Preventing disease by protecting the cervix: The unexplored promise of internal vaginal barrier devices

Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California, United States
AIDS (Impact Factor: 5.55). 10/2001; 15(13):1595-602. DOI: 10.1097/00002030-200109070-00001
Source: PubMed
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    • "Limited evidence from observational studies suggests that the diaphragm protects against STI and their sequelae, including gonorrhoea (Austin et al. 1984, Rosenberg et al. 1992), pelvic inflammatory disease (Wolner-Hanssen et al. 1990) and cervical dysplasia (Becker et al. 1994). This is biologically plausible—the cervix being a primary entry site for STIs such as HIV, Neisseria gonorrhoeae, Chlamydia trachomatis and the human papilloma virus (Moench et al. 2001). Ongoing trials aim to determine its protective efficacy against HIV. "
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    • "The SILCS diaphragm has been under development by the Program for Appropriate Technology in Health since 1994 as an advanced, single-sized, cervical-barrier contraceptive device (Figure 5).46–51 Similar in format to a reservoir-type vaginal ring device, SILCS contains a specially designed flexible polymeric spring core (made from nylon-6), which is over-molded with silicone elastomer to form the barrier sheath. "
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    ABSTRACT: Following the successful development of long-acting steroid-releasing vaginal ring devices for the treatment of menopausal symptoms and contraception, there is now considerable interest in applying similar devices to the controlled release of microbicides against HIV. In this review article, the vaginal ring concept is first considered within the wider context of the early advances in controlled-release technology, before describing the various types of ring device available today. The remainder of the article highlights the key developments in HIV microbicide-releasing vaginal rings, with a particular focus on the dapivirine ring that is presently in late-stage clinical testing.
    International Journal of Women's Health 11/2012; 4(1):595-605. DOI:10.2147/IJWH.S36282
    • "An advantage of microbicides over male and female condoms is that they are expected to interfere less with intimacy and sexual pleasure, and be more discrete.[20] "
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    ABSTRACT: HIV is a pandemic which has continually posed challenges to the scientific society in large and to medical fraternity in particular in terms of treatment as well as prevention. The treatment is lifelong suppressive than curative; hence the importance has always been to prevention strategies. The strategies like abstinence, monogamy and consistent condom use have various societal and behavioural issues and HIV vaccine is still not at the horizon. In such a scenario, pre-exposure prophylaxis (PrEP) and microbicides have emerged as newer options of prevention. Microbicides are referred to as topical PrEP. They are compounds that can be applied inside the vagina or rectum to protect against sexually transmitted infections (STIs) including HIV. Microbicides can be vaginal and rectal and can be formulated as gels, foams, rings, hydrogels, silicone elastomer gels, diaphragm, quick-dissolve polyvinyl alcohol based films, and bioadhesive vaginal tablets. The microbicides have been divided into various categories based on where they disrupt the pathway of sexual transmission of HIV. The article highlights the classes of microbicides and various trials conducted on them. It also enumerates various approaches in pipeline like antimicrobial peptides, aptamers, flavonoids, small interfering RNAs and DNAs, and bioengineered lactic acid bacilli.
    Indian Journal of Sexually Transmitted Diseases and AIDS 07/2012; 33(2):81-90. DOI:10.4103/0253-7184.102098
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