Cook R L, Rosenberg M J
Robert Wood Johnson Clinical Scholars Program, University of North Carolina at Chapel Hill, USA.
Sex Transm Dis. 1998 Mar;25(3):144-50. doi: 10.1097/00007435-199803000-00007.
There are conflicting opinions on whether to recommend spermicides containing nonoxynol-9 for prevention of sexually transmitted diseases, including human immunodeficiency virus (HIV).
To systematically review and summarize the medical literature on the effect of spermicides containing nonoxynol-9 on prevention of gonorrhea, chlamydial infection, and HIV.
Meta-analysis. Potential articles were identified through computerized literature searches. Articles were included if the design was clinical trial, cohort, case-control, or cross-sectional; original outcome data were presented for gonorrhea, chlamydial infection, or HIV; and spermicides containing nonoxynol-9 were used separately from other barrier methods. Study characteristics including design, population, spermicide dose, and delivery method were abstracted. Relative risks (RR) and 95% confidence intervals (CI) were determined from information published in the study or from study authors. Summary risk estimates were computed for clinical trials.
Twelve eligible articles were identified, including six clinical trials and six observational studies. Eleven articles evaluated gonorrhea; each found a reduced risk of infection with spermicide use. Among six clinical trials, the summary RR was 0.62 (95% CI, 0.49-0.78). The five articles evaluating chlamydial infection also found significant reduction among spermicide users, with the four clinical trials having a summary RR of 0.75 (95% CI, 0.62-0.91). The degree of spermicidal protection against gonorrhea and chlamydial infection did not differ materially among studies with different study designs or spermicidal preparations (i.e., sponge, gel, suppository, or film). Three studies evaluated degree of protection according to consistency of use and found stronger protection with more consistent use. The two studies on spermicidal prevention of HIV had contrasting results: An observational study found a significant protective effect (RR = 0.1), whereas a clinical trial found a nonsignificantly increased risk (RR = 1.7).
Nonoxynol-9-containing spermicides have an appreciable protective effect against both gonorrhea and chlamydial infection, and wider use of spermicides might substantially reduce the incidence of these diseases. However, insufficient data exist to judge their effect on HIV transmission, and more research on the effect of nonoxynol-9 on HIV transmission is urgently needed to make evidence-based clinical decisions and public health recommendations in the future.
对于是否推荐使用含壬苯醇醚 - 9的杀精剂来预防包括人类免疫缺陷病毒（HIV）在内的性传播疾病，存在相互矛盾的观点。
系统回顾和总结关于含壬苯醇醚 - 9的杀精剂对预防淋病、衣原体感染和HIV效果的医学文献。
荟萃分析。通过计算机文献检索识别潜在的文章。若研究设计为临床试验、队列研究、病例对照研究或横断面研究；呈现了淋病、衣原体感染或HIV的原始结局数据；且含壬苯醇醚 - 9的杀精剂与其他屏障方法分开使用，则纳入该文章。提取研究特征，包括设计、人群、杀精剂剂量和给药方法。相对风险（RR）和95%置信区间（CI）根据研究中发表的信息或研究作者提供的信息确定。计算临床试验的汇总风险估计值。
共识别出12篇符合条件的文章，包括6项临床试验和6项观察性研究。11篇文章评估了淋病；每篇都发现使用杀精剂可降低感染风险。在6项临床试验中，汇总RR为0.62（95%CI，0.49 - 0.78）。评估衣原体感染的5篇文章也发现杀精剂使用者的感染率显著降低，4项临床试验的汇总RR为0.75（95%CI，0.62 - 0.91）。在不同研究设计或杀精剂制剂（即海绵、凝胶、栓剂或薄膜）的研究中，杀精剂对淋病和衣原体感染的保护程度没有实质性差异。3项研究根据使用的一致性评估了保护程度，发现使用越一致保护作用越强。两项关于杀精剂预防HIV的研究结果相反：一项观察性研究发现有显著保护作用（RR = 0.1），而一项临床试验发现风险无显著增加（RR = 1.7）。
含壬苯醇醚 - 9的杀精剂对淋病和衣原体感染均有明显的保护作用，更广泛地使用杀精剂可能会大幅降低这些疾病的发病率。然而，现有数据不足以判断其对HIV传播的影响，迫切需要更多关于壬苯醇醚 - 9对HIV传播影响的研究，以便在未来做出基于证据的临床决策和公共卫生建议。
