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  • Title: Sex and spermicides: preventing unintended pregnancy and infection.
    Author: Cates W, Weisner PJ, Curran JW.
    Journal: JAMA; 1982 Oct 01; 248(13):1636-7. PubMed ID: 7109188.
    Abstract:
    All contraceptives except the IUD, which promotes development of pelvic inflammatory disease, appear to confer some degree of protection from sexually transmitted diseases (STDs). Results of a study by Jick and colleagues reported in volume 248 of the Journal of the American Medical Association indicated that women classified as spermicide "users" had gonorrhea rates only 1/4 those of women who used oral contraceptives or had undergone surgical sterilization. Their data also suggest that spermicides may protect against vaginal infections for which metronidazole is prescribed. The authors are cautious in interpreting the data because 2 key risk factors associated with a woman's development of gonorrhea could not be evaluated: differences in sexual behavior between women using spermicides and those using other contraceptives, and the concurrent protection effect of mechanical barrier contraceptives as distinct from the chemical antibacterial action of spermicides. No information was provided on whether women received their spermicide prescriptions specifically for STD prophylaxis, so that the extent of any selection bias could not be measured. Questions might also be raised concerning the data base and methodology used in the study, but the data is consistent with results of previous in vitro investigations and other observational data. If spermicides do provide protection against STDs, there are several possible concerns regarding their widespread promotion as prophylaxis for groups at high risk for both STDs and unintended pregnancy: such agents must be used regularly; their use may simply mask laboratory detection of some STDs without curing the infection; spermicides could be found to have teratogenic health risks; or their use could provide women with a false sense of security. The advantages of spermicides are that they are nonprescription items, less expensive than most contraceptives, under the control of women, and capable of selective use with casual partners. A sophisticated evaluation of possible public health benefits and risks is needed to measure the true effects of spermicides.
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