Nonoxynol-9 a No-No?
For years, the widely used spermicide nonoxynol-9 (N-9) has been touted for its potential ability to stop HIV as well as other sexually transmitted diseases. But some reports have suggested the opposite: the spermicide not only fails to prevent HIV, it may actually increase the risk of contracting STDs.

Looking at the issue of protection, Dr. Ronald E. Roddy led a two-year placebo-controlled study of 1297 Cameroonian women that found using N-9 film with condoms didn't safeguard women against HIV, gonorrhea, or chlamydia any better than condoms alone. For that very reason, however, the study doesn't tell us much about the impact of N-9 alone (although here it didn't appear to cause any harm).

Looking at safety, a London team reported in the April 1 issue of Journal of AIDS and Human Retrovirology that N-9 may increase the risk of STD transmission by irritating the epithelium of the genital tract and exposing immune cells to HIV. The team's findings were based on a study comparing 20 women taking 100 milligrams of N-9 a day with 20 women taking a placebo gel.

A similar conclusion was drawn by New York researchers from the Population Council, who found that in the rectums of mice, N-9 failed to protect against herpes simplex virus (HSV-2) and harmed the mice's rectal epithelium, exposing inner connective tissues. In humans, they suggest, pre-treatment with N-9 might increase one's risk of getting an STD. They recommend that "people avoid using nonoxynol-9 during anal sex when there is a risk of STD infection."

Not everyone agrees. While it's true that a small percentage of people may be mildly allergic to N-9, adverse reactions may also be related to the frequency and amount of the spermicide used, say some women's health advocates, who want to retain access to cheap, low-dose N-9 products (creams, jelly, foam, film and suppositories) until we have better options. The Today sponge (no longer on the market), for example, contained 1000 milligrams of N-9 and caused more problems than typical contraceptive products with 100 milligrams or less of N-9. At least one study shows that 100-milligram N-9 suppositories have caused no more mucosal irritation than what was reported by women not taking the product. Trials are now under way with microbicides, such as Advantage-24, that include low-dose nonoxynol-9. Meanwhile, a new spermicide being tested by the Dr. Osmond d'Cruz at the Hughes Institute is 400 times more effective than nonoxynol-9 and 10 times more potent against sperm, based on test-tube studies. Best of all, it also works against HIV and doesn't seem to cause inflammation. Human trials are planned for next year.

-Anne-christine d'Adesky