The value and efficacy of using nonoxynol-9 (N-9) containing products to help prevent HIV infection has been under discussion for some years. Nonoxynol-9 kills HIV and other STD germs in a test tube. However, studies with female sex industry workers have indicated that nonoxynol-9 may hurt vaginal tissue and might actually provide easier entry for HIV.

New data from the 2000 International AIDS Conference confirms that nonoxynol-9 used frequently and in high concentrations will cause inflammation and sores and seems to facilitate HIV infection.

• Public Health - Seattle & King County does not recommend N-9 use for prevention of HIV infection or other STDs.
• Public Health - Seattle & King County will no longer purchase condoms that have N-9 containing lubricants. Public Health does recommend the use of water-based lubricants without N-9 for use with condoms to help reduce the risk of breakage. 
• Using a condom (even if it contains N-9 lubricant) is much safer than unprotected sex. Condoms containing lubricants with N-9 are thought to pose little risk of tissue damage due to the low amounts of lubricant on the condom, unless they are used several times a day. 
• People who experience any sensitivity or allergy to N-9 should clearly avoid its use.
• Products containing N-9 used according to the manufacturer’s directions can be an effective contraceptive for people who do not need protection multiple times each day. Some Public Health programs will continue to provide vaginal contraceptives with N-9 (sponges, gels, creams, foam and film). If you have specific questions regarding N-9 as a contraceptive, please call the Sex Information Line at (206) 328-7711 (Monday - Thursday 2:00 - 8:00 pm)
• Messages about the use of N-9 containing products should now include caution about their potential for causing hypersensitivity and genital ulceration if used generously and frequently, and about their value and risks regarding HIV transmission. 

Nonoxynol-9 (N-9) is a detergent originally formulated to kill sperm. In the United States, N-9 is available in a variety of concentrations and formulations, including gels, creams, foams, suppositories, and film. Some of these products are meant to be used by themselves and others are meant to be used with a diaphragm or cervical cap. In addition, N-9 is used in some vaginal and rectal lubricants and in the lubricant on some male latex condoms. With perfect use, spermicides can be 94 percent effective in preventing pregnancy when used alone. However, the failure rate for typical users may be 26 percent per year.

In laboratory and animal studies, N-9 has been shown to destroy bacteria and viruses that cause sexually transmitted diseases (STDs), including herpes, gonorrhea, chlamydia, and HIV. Even so, clinical studies (of humans in real life settings) have been inconsistent and inconclusive as to N-9's efficacy and safety. There has been no evidence that N-9 provides protection against HIV in real life situations and several studies have shown that N-9 when used often may cause genital irritation. Some studies also show that spermicides or contraceptive sponges using N-9 can increase a woman’s risk of certain vaginal infections (yeast infections, bacterial vaginosis) and do not provide complete protection against STDs. 

Findings released at the XIII International AIDS Conference this summer showed that women using N-9 gel increased their risk of getting HIV. (NOTE: the women in the study were sex workers who were using large amounts of N-9 very frequently) 

The study was a randomized, placebo-controlled, triple-blind trial among sex workers. A total of 990 women were enrolled in the trial. Almost 90 percent of sex acts of women in the study were protected by the male condom. The study found a higher rate of new HIV infections among women using the N-9 gel than among placebo users. There was a 15 percent HIV incidence rate in the N-9 group, compared to 10 percent in the placebo group. Researchers assume that N-9 increased the risk of transmission by irritating the vaginal lining, causing microscopic sores that give the virus increased access to the body. 

The sex workers in the study applied N-9 up to 20 times a day. There is no evidence that persons who use it once or twice a day increase their risk of contracting HIV. 

N-9, when used very frequently and in substantial quantities seems to increase, rather than decrease the risk of HIV transmission. The real life evidence of potential problems, including hypersensitivity to the agent among some persons, and the possibility of genital ulceration, shows that this high level use of N-9 can actually increase risks for HIV transmission. However, when used in smaller quantities (e.g., occasional use with condoms lubricated including N-9), and with low frequency, the balance between its potential to kill HIV versus its risk of side effects and for increasing HIV transmission is unknown.

References