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spermicide as prevention tool
Apr 21, 2006

Hi Dr Bob. You answered a question from me a few weeks ago (outreach worker in alameda). I have another one.

I was just reading your response to the uncircumcised republican guy. The info you posted at the bottom said -"The proper use of latex and polyurethane condoms -- ideally, in combination with the spermicide nonoxynol-9, which kills all the HIV that is present in the condom -- is the keystone of all programs to prevent the transmission of HIV infection."

I have always told my female clients not to use spermicide because it often causes vaginal irritation for most women, which increases risk for HIV transmission. Is this correct? What should I be telling women? Not to use it at all? Just to put spermicide inside of the condom so it doesn't come in direct contact with them?

Also, does it really "kill all the HIV present in a condom?" I'd love to know. Thanks so much!

Rachelle

Response from Dr. Frascino

Hi Rachelle,

Welcome back to the forum and thank you for pointing out an omission I made when posting that response related to the Republican Guy's condom confusion. I had intended to add a caveat at the end of the proper-use-of-condom statements, reminding folks not to use nonoxynol-9. I "cut and pasted" those two condom-information pieces from articles readily available in the archives on The Body. I did not want to alter the core text, as it had been created by someone else. But I did intend to supplement the text with our newer information related to nonoxynol-9. To remedy that situation, I'll post a question from the archives below that addresses nonoxynol-9 and I'll edit Republican Guy's response to reflect this information as well. Thanks for pointing out my oversight!

Wasn't it a glorious day today in Alameda?!

Stay well.

Dr. Bob

Nonoxynol-9 Harmful, Should Not Be Used in Condoms, Lube

By John S. James

June 28, 2002

On June 25, 2002 the World Health Organization published a 27-page report summarizing what is known about nonoxynol-9 (N-9) -- the failed microbicide that actually increases risk of HIV transmission. They concluded that N-9 should never be used for preventing HIV transmission, has no value in preventing other sexually transmitted diseases, and should never be used rectally, where the problem may be much worse than with vaginal use. (The report acknowledges that women at low risk of HIV infection may use N-9 occasionally as a moderately effective, female-controlled form of birth control, when better means are not available to them.)

Condoms should not include N-9 for any use. However, if the only condom available has N-9, it is better than no condom. On May 10, 2002 the U.S. Centers for Disease Control and Prevention updated its Guidelines for the Treatment of Sexually Transmitted Diseases (PDF), also warning against using N-9 for STD prevention.

Background and Comment

N-9 kills HIV in the laboratory. But it also causes irritation in the vagina or rectum that can allow HIV to infect. A major clinical trial in women, reported two years ago at the International AIDS Conference in Durban, South Africa, studied over 800 sex workers randomly given either an N-9 or placebo gel, and found 48% more new HIV infections among those using N-9.

No one has done such a study with rectal use. But in both humans and animals the irritation is worse, with "sloughing of sheets of epithelium." The damage is later repaired, but by then HIV could have been transmitted.

A recent survey found that about 40% of condoms sold in the U.S. are lubricated with N-9, and about 40% of gay men look for it. Manufacturers of condoms and lube have no incentive to include N-9, except for this mistaken public demand; and all of these manufacturers also market parallel versions of their products without N-9. Now that there is a clear, official consensus that N-9 is harmful, especially for rectal use, it is likely to start disappearing from condoms and lubes.

The community will need to help get the word out, since no one has a commercial incentive to do so, and government agencies are reluctant to speak about anal sex.

References

1. WHO/CONRAD Technical Consultation on Nonoxynol-9, World Health Organization, Geneva 9-10 October 2001, Summary Report. (This is the report published June 25, 2002; the October 2001 meeting brought together experts to examine the evidence and prepare recommendations.)

As we go to press the report is available through www.who.int/reproductive-health/rtis/index.htm and also through: www.conrad.org.

2. "World Health Organization/Conrad Report Warns Against Use of Nonoxynol-9 As Microbicide," press statement issued June 25, available at the Web sites above.

Nonox-9 and "Non-Understanding" Jan 29, 2004

Dr. Bob,

Thanks for a terrific site and such a highly informative forum. I am a "questioning my orientation" male and have experienced insertive anal, and oral sex with me over the last year. I am OCD and hyper-sensitive about HIV, so condoms are used for insertive anal sex. And, up until recently, I thought that would protect me from HIV if used correctly (i.e. condom doesn't fall off, doesn't break).

Well, until I read this article on THE BODY: http://www.thebody.com/kaiser/2004/jan21_04/nonoxynol_9.html Now I'm confused and nervous. In previous posts (and believe me I've checked them all pertaining to this!), you had stated HIV really can't "jump" over the latex barrier in condoms - thus providing effective protection. However, this article seems to suggest nonox-9 DOES transmit HIV somehow. Can you elaborate on this? Are we at risk for catching HIV when using a nonox-9 lubricated condom? How exactly does that risk materialize?

Also, unrelated to above, 2-weeks after having protected insertive anal sex with a guy - I experienced a 100.3-degree fever, sore throat, ear ache, stuffy face and nasea. These all lasted less than 24-hours. Two days before all this, I was playing contact football with a cousin who was just getting over the flu. I did have my flu shot in October. Regarding ARS, I know the "symptoms" sound right but would the duration be longer - or not necesisarily so? I'm a regular HIV tester, doing so 3-mons after each episode.

Thanks for your time.... 9

Response from Dr. Frascino

Hello,

You're welcome. I'm pleased you have found the information helpful. As for your being a "questioning my orientation" kind of guy, well from your post, I'd say that question's been answered!

I do wonder about your statement, "I have experienced insertive anal and oral sex with me over the last year." Gosh, you must be very talented and remarkably flexible!

I haven't had the chance to review the article you reference, but let me give you the scoop on nonoxynol-9. It is true that the spermicide N-9 has been shown to increase the risk of HIV transmission, because it strips away the protective epithelial cells in the anus and vagina. However I think you may be confused about how this finding pertains --or does not pertain -- to your particular situation.

Ironically, N-9 was once touted as an HIV preventive, because initial tests showed it killed the virus. It was added to lubricants and condoms, and marketed as extra protection against HIV. However, subsequent tests involving human subjects showed that it had the opposite effect, because of its damage to the epithelial cells lining the anus and vagina. Please note these studies were done to see if N-9 would be an effective preventative barrier when condoms were not used or if condoms failed. Clearly that is not the case. If the lining of the anus or vagina is inflamed or damaged by N-9 and then comes into contact with HIV-infected ejaculate, HIV transmission becomes more likely. However, if there is no contact with infected ejaculate (condom remains intact), then HIV transmission still cannot occur. Since there is no upside for using N-9 and there is a definite downside, the product should not be used. Recently Durex, one of the top three condom makers, announced it would no longer make condoms lubricated with N-9. That leaves only the manufacturer of Lifestyles and Trojan brands making N-9 condoms. Pressure is being applied to these companies to discontinue N-9. We advise everyone to stop purchasing N-9 condoms and to ask their local pharmacies to remove the products from their shelves. Educating consumers and encouraging activism should speed the entire process along. Bottom line for your bottom since the condoms didn't fail, you should not be at any risk. But from here on "out" (so to speak), use only non-N-9 lubes and lubricated condoms. Buyer beware!

Stay well.

Dr. Bob



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