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OTC spermicides: how helpful in STD prevention?


 Concerns about the potential of nonoxynol-9 to irritate the vaginal mucosa have deterred the US Centers for Disease Control from endorsing use of this product for the prevention of sexually transmitted diseases (STDs), including HIV. To date, no manufacturers of over-the-counter spermicides have applied for product labeling changes. The US Food and Drug Administration recently held a joint committee meeting of four advisory panels aimed at encouraging spermicide manufacturers to submit clinical results pertaining to STD transmission. The committee concluded that, while manufacturers of over-the-counter spermicides may claim short-term protection against chlamydia and gonorrhea, the long-term safety of such products remains unclear. Needed are clinical trials that investigate the effects of spermicide-induced cervical and vaginal irritation on the risk of HIV transmission. The joint committee indicated that studies conducted in STD clinics and with commercial sex workers would be acceptable evidence. The National Institute of Allergy and Infectious Diseases soon will release the findings of a case-control study that used colposcopy to document the extent of epithelial erosion and other lesions associated with low doses of nonoxynol-9. Of continuing concern is the possibility that the labeling of spermicides as effective against STDs will reduce use of condoms, the most effective barrier to HIV transmission.
