Longevity of Gynol II and Ortho Creme in the Prentif cervical cap

A review of the literature yielded no scientific basis for current recommendations on the length of time spermicide-filled cervical caps can be worn while continuing to protect against pregnancy. Ten cervical cap users provided 99 samples of cap contents after a variety of insertion periods using Gynol II, Ortho Creme and vehicle controls. Testing for spermicidal effect was performed in the laboratory using quality semen from two donors and employing the Multiple Exposure Photography system of semen analysis. Criteria for determining spermicide effectiveness were developed. Results suggest that 3 to 4 days is the reasonable limit for cap use with Gynol II and 5 days with Ortho Creme, contrasted with 1 day limits for Gynol II and 2 day limits for Ortho Creme using existing criteria. Limited experience with samples exposed to semen in vivo suggest that spermicidal potency is not lost through repeated intercourse. Recommendations for validating these limits with clinical studies are made.

Longevity of Ortho Creme and Gynol II in the contraceptive diaphragm

A literature review yielded no scientific basis for the currently accepted recommendations on the length of time spermicides used with diaphragms continue to kill sperm. Twelve volunteers provided 68 spermicide samples representing 6, 12, 18, and 24 hours of in vivo insertion in a contraceptive diaphragm using Ortho Creme, Gynol II, and vehicle controls. Testing for continued spermicidal effect was performed in the laboratory using quality semen from 2 donors and employing the Multiple Exposure Photography system of semen analysis. Results showed effective spermicidal action after 12 hours of insertion, mixed effectiveness after 18 hours, and poor effectiveness after 24 hours with both products, with Ortho Creme being more effective in the longer insertions. Placebo jelly enhanced sperm activity while placebo creme had a moderate inhibitory effect. Recommendations for further study are made.

Parity and use-effectiveness with the contraceptive sponge

The results of a randomized United States study indicated that the Today contraceptive sponge was less effective than the diaphragm (1-year cumulative life-table rate of 17.4 versus 12.9 pregnancies per 100 women, p = 0.01). However, this overall comparison is misleading. Using univariate and multivariate analyses to account for the effects of user characteristics we found parity to be the most important single determinant of effectiveness for users of the sponge, but parity was unimportant as a risk factor for pregnancy among diaphragm users. For nulliparous women the sponge was as effective as a physician-prescribed barrier method (13.9 for sponge, 12.8 for diaphragm, p = 0.45); however, parous women using the sponge were twice as likely to become pregnant (28.3 for sponge, 13.4 for diaphragm, p = 0.001). The effect of parity among sponge users is consistent with the results of international studies of the contraceptive sponge.

Spermicidal effect in vitro by the active principle of garlic

The in vitro spermicidal effect of Allitridum, an active principle of garlic, was investigated. The data showed that sperm motility was inhibited with various concentrations of Allitridum at different intervals ranging from 20 seconds-200 minutes as compared to control. An obvious immobilization of spermatozoa occurred at 7.5 mg/ml of Allitridum. The effects on sperm motility appeared to be dose-dependent.

Comparison of the potency of d-propranolol, chlorhexidine and nonoxynol-9 in the Sander-Cramer test

The potency of two new candidate spermicides, d-propranolol and chlorhexidine, was compared with an established agent nonoxynol-9 by the Sander-Cramer test. The lowest concentrations of nonoxynol-9, d-propranolol and chlorhexidine which consistently inhibited progressive forward sperm motility within twenty seconds were found to be 0.12, 0.44, and 4.81 mg/ml, respectively. These relative potencies and other properties of d-propranolol and chlorhexidine indicate that they should be further investigated as alternatives to nonoxynol-9 in spermicidal preparations.

Personal protection against sexually transmitted diseases

Primary prevention of sexually transmitted diseases has received little emphasis in control programs. To evaluate the effectiveness of prevention strategies, we reviewed the world's literature on this topic. Use of condoms and spermicides greatly reduces the risk of gonorrhea, and barrier methods are practical and acceptable. Certain systemic antibiotics are effective, but for practical reasons, their use cannot be recommended. Washing or urinating after sexual exposure does not appear to protect against infection. Although the effectiveness of modifying sexual behavior to reduce the risk of sexually transmitted diseases has not been evaluated, many people have changed or are willing to change their behavior. Even if preventive measures are used consistently by only a minority of persons at risk, rates of sexually transmitted diseases would decline rapidly. In this era of sexually transmitted diseases that are not readily cured by antibiotics, use of effective preventive measures should be strongly encouraged.

Primary prevention of sexually transmitted diseases. A primer for clinicians

With the advent of sexually transmitted infections for which curative therapy is not available, primary prevention has assumed greater importance. The spectrum of sexually transmitted diseases (STDs) has broadened, and clinicians need to understand the mechanisms of their transmission and prevention. Modifying selection of sexual partners and avoiding certain sexual practices should theoretically reduce the risk of infection. Clinical and laboratory studies indicate that the use of condoms, diaphragms, and spermicides reduces the risk of acquiring certain infections. At present, hepatitis B is the only STD for which a safe, effective vaccine is available. Use of oral antibiotics cannot be recommended. Postcoital washing or urination have not been shown to have a protective effect against infection. Because of the potential benefits, persons at risk for STDs should be encouraged to modify their sexual behavior and use barrier methods and spermicides to protect themselves against sexually transmitted infections.

Comparison of the action of nonoxynol-9 and chlorhexidine on sperm

The effect on sperm motility of nonoxynol-9 chlorhexidine diacetate was compared in semen and cervical mucus. Both compounds had similar spermicidal potency in semen, abolishing sperm motility within 3 minutes at 0.5 mg/ml. When these compounds were allowed to diffuse into mucus, the subsequent survival of sperm in the mucus was different. Restricted penetration and loss of motility occurred rapidly after treatment with 0.1 mg/ml chlorhexidine, whereas sperm survived normally in mucus after prolonged contact with 200 mg/ml chlorhexidine. When the compounds were mixed directly with the mucus before sperm penetration was attempted, chlorhexidine still immobilized sperm, but concentrations of nonoxynol-9 that would be spermicidal in semen had no effect in mucus.