Nonoxynol-9 vaginal pessary: a preliminary Indian experience.

BACKGROUND: Barrier methods of contraception do not have systemic effects and allow the user complete control over their use. For women, the ease of use of a contraceptive is often more important than its efficacy. Hence, barrier methods could be offered as a useful alternative method of contraception. Nonoxynol-9 (a spermicide) is a locally acting, non-hormonal method free from systemic side-efforts. It is a woman-controlled, reversible method which is to be used before intercourse. There are little data available on its efficacy, side-effects and acceptability among Indian women. METHODS: The vaginal pessary nonoxynol-9 was offered as a contraceptive option to 3200 women attending the Family Planning clinics at 31 Human Reproduction Research Centres (HRRCs) of the Indian Council of Medical Research. The other contraceptives offered included an intrauterine device, oral pills, condoms, Norplant, tubal sterilization and vasectomy using the cafeteria approach. Those who accepted nonoxynol-9 were followed up to assess the rates of continuation, failure and side-effects. RESULTS: The nonoxynol-9 pessary was accepted by 541 women who were followed up for 3470 woman-months of use. The reasons given for acceptance were that it was user-controlled and/or they did not wish to use other methods because of the side-effects or contraindications of these methods. The overall continuation rates were 41.2% and 33% at 9 and 12 months of use, respectively. Most women (31.3%) discontinued its use due to personal reasons such as husband dissatisfaction, desire for further pregnancy, irregular use of pessary and difficulty in insertion. Twenty-nine women became pregnant during the study period (15 due to method failure and 14 due to user failure) giving a use-effectiveness of 8.8% at 12 months. The method failure rate was 4.3% at 12 months of use. The failure rates were lower compared with the reported failure rates of barrier contraceptives (1%-30% at 1 year of use) and the side-effects were minimal. CONCLUSION: Nonoxynol-9 had low acceptability (16.9%) and overall continuation rates--41.2% and 33% at 9 and 12 months of use. It could be offered to women looking for a short term, user-controlled contraceptive.

Immunodiagnostic moieties in somatic and excretory/secretory antigens of Fasciola gigantica.

Immunodiagnostic potential fractions in fluke antigens and excretory/secretory (E/S) antigen of F. gigantica have been identified using double immunodiffusion (DID), immunoelectrophoresis (IEP) and sodium dodecyl sulphate (SDS) PAGE electrophoresis. Hyperimmunised rabbits elicited considerable level of antibody response with few precipitin lines showing reaction of identity in DID suggesting presence of some common fractions in all antigens. Mature fluke somatic (MFSAg) and immature fluke somatic (IMFSAg) antigens showed exactly similar pattern of precipitin lines in both DID and IEP. Antibodies to experimentally infected rabbits with F. gigantica were also detected by DID using MFSAg and E/S antigens at 4 weeks post infection. However, out of 6-7 fractions obtained from Sephadex G-200 column chromatography in MFSAg and IMFSAg antigens only F3, F4 and F5 along with E/S antigen were able to detect antibodies by DID. Mature fluke and E/S antigen separated out in 9 bands in the range of 12 to 95 kDa and 5 bands in the range of 12 to 29 kDa respectively of which proteins of molecular weight 12, 15, 18, 28 and 29 kDa were common in both antigens. Therefore, it appears that immunodiagnostic fractions of antigens may be present in between 12 and 29 kDa.