Advantage-S, a spermicide containing
nonoxynol-9 (N-9), has recently been shown in a randomised, controlled trial sponsored by UNAIDS not to offer women protection against sexual transmission of HIV. The women in the trial, all sex workers, reported having an average of 3.6 partners per day and about 70 coital acts per month during the study period. At the end of the trial, the
Advantage-S group was found to have a higher incidence of new
HIV infections than the control group, who were using a vaginal
lubricant. Two other recent studies have found that low dose N-9 products do not provide protection against bacterial
STDs such as gonorrhoea and chlamydia--a finding that contradicts earlier wisdom based on less rigorous studies. Contrary to certain media headlines, however, the results of these trials do not suggest that effective
microbicides cannot be developed, only that
Advantage-S, which was developed as a spermicide and not as a
microbicide, is probably not one of them. The failure of
Advantage-S to show protection in the UNAIDS-sponsored trial underscores the urgent need to accelerate research to develop a safe and effective topical
microbicide.