PIP: The efficacy and use of barrier contraceptives are discussed in the context of the current need to prescribe 2 methods simultaneously to women who are at risk for both pregnancy and sexually transmitted diseases (STDs). Latex condoms prevent passage of bacteria, chlamydia, and viruses, even the small viruses herpes and HIV. Laboratory tests suggest that use of spermicidal lubricants will kill HIV in the event of condom breakage. With the emergence of HIV, condom use has increased among U.S. homosexual men, resulting in a plateau in HIV infections in that group, but use has not risen among teens, iv drug users or their partners. A female condom, consisting of 2 polyurethane rings in a polyurethane sheath, meant to protect women from STDs more effectively, is being studied. It is now recognized that there is some risk of urinary tract infections (UTI) and a slight risk of toxic shock syndrome associated with use of diaphragms. UTIs may be due to obstructive urethropathy, especially if the diaphragm is too large, or to vaginal colonization with E. coli, resulting from constant exposure to the detergent activity of spermicide. It is recommended that neither diaphragms, sponges nor cervical caps be used during menses to reduce risk of toxic shock syndrome, although the most common spermicide, nonoxynol-9, is reported to kill the causative organism, Staph. aureus. Nonoxynol-9 is bactericidal and virucidal, effective against gonococci, chlamydia and HIV. The FDA has approved octoxynol-9 and menfegol for use in over-the-counter spermicides, but turned down 3 other surfactants and 2 mercurials.