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It's time to start asking serious questions about the safety of lube

The stuff you use to make sex a little more smooth might have some serious drawbacks. Nothing has been proven yet — most of the data comes from disembodied cell cultures and animal testing, which doesn't necessarily give you an accurate picture of what's happening in humans — but several studies over the last few years have drawn connections between lubricant use and increased rates of STD transmission. (It also looks like some lubricants might kill off natural vaginal flora — the good bacteria that live "up there" and make the difference between a healthy vagina and, say, a raging yeast infection.)

Some of these studies have provided evidence suggesting that the ingredients in lubricants damage the cells lining the vagina and rectum — which would explain why those lubricants might facilitate STD transmission.

At Chemical and Engineering News, Lauren Wolf has a really well-researched, well-written story that will give you the low-down on this research without hype and without fear-mongering. Her story is easy to understand and explains what we know, what we don't know, and why this matters (besides the obvious, lubricants have been proposed as a possible means of applying topical anti-microbial STD preventatives).

Right now, the Food & Drug Administration doesn’t typically require testing of personal lubricants in humans. The agency classifies them as medical devices, so the sex aids have to be tested on animals such as rabbits and guinea pigs. Rectal use of lubricants is viewed by the agency as an “off-label” application—use at your own risk.

Questions about lubricant safety arose nearly a decade ago when micro­bicide developers were testing whether the detergent nonoxynol-9 could block HIV transmission. Manufacturers had been incorporating the compound into spermicidal lubricants for years because of its ability to punch holes in the cell membranes of sperm. In 2002, however, a Phase II/III clinical trial of a nonoxynol-9 vaginal gel failed to protect women from HIV infection. Not only that, but the detergent actually increased the risk of HIV infection in the sex workers tested—women living in countries such as South Africa and Thailand who used the product three or four times per day.

Lab work eventually revealed the reason for the paradoxical increase: Nonoxynol-9 is so good at punching holes in cell membranes that it not only bores into sperm but also into the cells lining the vagina and rectum. The mucosal lining of the vagina is a good barrier to infection all by itself, says Richard A. Cone, a biophysicist at Johns Hopkins University. But if that barrier gets compromised, all bets are off, he explains. After nonoxynol-9—still used on some condoms today—went from promising microbicide candidate to malevolent cell killer, scientists like Cone began to question the safety of other supposedly innocuous spermicide and personal lubricant ingredients.

Read the full story

Via David Kroll

Image: Beer Lube?, a Creative Commons Attribution (2.0) image from 28096801@N05's photostream

Resolution for 2013: Don't catch the clap

Over the weekend, during a conversation with "scary disease girl" (and amazing science journalist) Maryn McKenna, I was reminded of a public health issue that we've talked about here before, but which is still not getting enough attention. Gonorrhea (aka "the clap") has long been the STD you worried least about, thanks to easy treatment with antibiotics. But that time is over. Antibiotic resistance is turning gonorrhea into a superbug. As of August, we're down to one antibiotic that can reliably treat it. Your best defense is now, most definitely, offense. Get yourself tested. Make sure your sexual partners are tested (oral sex, too!). And use barrier protection (oral sex, too!) Maggie

The end of cheap STD control?

More than 700,000 people in the United States probably get gonorrhea each year. I say "probably" because the Centers for Disease Control doesn't know for sure. It's an estimate, because a lot of those cases go untested, unreported, and untreated.

The good news is that, since the 1940s, getting people to get themselves tested has been the hard part. Once you know the gonorrhea is there, antibiotics have made it both easy and cheap to treat. The (more) bad news: That's changing.

At her Superbug blog, Maryn McKenna talks about the threat of antibiotic-resistant gonorrhea—it's not just an issue of health, it's also an issue of how much health costs. So far, there's not been gonorrhea reported that's immune to all the drugs we can throw at it. Just the inexpensive drugs. Anticipating big problems when treating gonorrhea becomes a pricy proposition, the World Health Organization has put together a plan for improving treatment today.

The plan specifically calls out an aspect of the growing resistance problem that we highlighted at SciAm: Community control now depends on rapid molecular tests that identify the gonorrhea organism (Neisseria gonorrhaea) but cannot distinguish between drug-susceptible and antibiotic-resistant organisms. Hence, patients who were treated, and then went back to their doctors with the same symptoms, were assumed to have been cured and then reinfected. Physicians have not had the tools to identify ongoing infections that never responded to treatment — and patients who had those resistant, not-responding infections then went on to unknowingly infect others.

In order to address that problem, the plan calls specifically for improvements in lab capacity, diagnosis and surveillance, as well as asking for things that apply to the greater problem of antibiotic resistance: improved awareness, bigger efforts at prescribing antibiotics appropriately and better drugs. One thing that it particularly calls for — as the CDC did in the New England Journal last February — is for physicians to start applying a “test of cure,” actually checking microbiologically to see whether a patient who was prescribed an antibiotic for gonorrhea is clear of infection, or harboring a resistant strain.

Of course, that's expensive, too. The cheapest option is still to not get gonorrhea at all. Get tested. Make sure your partners are tested. And use protection. In the future, we're not going to be able to afford treating some STDs as "no big deal".

Read more about the WHO plan and antibiotic-resistant gonorrhea at the Superbug blog