MUCOSAL DISRUPTION DUE TO USE OF A WIDELY-DISTRIBUTED COMMERCIAL VAGINAL PRODUCT - POTENTIAL TO FACILITATE HIV TRANSMISSION

Objective: Policresulen vaginal suppositories are a condensation produ ct of metacresolsulfonic acid and formaldehyde. We investigated their use by female commercial sex workers (CSW) and whether such use could facilitate HIV transmission. Methods: We interviewed female CSW in Tha iland about use of the product, and we directly observed the effects o f self-administration of a single suppository by each of six women. Re sults: Of 200 CSW interviewed, 32% had used policresulen vaginal suppo sitories in the preceding year and 46% had used them at some time. Man y used them for reasons not listed on the package insert, such as impr oving their male partners' sexual pleasure, and most did not abstain f rom vaginal sex following use. Among 36 brothel-based and 67 non-broth el-based CSW with known HIV infection, the use of the product was not associated with HIV-1 infection (adjusted relative risk 1.0, 95% confi dence interval, 0.5-2.0). Exfoliation of the vaginal and cervical muco sa was observed in all six CSW 1 day after product use, and, although it could have been the result of repeated examinations, an increase in genital HIV-1 RNA shedding was also detected in all three HIV-seropos itive women. Conclusion: Although there was no epidemiological associa tion with HIV infection, policresulen vaginal suppository use did disr upt the genital mucosa and therefore may have the potential to facilit ate HIV transmission. Drug licensing authorities may wish to reassess the safety of this product. If the product continues to be distributed , steps should be taken to limit its use to the specific conditions fo r which it is indicated and to ensure that women abstain from vaginal sex following its use. (C) 1998 Lippincott-Raven Publishers.