The effect of chemical intravaginal contraceptives and Betadine on Ureaplasma urealyticum.

The purpose of this study was to find a barrier contraceptive agent capable of controlling infections and sexual transmission of Ureaplasma urealyticum from the female genital tract, especially to help reduce nongonococcal urethritis in males caused by this organism. Therefore, the in vitro antimicrobial activity of six intravaginal contraceptives and BetadineR against the eight serotypes of the organism was investigated. The results indicate that some of these contraceptives produce partial inhibition of the Ureaplasma at low dilutions, while BetadineR produces a ureaplasmacidal effect up to dilutions of 1:64. These effects appear not to be due primarily to the pH of these agents. Thus, some of these agents may have a potential role in controlling transmission of Ureaplasma urealyticum.

PIP: An in vitro study was conducted in an effort to find a barrier contraceptive agent capable of controlling infections and sexual transmission of Ureaplasma urealyticum from the female genital tract, especially to help reduce nongonococcal urethritis in males caused by this organism. The in vitro antimicrobial activity of 6 intravaginal contraceptives and Betadine against the 8 serotypes of the organism was investigated. All 8 serotypes of Ureaplasma urealyticum exhibited a uniform response to each of the different products tested. Metabolic inhibition of Ureaplasma was examined at 24, 48, and 72 hours. At 24 hours, metabolic inhibition was observed with 6 of the 8 agents tested. 2 of the agents, Betadine solution and Betadine vaginal gel, produced inhibition up to 1:64. 4 agents -- Emko foam, Delfen foam, Kormex ii, and Conceptrol -- exhibited inhibition at either 1:16 or 1:32. The 2 other agents, NeoSampoon and Encare Oval, failed to produce inhibition of the lowest dilution tested. There was no change in the observed endpoint of 1:64 for the Betadine preparations at 48 and 72 hours. 4 of the agents demostrated a decrease in the endpoint upon prolonged incubation to 72 hours, with growth of the organism in the lowest dilutions of Emko and Delfen foams. Results of subcultures of all dilutions of the agent-broth mixtures at 5 minutes showed that Betadine in its 2 forms tested, Koromex II and Conceptrol, produced apparent killing of Ureaplasma at dilutions of 1:32, 1:4, and 1:4 respectively. Subcultures after 24 hours of contact between the agent and Ureaplasma indicated a killing effect up to dilutions of 1:64 for the Betadine preparations and 1:4 for Meko foam. All other endpoints remained unchanged at 24 hours. The measurements of the pH of the emulsions and the pH of 1:1 mixture of U9B medium with the agent emulsion ranged from 4.0 (Concetrol) to 7.9 (NeoSampoon) for the agent emulsons and from 4.2 Conceptrol) to 7.3 (Neo Sampoon) for the the U9B-emulsion mixtures. Betadine solution and gel were found to have a pH of 2.5 in saline dilution and 3.5 in solution with U9B broth. On the basis of these "in vitro" experiments, the intravaginal contraceptives may have a role in the prevention of sexually transmissble infection or colonization by Ureoplasma.

Coprecipitation of nonoxynol-9 with polyvinylpyrrolidone to decrease vaginal irritation potential while maintaining spermicidal potency.

The aim of this study was to test the hypothesis that polyvinylpyrrolidone (PVP) would increase the critical micelle concentration (CMC) of nonoxynol-9 (N-9), providing a reduction in its irritation potential, while maintaining essential spermicidal activity. Solid coprecipitates of N-9 with PVP were manufactured with the use of a modified lyophilization process. The irritation potential of N-9 was estimated by an in vitro assay, monitoring the extent of hemolysis of red blood cells. CMCs of N-9 were measured in the presence of various concentrations of PVP. A modified Sander-Cramer assay was implemented to measure the spermicidal activity of N-9 and the N-9/PVP coprecipitates. With the use of the lyophilization process and more suitable solvents, solid coprecipitates of N-9/PVP were manufactured with no residual organic solvents. The irritation potential of N-9 was reduced when in the presence of PVP-50% hemolysis values increased from 0.054 mM to more than 0.2mM. N-9 CMC values increased in the presence of PVP from 0.085 mM (0% PVP) to 0.110 mM (3.5% PVP) and 0.16 6mM (10% PVP). However, spermicidal activities ranged from 0.213 mM to 0.238 mM, N-9 remaining steady regardless of the amount of PVP. By use of N-9/PVP coprecipitates, the self-association properties and irritation potentials of N-9 were altered. This result suggests a process to produce a spermicidal product that reduces the detrimental implications to the vaginal epithelium while maintaining the essential spermicidal activity.

A follow-up study of methods of contraception, sexual activity, and rates of trichomoniasis, candidiasis, and bacterial vaginosis.

A randomized, clinical trial was conducted to evaluate the spermicidal agent nonoxynol 9 as prophylaxis for sexually transmitted diseases. Eight hundred eighteen women using birth control who attended a sexually transmitted disease clinic were evaluated monthly for trichomoniasis, candidiasis, and bacterial vaginosis for 6 months. Women using the active spermicide experienced a somewhat lower incidence rate of trichomoniasis (relative rate 0.83; 95% confidence interval 0.61 to 1.12) and bacterial vaginosis (relative rate 0.86; 95% confidence interval 0.69 to 1.12) as compared with placebo users. The rate of candidiasis was nearly identical for spermicide and placebo users (relative rate 1.02; 95% confidence interval 0.77 to 1.35). The number of sexual partners during the preceding month was related directly to the occurrence of trichomoniasis (p = 0.047) and bacterial vaginosis (p = 0.009) but not candidiasis (p = 0.99). Subjects using oral contraceptives experienced a statistically significant lower rate of trichomoniasis than did women using an intrauterine contraceptive device or who had had a tubal ligation (relative rate 0.56; 95% confidence interval 0.39 to 0.81).

Concepts of anaerobic infection in relation to prevention and management.

Concepts of anaerobic infection are reviewed in relation to the management of wounds that might be contaminated by facultative or anaerobic organisms or mixtures of these. Considerations of post-operative wound infections oblige us to consider the indications for per-operative antimicrobial prophylaxis and to bear in mind the role of anaerobes and the possibility of pathogenic synergy in these situations. Pathogenic associations of anaerobes with other organisms are further considered in relation to periodontal disease and anaerobic vaginosis. The various roles of anaerobes in enteropathogenic conditions are briefly considered. There is a continuing obligation on clinical bacteriologists and clinicians to work together towards the more effective prevention and management of infections that may or may not have a significant anaerobic component.