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Topical microbicides for preventing sexually transmitted infections.

Jael Obiero1, Paul Ogongo2, Peter G Mwethera3

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Topical microbicides, including dapivirine, show potential in preventing HIV acquisition among women. However, other vaginal microbicides have not demonstrated significant effectiveness against sexually-transmitted infections (STIs).

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Area of Science:

  • Public Health
  • Infectious Diseases
  • Clinical Trials

Background:

  • Sexually-transmitted infections (STIs) present a significant global health challenge.
  • Effective prevention strategies are crucial for controlling STI transmission worldwide.
  • Topical microbicides are being investigated as a key prevention method.

Purpose of the Study:

  • To evaluate the efficacy and safety of vaginal microbicides in preventing STI acquisition, including HIV.
  • To synthesize evidence from randomized controlled trials on microbicide effectiveness.

Main Methods:

  • A comprehensive search of multiple databases and trial registries was conducted up to August 2020.
  • Twelve randomized controlled trials involving 32,464 women were included in the meta-analysis.
  • GRADE approach was used to assess the certainty of evidence.

Main Results:

  • Vaginal dapivirine microbicide demonstrated a probable reduction in HIV acquisition risk (RR 0.71, 95% CI 0.57 to 0.89).
  • Other tested microbicides showed little to no effect on HIV acquisition.
  • Evidence for other STIs like HSV-2, syphilis, chlamydia, gonorrhea, HPV, and trichomoniasis was limited or showed no significant effect.

Conclusions:

  • Vaginal dapivirine microbicide likely reduces HIV acquisition in women.
  • Current evidence does not support the effectiveness of other vaginal microbicides for STI prevention.
  • Continued research and development of novel microbicides are recommended.