On the Horizon: A New Way to Rein in Sexually Transmitted Disease

From the WebMD Archives

Jan. 3, 2001 -- They're an effective means of preventing the spread of sexually transmitted diseases, but condoms can't do any good unless they're used consistently and properly. The fact they're not has created demand for a new class of products, some 60 of which are in various stages of human testing. They are topical microbicides -- germ killers -- designed for application directly to the genitals.

"We're talking about microbicides as a method that expands the range of options for people who cannot or will not use condoms," says Polly Harrison, PhD, director of the Alliance for Microbicide Development, an advocacy group based in Maryland. "We know consistent condom use is pretty low" especially in developing countries, she adds.

Harrison says the idea of these microbicides first surfaced in the late 1980s, when medical experts realized the HIV epidemic was not something confined to homosexual men. Researchers knew that older products used to kill sperm also showed activity against some sexually transmitted diseases. "That was what sort of kicked-off scientific work with microbicides," she says.

One of those compounds, nonoxynol-9, showed extreme promise in the lab as a way to kill off HIV. But a landmark study showed it might even lead to an increase in infections -- perhaps by irritating the tissue and making it more vulnerable to infection.

But now the drug pipeline is bulging with contenders. Harrison says the leading two, PRO-2000 and BufferGel, should enter the final phase of testing next summer. Four other products are set to enter earlier phases of testing, and another 50 compounds are in the earliest stages of development. More than 80 entities -- including small pharmaceutical firms, nonprofit groups, and public sector organizations -- are on the hunt for a marketable compound, she says.

One of them is Biosyn in Philadelphia, which is developing a vaginal gel called SAVVY. The reason: "There isn't presently a method women can use to prevent [sexually transmitted diseases] without the cooperation of their partner," says Business Development Manager Kathryn LaMaina. However, she says that doesn't mean SAVVY or any other microbicide product is a replacement for condoms. "That's certainly not advocated by anyone, particularly Biosyn. There is somewhat of a hierarchical order of prevention methods and condoms have always been at the top."

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Harrison agrees. There's just one problem: "People don't like condoms." Still, she says, "To say microbicides are going to replace condoms is not accurate and even risky. If people use condoms consistently, they lower their risk."

And yet, there is the hope microbicides can safely go it alone, says Jacqueline E. Darroch, senior vice-president and vice-president of research for the Alan Guttmacher Institute in New York, which studies public policy issues. "Right now, these are still in the development phase. It's not clear whether they will be contraceptive and protective against [sexually transmitted diseases]." But, she says, it's likely any initial recommendation for use would include a condom.

Two years ago, the institute conducted a national survey of women aged 18-44 to gauge the level of interest in microbicides. The survey found 40% of women expressing at least some level of interest in using an antimicrobial. But that proportion jumped to more than 90% when women were asked whether they would be receptive if in a situation where a sexually transmitted disease would be a risk. Moreover, a huge majority -- 84% -- said they would likely not use even a highly effective product without a condom.

"We have good methods of contraception," Darroch says. But the status quo "leaves women who are unable to get their partner to use a condom or to [accept] a female condom without other options. So finding a vaginal microbicide for women to use on their own is something that is well needed around the world."

WebMD Health News Reviewed by Gary D. Vogin, MD
© 2001 WebMD, Inc. All rights reserved.

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