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Nonoxynol-9 doesn't work

ANTWERP, Belgium — A contraceptive many hoped would protect against sexually transmitted diseases, including AIDS, offers no such benefits, according to a review of studies on the issue presented Monday.

The first-ever meta-analysis of studies on the protective benefits of nonoxynol-9 against HIV and other sexually transmitted diseases found that the spermicide offered no significant protection against any such infections, said Dr. David Wilkinson, a professor of rural health at the University of South Australia in Adelaide who conducted the analysis.

"Nonoxynol-9 doesn't work. It doesn't prevent HIV," said Wilkinson, one of 650 scientists attending a conference this week on microbicides — gels and creams that many researchers believe could significantly enhance AIDS-prevention efforts.

Researchers had hoped that nonoxynol-9, which is said to increase the effectiveness of condoms but is considered a poor contraceptive when used alone, would be the first effective microbicide against HIV and other sexually transmitted infections.

"The story is over. Nonoxynol-9 is over as a microbicide," Wilkinson said. "That's the bottom line."

The analysis confirmed the results of a widely reported 2000 study that showed that nonoxynol-9, the most commonly used spermicide in the world, offered no protection against HIV. But it differed from that study in one important respect: The 2000 study said that nonoxynol-9 increased the risk of HIV, while the new analysis on all available studies suggested the product doesn't increase risk of HIV infection.

Ward Cates, president of the research organization Family Health International, said the study "is not even the nail in the coffin. This is putting the tombstone in.

"The field has moved far beyond N-9," he added.

Nonoxynol-9, which condom manufacturers say is contained in 45 percent of condoms sold commercially, does increase risk of genital lesions, according to the analysis, which reviewed 27 studies of a total of 5,096 women. Such lesions have been associated with increased risk of AIDS.

The study also found that nonoxynol-9 seemed to increase risk of Trichomonas, parasites that are frequently sexually transmitted, and of bacterial vaginosis, a common vaginal infection.

"The data on genital ulcerations is worrying," Wilkinson said. "That we see increased genital ulcerations is not good news, but it doesn't seem to increase risk" of HIV.

But Wilkinson added that because most of the women in the studies were commercial sex workers who used nonoxynol-9 multiple times daily, the risk of lesions was likely much lower for women who use it twice a day or less often.

The implications of the analysis on use of nonoxynol-9 for contraceptive purposes are unclear, but within the next few weeks the World Health Organization will issue recommendations on the topic, said Timothy Farley, who is coordinating the agency's response.

Wilkinson implied that health officials are concerned about nonoxynol-9's effectiveness as a contraceptive.

"As for pregnancy, it doesn't do a whole lot against that, either," Wilkinson said.