Abstract
In Reply.—Dr Dratman is correct in pointing out, as does our article, that we demonstrated an association of spermicide or diaphragm-spermicide use with bacteriuria and vaginal colonization with Escherichia coli rather than with urinary tract infection (UTI). Given our study design, we did not expect to find an association with infection. However, a strong association between diaphragm-spermicide use and UTI has been established previously1-3 and is widely accepted among investigators in the field. Whether an association exists between spermicide use alone and UTI remains to be established.The mechanisms underlying the findings reported in our study are not known. It seems unlikely that any significant alterations in vaginal flora are due to the latex in condoms because condoms are in relatively brief contact with vaginal flora. We are aware of no data that demonstrate that the latex used in diaphragms has antibacterial effects. It is certainly possible that
