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Recommendations for Contraceptive Use |
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Barrier Methods |
Q.3. Do spermicides protect one
against: a) pregnancy? b) HIV/AIDS? c) other STDs?
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| a) Against pregnancy? Yes. Spermicides can be fairly protective for pregnancy prevention
as long as they are used correctly and consistently. However, with typical use,
spermicides provide much less protection against pregnancy than with perfect use. |
a) The failure rates of
spermicides in the first year of use range from 6% with perfect use to 21% with typical
use. These rates are similar to those for the diaphragm and female condom.
- Trussell J, Kost K. Contraceptive
failure in the United States: a critical review of the literature. Studies in Family
Planning 1987;18(5):237-83.
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| b) Against HIV/AIDS? Possibly. Spermicides are not generally recommended for human
immunodeficiency virus (HIV) prevention.
However, for sexually active women who cannot use male or
female condoms, a spermicide product may be preferable to unprotected intercourse, unless
there are multiple acts of intercourse per day. |
b) Little research has been done
on spermicide use and HIV risk, and the findings of the only two published studies
conflict. In one study, nonoxynol-9 (N-9) contraceptive sponge users had a higher
incidence of HIV infection. In the second study, N-9 suppository users had a lower
incidence of HIV. Until large randomized studies currently under way can resolve the
controversy, spermicide alone cannot currently be recommended for HIV prevention. Theoretically, spermicides may reduce the incidence of HIV
indirectly by preventing bacterial STD co-factors. Spermicides have also been shown to
have direct effects on HIV in vitro.
- Kreiss J, Ngugi E, Holmes K,
Ndinya-Achola J, Waiyaki P, Roberts PL, et al. Efficacy of nonoxynol-9 contraceptive
sponge use in preventing heterosexual acquisition of HIV in Nairobi prostitutes. Journal
of the American Medical Association 1992;268:477-82.
- Zekeng L, Feldblum PJ, Godwin SE,
Oliver RM, Kaptue L. HIV infection and barrier contraceptive use among high-risk women in
Cameroon. AIDS 1993;7:725-31.
- Feldblum PJ, Weir SS. The protective
effect of nonoxynol-9 against HIV infection (letter). American Journal of Public Health
1994;84:1032-4.
- Centers for Disease Control. Update:
barrier protection against HIV infection and other sexually transmitted diseases. MMWR
1993;42:589-91 and 597.
- Feldblum PJ, Morrison CS, Roddy RE,
Cates W Jr. The effectiveness of barrier methods of contraception in preventing the spread
of HIV. AIDS 1995;9(Suppl A):S85-S93.
- Jennings R, Clegg A. The inhibitory
effect of spermicidal agents on replication of HSV-2 and HIV-1 in vitro. Journal of
Antimicrobial Chemotherapy 1993;32:71-82.
The highest risk of sexually acquired HIV infection is
associated with unprotected intercourse. Women need methods to protect themselves against
HIV and other STDs, even if protection is only partial.
- Rosenberg MJ, Gollub EL. Methods women
can use that may prevent sexually transmitted disease, including HIV (commentary).
American Journal of Public Health 1992;82:1473-8.
- Elias CJ, Heise LL. Challenges for the
development of female-controlled vaginal microbicides. AIDS 1994;8:1-9.
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| c) Against other STDs? Yes, spermicides are modestly protective against cervical gonorrhea
and chlamydia, compared to users of no method. While the level of protection may not be
great, it may offer some protection that women can themselves control.
The effectiveness of any coital-dependent method (i.e.,
one that must be applied at or around the time of intercourse) depends on the consistency
and correctness of use. For these methods, acceptability and compliance are as important,
if not more so, as their effectiveness during perfect use. Even if a female method is less
efficacious than the male condom during perfect use, it may have a greater impact on
disease rates if it is used more consistently. Consistent condom with spermicide use may
be more effective. |
c) Spermicides have been shown
to provide protection against some bacterial STDs. Studies with different kinds of
participants and different study designs have consistently demonstrated that spermicide
use reduces the number of new gonorrheal and chlamydial infections. One study found an
overall reduction in gonorrhea of about 50% in nonoxynol-9 users, but that figure includes
both consistent and correct users as well as inconsistent users. A greater reduction was
found in the most consistent users of the spermicide. Another study found a 25% reduction
overall in nonoxynol-9 users. In studies that have compared bacterial STD risk among women
relying on male condoms to those using a spermicidal method, the risks were about the same
for infections. Most likely, the spermicides were used more consistently than were male
condoms.
- Niruthisard S, Roddy RE, Chutivongse
S. Use of nonoxynol-9 and reduction in rate of gonococcal and chlamydial cervical
infections. Lancet 1992;339:1371-5.
- Weir SS, Feldblum PJ, Zekeng L, Roddy
RE. The use of nonoxynol-9 for protection against cervical gonorrhea. American Journal of
Public Health 1994;84:910-4.
- Louv W, Austin H, Alexander W, Stagno
S, Cheeks J. A clinical trial of nonoxynol-9 for preventing gonococcal and chlamydial
infections. The Journal of Infectious Diseases 1988;158(3):518-22.
- Rosenberg M, Rojanapithayakorn W,
Feldblum P, Higgins J. Effect of the contraceptive sponge on chlamydial infection,
gonorrhea, and candidiasis: a comparative clinical trial. Journal of the American Medical
Association 1987;257:2308-12.
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