Cates W, Stewart F H, Trussell J
Epidemiology Program Office, Centers for Disease Control, Atlanta, Ga. 30333.
Am J Public Health. 1992 Nov;82(11):1479-82. doi: 10.2105/ajph.82.11.1479.
The companion article by Rosenberg and Gollub in this issue summarizes data from 10 observational studies and concludes that female-controlled contraceptive methods, under typical conditions, are comparable to condoms in preventing sexually transmitted diseases and should be merchandized as such. While we agree that chemical and mechanical contraceptives provide protection against some sexually transmitted diseases, we think the authors have overstated the scientific case for these methods, especially in comparison with the condom. We think the current data remain inconclusive regarding the absolute protection of spermicides against the human immunodeficiency virus and their level of protection--relative to that of the condom--against other sexually transmitted diseases. Three reasons account for our differences: the limitations in the comparative data; the reported adverse effects of spermicides on vaginal conditions, including genital ulcers; and the relative value of condoms, even under typical conditions, in preventing sexually transmitted diseases. For these reasons, we would currently counsel both women and men who practice high-risk sexual behaviors to use condoms as their first line of defense. If this is unacceptable, the female barriers become a fallback position to protect against bacterial sexually transmitted diseases.
本期罗森伯格和戈卢布的相关文章总结了10项观察性研究的数据，并得出结论：在典型情况下，女性控制的避孕方法在预防性传播疾病方面与避孕套相当，应以此进行推广。虽然我们同意化学和机械避孕方法能预防某些性传播疾病，但我们认为作者夸大了这些方法的科学依据，尤其是与避孕套相比。我们认为，关于杀精剂对人类免疫缺陷病毒的绝对防护以及其相对于避孕套对其他性传播疾病的防护水平，目前的数据仍无定论。我们存在分歧有三个原因：比较数据的局限性；杀精剂对包括生殖器溃疡在内的阴道状况的不良影响报告；以及即使在典型情况下避孕套在预防性传播疾病方面的相对价值。出于这些原因，我们目前建议有高危性行为的女性和男性都将避孕套作为首要防线。如果这不可接受，女性屏障可作为预防细菌性传播疾病的备用选择。
