Mucosal disruption due to use of a widely-distributed commercial vaginal product: potential to facilitate HIV transmission.

Policresulen vaginal suppositories are a condensation product of metacresolsulfonic acid and formaldehyde manufactured and distributed mainly for the treatment of vaginitis through a process involving intravaginal mucosal coagulation and subsequent elimination. The authors investigated the use of such suppositories in a sample of female prostitutes in Thailand and whether that use could facilitate HIV transmission. The effects of self-administration of a single suppository by each of 6 women were also directly observed; 3 women were HIV-seronegative and 3 were HIV-seropositive. Of the 200 prostitutes interviewed 32% had used policresulen vaginal suppositories in the preceding year and 46% had ever used them. Many used them to ends not listed on the package insert such as for improving their male partners sexual pleasure and most did not abstain from vaginal sex after use. Among 36 brothel-based and 67 non-brothel-based prostitutes with known HIV infection status the use of the product was not associated with HIV-1 infection. Exfoliation of the vaginal and cervical mucosa was observed in each of the 6 prostitutes directly observed 1 day after product use. An increase in genital HIV-1 RNA shedding was also detected in each of the 3 HIV-seropositive women directly observed. The disruption of genital mucosa caused by the use of policresulen vaginal suppositories may facilitate the transmission of HIV.