What's up with nonoxynol-9?

Abstract

Advantage-S, a spermicide containing nonoxynol-9 (N-9), has recently been shown in a randomised, controlled trial sponsored by UNAIDS not to offer women protection against sexual transmission of HIV. The women in the trial, all sex workers, reported having an average of 3.6 partners per day and about 70 coital acts per month during the study period. At the end of the trial, the Advantage-S group was found to have a higher incidence of new HIV infections than the control group, who were using a vaginal lubricant. Two other recent studies have found that low dose N-9 products do not provide protection against bacterial STDs such as gonorrhoea and chlamydia--a finding that contradicts earlier wisdom based on less rigorous studies. Contrary to certain media headlines, however, the results of these trials do not suggest that effective microbicides cannot be developed, only that Advantage-S, which was developed as a spermicide and not as a microbicide, is probably not one of them. The failure of Advantage-S to show protection in the UNAIDS-sponsored trial underscores the urgent need to accelerate research to develop a safe and effective topical microbicide.

Surface Area of the Human Vagina as Measured from Vinyl Polysiloxane Casts

“…Conceivably a large quantity of protectant placed directly under the cervix may suffice, assuming that all microbes and viruses are killed on contact or damaged, so that they are unable to move into unprotected areas. Another consideration is the irritability of the protectant; if an irritable agent such as nonoxynol-9 [5,6] is dispersed to cover the entire vaginal surface, logically the rate of infection might be increased.…”

Imaginings of Empowerment and the Biomedical Production of Bodies

“…Diff erent trial designs were used, not all of the trials were randomised controlled clinical trials, the amount of Nonoxynol-9 diff ered from compound to compound (as much as from 50 mg to 1000 mg) and the suppositories diff ered, as some tested rings, some foams, some fi lms etc. (Martin et al, 1997;Van Damme et al, 2002;Forbes and Heise, 2000). Furthermore, the data produced by the safety trials as well as the effi cacy trials was confl ictual and is still incredibly diffi cult to compare.…”

“…Rather, the GCM's point of focus was the extent to which the trial was harmful to women. As such, Heise and Forbes (2000) published an article in Reproductive Health Matters entitled What's Up With Nonoxynol-9? and the GCM website devoted a page to Nonoxynol-9 in which they disseminated information.…”

“…and the GCM website devoted a page to Nonoxynol-9 in which they disseminated information. Both the GCM website and the article by Heise and Forbes (2000) situate the difficulty of the trial results within a larger HIV epidemic. Specifically, they make a statement that the RCT in itself does not increase women's risk:…”

“…The challenges associated with designing ethical prevention trials are complex, given the fact that some seroconversion among participants is likely to occur despite condom promotion and other safeguards. But they are not insoluble (GCM, 2010c;Forbes and Heise, 2000).…”