THE USE OF NONOXYNOL-9 FOR PROTECTION AGAINST CERVICAL GONORRHEA

Objectives. Although condoms are the best defense against sexually tra nsmitted disease, little is known about the effectiveness of female-co ntrolled methods containing nonoxynol-9 as backup protection when cond oms are not being used. Methods. To assess the extent to which nonoxyn ol-9 protects women against gonorrhea, a cohort of 303 female sex work ers (prostitutes) in Yaounde, Cameroon, were asked to use condoms and suppositories containing nonoxynol-9 at every sexual encounter and to record daily sexual activity and use of condoms and suppositories on c oital logs that were reviewed monthly. Evidence of gonorrheal infectio n was based on a positive gonorrhea culture. Stratified analysis and p roportional hazards regression were used to estimate rate ratios. Resu lts. Forty-one women enrolled in the study were excluded from the curr ent analysis. The estimated incidence of gonorrhea was 6.2 infections per 100 person-months of observation. Incidence rate ratios estimated from proportional hazards regression models controlling for condom use showed that using nonoxynol-9 during acts not protected by condoms re duced the risk of infection. Conclusions. Although the protective effe ct of condoms against sexually transmitted disease is greater than tha t afforded by nonoxynol-9, using nonoxynol-9 when condoms are not used is a far better strategy in gonorrhea prevention than using no method at all.