EFFECT ON NORMAL VAGINAL FLORA OF 3 INTRAVAGINAL MICROBICIDAL AGENTS POTENTIALLY ACTIVE AGAINST HUMAN-IMMUNODEFICIENCY-VIRUS TYPE-1

The effect on normal vaginal flora of three intravaginal microbicides potentially active against human immunodeficiency virus type 1 was exa mined. Volunteers received dextrin sulfate (D2S), nonoxynol-9 (N-9), o r docusate sodium in separate placebo-controlled studies. High vaginal swabs were obtained for bacterial culture before and after microbicid e application. D2S did not affect the vaginal flora. However, lactobac illi decreased by greater than or equal to 10(2) cfu/mL in 9 (56%) of 16 women given N-9 and in 5 (63%) of 8 women given docusate sodium. Wo men using N-9 were also significantly more likely to become colonized abnormally (usually with aerobic gram-negative rods) than were those u sing placebo, as were women using docusate sodium. Women with reduced lactobacilli were less likely to regain normal flora than were those w hose lactobacilli were unaffected. However, coliform colonization occu rred whether lactobacilli produced H2O2 or not. Continuous use of N-9 could induce susceptibility to urinary and gynecological infection. It is essential that potential microbicides are examined for activity ag ainst normal vaginal flora.