title: Female genital tract secretions and semen impact the development of microbicides for the prevention of HIV and other sexually transmitted infections.
abstract: Pharmacologic strategies for the prevention of HIV include vaccines, post-exposure prophylaxis with antiretroviral therapy, and topical microbicides. Vaginal microbicides have the potential to augment innate defenses in the genital tract but may also disrupt endogenous protection and increase HIV acquisition risk, as observed in clinical trials of nonoxynol-9. The initially disappointing results of microbicide clinical trials stimulated the development of more sensitive and comprehensive pre-clinical safety studies, which include dual-chamber culture systems to model the epithelial barrier and post-coital studies to evaluate the effects of semen and sexual intercourse on microbicide efficacy. This review discusses the key factors that contribute to a healthy female genital tract environment, the impact of semen on mucosal defense, and how our understanding of these mediators informs the development of effective vaginal microbicides.
authors.affiliation: Department of Pediatrics, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10467, USA. betsy.herold@einstein.yu.edu
authors.forename: Betsy C
authors.initials: BC
authors.lastname: Herold
authors.forename: Pedro M
authors.initials: PM
authors.lastname: Mesquita
authors.forename: Rebecca P
authors.initials: RP
authors.lastname: Madan
authors.forename: Marla J
authors.initials: MJ
authors.lastname: Keller
mesh_terms: D000891:Anti-Infective Agents, Local / Q000494:pharmacology* / Q000627:therapeutic use; D005260:Female; D005836:Genitalia, Female / Q000378:metabolism*; D015658:HIV Infections / Q000276:immunology / Q000517:prevention & control*; D006801:Humans; D018928:Immunity, Mucosal; D017137:Nonoxynol / Q000494:pharmacology / Q000627:therapeutic use; D012661:Semen; D012749:Sexually Transmitted Diseases / Q000276:immunology / Q000517:prevention & control*
chemical_list: D000891:Anti-Infective Agents, Local; D017137:Nonoxynol