WHO Drug Information Vol. 16, No. 2, 2002
(2002; 91 pages) View the PDF document
Table of Contents
Open this folder and view contentsHerbal Medicines
Close this folderCurrent Topics
View the documentMiltefosine registered for visceral leishmaniasis in India
View the documentTetanus vaccine pre-filled injection device
View the documentNonoxinol 9 ineffective in preventing HIV infection
View the documentNew formula oral rehydration salts
View the documentInternational AIDS Society recommendations for antiretroviral treatment: adult HIV infection
Open this folder and view contentsGood Clinical Practices
Open this folder and view contentsSafety Information
Open this folder and view contentsRegulatory Action
Open this folder and view contentsEssential Medicines
Open this folder and view contentsRecent Publications and Sources of Information
View the documentProposed International Nonproprietary Names: List 87

Nonoxinol 9 ineffective in preventing HIV infection

Spermicides containing nonoxynol-9 do not protect against HIV infection and, according to a WHO report, may even increase the risk of HIV infection in women using these products frequently (1). The report also advises women at high risk of HIV infection against using nonoxinol 9 spermicides for contraception.

The report contains the recommendations of a meeting of experts convened by WHO's Department of Reproductive Health and Research and the CONRAD Program based in the Eastern Virginia Medical School, USA. The experts also concluded that spermicides containing nonoxinol 9 do not protect against two other common sexually transmitted infections - cervical gonorrhoea and chlamydia.

Nonoxinol 9 is present in most spermicides on the market today. It has been used over the past half-century in a wide range of spermicidal products -vaginal gels, creams, foams, suppositories, sponges, and films, used alone or with other contraceptive devices, such the diaphragm. While it had been hoped that these products might reduce the risk of sexually transmitted infections, including HIV infection, they have primarily been used as methods of contraception. Estimated numbers of women of reproductive age using spermicides vary from country to country, from less than 1 % in Asia to nearly 17% in some Latin American countries.

In the 1970s and 1980s, laboratory tests showed that nonoxinol 9 could inactivate the organisms that cause gonorrhoea, chlamydial infections, and other sexually transmitted infections, as well as HIV. These findings fuelled hopes that it could be used not only for contraceptive but also for microbicidal purposes. Clinical trials conducted to date do not support these hopes.

On the contrary, two studies mentioned in the report point to an increased risk of sexually transmitted infections, including HIV infection, in women using nonoxinol 9 products. A possible reason, suggested by the findings of other studies, is that nonoxinol 9 can disrupt the epithelium, or wall, of the vagina, thereby potentially facilitating invasion by an infective organism. The frequency of this epithelial disruption seems to depend on the intensity of use of the product - from 18% of women using the product every other day to 53% using it four times a day.

Regarding the use of spermicides for contraception, the report concluded that, when used alone, non-oxinol is only moderately effective for pregnancy prevention but better than no contraceptive method at all. Nonoxinol 9 is sometimes added to male condoms as a lubricant. The experts found no evidence that nonoxinol 9-lubricated condoms provided any more protection against pregnancy or sexually transmitted infections than condoms lubricated with silicone and nonoxinol 9 may cause adverse effects.

Reference: WHO/CONRAD Technical Consultation on Nonoxinol 9 Summary Report of the Meeting held on 9-10 October 2001. http://www.who.int/ reproductive-health/rtis/ index.htm

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