Niruthisard S, Roddy R E, Chutivongse S
Science Division, Queen Saovbha Memorial Institute, Thai Red Cross Society, Bangkok, Thailand.
Lancet. 1992 Jun 6;339(8806):1371-5. doi: 10.1016/0140-6736(92)91195-e.
The spermicide nonoxynol-9 (N-9) has been used as a contraceptive for over 30 years, but the use of a vaginal spermicide and condoms for the prevention of sexually transmitted infections has not been examined in randomised studies. We report a single-blind randomised field trial to assess the effect of N-9 film on the rate of gonococcal and chlamydial cervical infection in women at high risk of these diseases. 343 women were randomly assigned to use either condoms and N-9 (186 women) or condoms and a placebo (157). Compliance with condom use was much the same in the two groups. Overall, N-9 reduced the rate of cervical infection by 25% (rate ratio [RR] 0.75, 95% confidence interval [Cl] 0.5-1.1); in women who used N-9 for more than 75% of their coital acts the infection rate was reduced by 40% (RR 95% Cl 0.3-1.0). The rate of yeast vulvovaginitis or genital ulcers was not higher in N-9 users than in placebo users, but the rate of symptomatic irritation was increased by 70% (RR 95% Cl 1.1-2.6) among N-9 users. Condom use was more protective against cervical infection than N-9 use. The rate of infection was 50% (RR 95% Cl 0.3-0.7) lower with 75% than with 0-50% condom compliance. The use of a vaginal N-9 spermicide with condoms whenever possible seems to be a better strategy than the use of condoms only for prevention of gonococcal and chlamydial cervical infection.
杀精剂壬苯醇醚-9（N-9）作为一种避孕药已使用了30多年，但阴道杀精剂与避孕套联合用于预防性传播感染的效果尚未在随机研究中得到检验。我们报告了一项单盲随机现场试验，以评估N-9薄膜对这些疾病高危女性淋病和衣原体宫颈感染率的影响。343名女性被随机分配使用避孕套和N-9（186名女性）或避孕套和安慰剂（157名）。两组中避孕套的使用依从性大致相同。总体而言，N-9使宫颈感染率降低了25%（率比[RR]0.75，95%置信区间[Cl]0.5-1.1）；在性交行为中使用N-9超过75%的女性中，感染率降低了40%（RR 95% Cl 0.3-1.0）。使用N-9的女性中，念珠菌性外阴阴道炎或生殖器溃疡的发生率并不高于使用安慰剂的女性，但使用N-9的女性中有症状的刺激发生率增加了70%（RR 95% Cl 1.1-2.6）。使用避孕套比使用N-9对宫颈感染的防护作用更强。避孕套使用依从性为75%时的感染率比为0-50%时低50%（RR 95% Cl 0.3-0.7）。尽可能将阴道N-9杀精剂与避孕套联合使用似乎是比仅使用避孕套更好的预防淋病和衣原体宫颈感染的策略。
