Abstract

PIP: The development and marketing of effective topical microbicides would provide women with a way to protect themselves against sexually transmitted diseases (STDs). However, the strong desire among researchers to secure such a method could cause people to accept encouraging results from less than optimal studies. Not all randomized controlled trials (RCT) are well done, and studies of lower quality have been found to exaggerate estimates of treatment effect. Recent data and problems inherent to the process of meta-analysis indicate the need for caution about endorsing the use of nonoxynol-9 (N-9) for STD protection. The 3 better-quality RCTs have compared 3 different N-9 products: a gel, the sponge, and the film. Taken together in a common graphic, the studies have shown N-9 reduces the risks of both gonorrhea and chlamydial infection at relatively low levels of protection. Questions also exist upon how to factor in results from observational studies and which level of protection will induce women to use microbicides. Moreover, studies of barrier methods of contraception or STD prophylaxis are especially susceptible to compliance bias.