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Meta-Analysis
. 2002;2002(4):CD003939.
doi: 10.1002/14651858.CD003939.

Nonoxynol-9 for preventing vaginal acquisition of sexually transmitted infections by women from men

D Wilkinson  1 , G Ramjee, M Tholandi, G Rutherford
Affiliations
Meta-Analysis

Nonoxynol-9 for preventing vaginal acquisition of sexually transmitted infections by women from men

D Wilkinson et al. Cochrane Database Syst Rev. 2002.

Abstract

Background: The incidence and prevalence of sexually transmitted infections (STI) and other reproductive tract infections (RTI) is high in much of the developing and parts of the developed worlds. STIs and RTIs are associated with the vaginal transmission of HIV. Additional strategies to improve STI control are needed, and vaginal microbicides are a possible strategy. One potential vaginal microbicide is the widely used spermicide, nonoxynol-9 (N-9).

Objectives: To determine the safety and effectiveness of N-9 in preventing vaginal acquisition of sexual transmitted infections (exclusive of HIV) by women from men.

Search strategy: Systematic search of electronic databases, conference abstracts, reference lists of relevant studies and contact with experts and funders.

Selection criteria: Randomised controlled trials meeting pre-determined quality criteria with STI as the outcome.

Data collection and analysis: Data were extracted by one reviewer and checked by another.

Main results: Ten of 12 identified randomised controlled trials were included and findings among them were broadly consistent. In meta-analysis, the risks of gonorrhoea (relative risk [RR] 0.91, 95%CI 0.67-1.24), cervical infection (RR 1.01, 0.84-1.22), trichomoniasis (RR 0.84, 0.69-1.02), bacterial vaginosis (0.88, 0.74-1.04), chlamydia (RR 0.88, 0.77-1.01) and candidiasis (RR 0.97, 0.84-1.12) were not statistically significantly different in women receiving N-9 compared with placebo. Genital lesions were more common in the N-9 users (RR 1.17, 95%CI 1.02-1.35).

Reviewer's conclusions: There is good evidence that nonoxynol-9 does not protect against sexually transmitted infections, and there is some evidence that it may be harmful by increasing the rate of genital ulceration. As such, this product cannot be recommended for STI prevention.

PubMed Disclaimer

Conflict of interest statement

Gita Ramjee was an investigator in one of the trials cited.

Figures

1.1
1.1. Analysis
Comparison 1 N‐9 vs placebo, Outcome 1 Gonorrhoea.
1.2
1.2. Analysis
Comparison 1 N‐9 vs placebo, Outcome 2 Chlamydia.
1.3
1.3. Analysis
Comparison 1 N‐9 vs placebo, Outcome 3 Cervical infection.
1.4
1.4. Analysis
Comparison 1 N‐9 vs placebo, Outcome 4 Trichomoniasis.
1.5
1.5. Analysis
Comparison 1 N‐9 vs placebo, Outcome 5 Bacterial vaginosis.
1.6
1.6. Analysis
Comparison 1 N‐9 vs placebo, Outcome 6 Candidiasis.
1.7
1.7. Analysis
Comparison 1 N‐9 vs placebo, Outcome 7 Genital lesions.
See this image and copyright information in PMC

References

References to studies included in this review

Barbone 1990 {published data only}
    1. Barbone F, Austin H, Louv WC, Alexander WJ. A follow‐up study of methods of contraception, sexual activity, and rates of trichomoniasis, candidiasis, and bacterial vaginosis. American Journal of Obstetrics and Gynaecology 1990;163(2):51‐514. - PubMed
Kreiss 1992 {published data only}
    1. Kreiss J, Ngugi E, Holmes KK, Ndinya‐Achola J, Waiyaki P, Roberts PL, Ruminjo I, Sajabi R, Kimata J, Fleming TR, Anzala A, Holton D, Plummer F. Efficacy of nonoxynol‐9 contraceptive sponge use in preventing heterosexual acquisition of HIV in Nairobi prostitutes. JAMA 1992;268(4):477‐482. - PubMed
Louv 1988 {published data only}
    1. Louv WC, Austin H, Alexander WJ, Stagno S, Cheeks J. A clinical trial of nonoxynol‐9 for preventing gonococcal and chlamydial infection. Journal of Infectious Diseases 1988;158(3):518‐523. - PubMed
Niruthisard 1992 {published data only}
    1. Niruthisard S, Roddy RE, Chutivongse S. Use of nonoxynol‐9 and reduction in rate of gonococcal and chlamydial cervical infections. Lancet 1992;339(8806):1371‐1375. - PubMed
Rendon 1980 {published data only}
    1. Rendon AL, Covarrubias J, McCarney KE, Marion‐Landais G, Luna del Villar J. A controlled comparative study of phenylmercuric acetate, nonoxynol‐9 and placebo vaginal suppositories as prophylactic agents against gonorrhoea. Current Therapeutic Research 1980;27:780‐783.
Roddy 1998 {published data only}
    1. Roddy RE, Zekeng L, Ryan KA, Tamoufe U, Weir SS, Wong EL. A controlled trial of nonoxynol‐9 film to reduce male to female transmission of sexualy transmitted diseases. New England Journal of Medicine 1998;339(8):504‐510. - PubMed
Roddy 2001 {published data only}
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Rosenberg 1987 {published data only}
    1. Rosenberg MJ, Rojanapithayakorn W, Feldblum PJ, Higgins JE. Effect of the contraceptive sponge onchlamydial infection, gonorrhoea, and candidiasis. A comparative clinical trial. JAMA 1987;257(17):780‐783. - PubMed
Van Damme 2001 {published data only}
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References to studies excluded from this review

Cutler 1977 {published data only}
    1. Cutler JC, Singh B, Carpenter U, Nickens O, Scarola A, Sussman N, Wade M, Volkin L, Marsico A, Balinsky H. Vaginal contraceptives as prophylaxis against gonorrhoea and other sexually transmissible diseases. Advanced Planned Parenthood 1977;12:45‐56.
Sacks 1990 {published data only}
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Additional references

Cook 1998
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WHO 1995
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