. Oxford, UK: Update Software, 2003; Wilkinson D, Ramjee G, Tholandi M, et al. Nonoxynol-9 for preventing vaginal acquisition of sexually transmitted infections by women from men (Cochrane Review). In The Cochrane Library, Issue 1. Oxford, UK: Update Software, 2003.

(5.) Cook L, Nanda K, Grimes D. Diaphragm versus diaphragm with spermicides for contraception (Cochrane Review). In The Cochrane Library, Issue 1. Oxford, UK: Update Software, 2003.
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Title Annotation:nonoxynol-9
Author:Shears, Kathleen Henry
Publication:Network
Date:Jun 22, 2003
Words:553
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