Use of nonoxynol-9 and changes in vaginal lactobacilli.
Several in vitro studies have shown nonoxynol-9 (N-9) to be toxic to lactobacilli, especially to strains that produce H2O2. Data from a randomized, double-blind, placebo-controlled crossover trial that investigated the safety and toxicity of 2 weeks of daily vaginal application of an N-9 gel were analyzed, to examine the effect of N-9 use on vaginal lactobacilli and bacterial vaginosis. In vivo, N-9 promoted sustained colonization by H2O2-producing lactobacilli among women already colonized (relative risk [RR], 1.8; 95% confidence interval [CI], 1.2-2.7). In addition, use of N-9 for 2 weeks reduced the likelihood of bacterial vaginosis (RR, 0.5; 95% CI, 0.3-1.0). In contrast, N-9 use by women initially colonized only by non-H2O2-producing lactobacilli resulted in loss of vaginal lactobacilli (RR, 2.5; 95% CI, 1.2-5.3). These data suggest that daily use of N-9 does not adversely affect vaginal colonization by H2O2-producing lactobacilli but that such use may promote loss of non-H2O2-producing strains.
Department of Biostatistics, University of Washington, Seattle 98104-2499, USA. barbrar@u.washington.edu
B A
BA
Richardson
H L
HL
Martin
C E
CE
Stevens
S L
SL
Hillier
A K
AK
Mwatha
B H
BH
Chohan
P M
PM
Nyange
K
K
Mandaliya
J
J
Ndinya-Achola
J K
JK
Kreiss
D000328:Adult; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D018592:Cross-Over Studies; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology; D006801:Humans; D007778:Lactobacillus / Q000187:drug effects* / Q000254:growth & development / Q000302:isolation & purification; D008875:Middle Aged; D017137:Nonoxynol / Q000009:adverse effects / Q000627:therapeutic use*; D013501:Surface-Active Agents / Q000627:therapeutic use; D014621:Vagina / Q000382:microbiology*; D014622:Vaginal Creams, Foams, and Jellies / Q000009:adverse effects / Q000627:therapeutic use*; D016585:Vaginosis, Bacterial / Q000188:drug therapy* / Q000382:microbiology
D000900:Anti-Bacterial Agents; D013501:Surface-Active Agents; D014622:Vaginal Creams, Foams, and Jellies; D017137:Nonoxynol