Safety of a nonoxynol-9 vaginal gel in Kenyan prostitutes. A randomized clinical trial
Martin, H.L.; Stevens, C.E.; Richardson, B.A.; Rugamba, D.; Nyange, P.M.; Mandaliya, K.; Ndinya-Achola, J.; Kreiss, J.K.
Sexually Transmitted Diseases 24(5): 279-283
1997
ISSN/ISBN: 0148-5717 PMID: 9153737 DOI: 10.1097/00007435-199705000-00008Document Number: 267425
Objectives: To evaluate the safety and toxicity of once-daily administration of Advantage-24 (Columbia Research Laboratories, Inc., Rockville Centre, NY), a vaginal gel containing 52.5 mg of nonoxynol-9 (N-9), including the effects of this gel on the vaginal and cervical epithelium. Study Design: Randomized, placebo-controlled, double-blind crossover trial, with a 2-week product application period and a 2-week washout period. Methods: Female sex workers in Mombasa, Kenya were randomized to one of two sequences, N-9 followed by placebo, or vice versa. Women were instructed to apply one applicator of N-9 or placebo gel vaginally once each day. During each of the two product periods, subjects were evaluated by questionnaire and physical examination, including colposcopy, after 7 and 14 days of product use. The primary outcome was genital epithelial disruption. Results: Sixty subjects were randomized, of whom 52 (87%) had complete follow-up. There were four episodes of epithelial disruption, three of which occurred during the placebo period and one during the N-9 period. The estimated risk of epithelial disruption associated with N-9 use was 0.33 (95% confidence interval, 0.03-3.26). There was no increased frequency of other, nondisruptive epithelial lesions during N-9 use. Conclusions: No genital epithelial toxicity of N-9 vaginal gel was observed. This safety profile suggests that this N-9 product is appropriate for evaluation for human immunodeficiency virus type 1 prevention in a phase III efficacy trial.