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  • Title: Update: barrier protection against HIV infection and other sexually transmitted diseases.
    Author: Centers for Disease Control and Prevention (CDC).
    Journal: MMWR Morb Mortal Wkly Rep; 1993 Aug 06; 42(30):589-91, 597. PubMed ID: 8336689.
    Abstract:
    Although refraining from intercourse with infected partners remains the most effective strategy for preventing human immunodeficiency virus (HIV) infection and other sexually transmitted diseases (STDs), the Public Health Service also has recommended condom use as part of its strategy. Since CDC summarized the effectiveness of condom use in preventing HIV infection and other STDs in 1988 (1), additional information has become available, and the Food and Drug Administration has approved a polyurethane "female condom." This report updates laboratory and epidemiologic information regarding the effectiveness of condoms in preventing HIV infection and other STDs and the role of spermicides used adjunctively with condoms. Additional information has become available since the US Centers for Disease Control's summary of 1988 on the effectiveness of consistent and proper condom use in preventing the transmission of HIV and other sexually transmitted diseases (STD). The Food and Drug Administration has also approved a polyurethane "female condom" in the interim. This report updates laboratory and epidemiologic information regarding the effectiveness of condoms in preventing HIV infection and other STDs and the role of spermicides used together with condoms. It is clear that condom use reduces the risk for gonorrhea, herpes simplex virus infection, genital ulcers, and pelvic inflammatory disease. Intact latex condoms also provide a continuous mechanical barrier to HIV, HSV, hepatitis B virus, Chlamydia trachomatis, and Neisseria gonorrhea. Three prospective studies in developed countries found that condoms are unlikely to break or slip during proper use; reported breakage rates were 2% or less for vaginal or anal intercourse. Lab studies further indicate that the female condom is an effective mechanical barrier to viruses, including HIV; no clinical studies, however, have been completed to determine the level of protection actually conferred in vivo against HIV infection and other STDs. An estimated 12-month contraceptive failure rate of 11% was found among 86 women who used the device consistently and correctly over a six-month period. Lab studies further indicate that nonoxynol-9, a nonionic surfactant used as a spermicide, inactivates HIV and other sexually transmitted pathogens. Although cohort studies have found the vaginal use of nonoxynol-9 by women without condom use to reduce the degree of infection with gonorrhea and chlamydia, no reports as yet indicate that nonoxynol-9 used alone without condoms can effectively prevent the sexual transmission of HIV. Instead, a randomized controlled trial among prostitutes in Kenya found no protection against HIV infection with use of a vaginal sponge containing a high dose of nonoxynol-9. No studies have shown that nonoxynol-9 used with a condom increases the protection provided by condom use alone against HIV infection.
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