Diaphragm/spermicide use increases the risk of urinary tract infection (UTI). To determine whether spermicide-coated condoms are also associated with an increased risk of UTI, the authors conducted a case-control study at a large health maintenance organization in Seattle, Washington. Cases were sexually active young women with acute UTI caused by Escherichia coli, identified from computerized laboratory files during 1990-1993. Age-matched controls were randomly selected from the enrollment files of the plan. Of 1,904 eligible women, 604 cases and 629 controls (65%) were interviewed. During the previous year, 40% of the cases and 31% of the controls had been exposed to any type of condom. The unadjusted odds ratio for UTI increased with frequency of condom exposure from 0.91 (95% confidence interval (CI) 0.65-1.28) for weekly or less during the previous month to 2.11 (95% CI 1.37-3.26) for more than once weekly. Exposure to spermicide-coated condoms conferred a higher risk of UTI, with odds ratios ranging from 1.09 (95% CI 0.58-2.05) for use weekly or less to 3.05 (95% CI 1.47-6.35) for use more than once weekly. In multivariate analyses, intercourse frequency (odds ratio (OR) = 1.14 per weekly episode), history of UTI (OR = 2.64), and frequency of spermicide-coated condom exposure (OR = 3.34 for more than once weekly and 5.65 for use more than twice weekly) were independent predictors of UTI. Spermicide-coated condoms were responsible for 42% of the UTIs among women who were exposed to these products.
PIP: A large population-based case-control study found that condoms coated with the spermicide nonoxynol-9 were responsible for 42% of urinary tract infections (UTIs) in women exposed to these products. 604 women 18-40 years old who presented to a health maintenance organization in Seattle, Washington, during 1990-93 with acute UTI caused By Escherichia coli served as cases; 629 age-matched controls were randomly selected from the health facility's files. In the preceding month, nonoxynol-coated condoms had been used by 35% of cases and 25% of controls. The unadjusted odds ratios for having an acute UTI among women who had used any type of condom in the previous month and previous year were 1.24 (95% confidence interval, 0.94-1.63) and 1.47 (1.16-1.85), respectively. The UTI risks for women who used the nonoxynol-9 coated condoms in the previous month and more than twice a week during the past year were 1.72 (1.08-2.75) and 2.39 (1.10-5.16), respectively. Independent predictors of UTI, identified through multivariate analyses, included intercourse frequency (odds ratio of 1.14 per weekly episode), past history of UTI (2.64), and frequency of coated condom exposure (3.34 for more than once weekly and 5.65 for use more than twice weekly). Among cases exposed to spermicide-coated condoms during the previous month, 41.9% of UTIs were due to coated condoms. The association confirmed in this study is supported by research indicating that nonoxynol-9 induces changes in the normal vaginal flora that facilitate colonization with coliform bacteria.