CA2245920A1 - Contraceptive release systems with antibacterial and/or antiviral effect - Google Patents

Abstract

The invention relates to the combination of at least one compound with contraceptive effect and/or one compound with antibacterial and/or antiviral effect for incorporation/application to an intravaginal, intrauterine or intracervical release system. The invention also relates to the use of said release system.

Description

CA 0224~920 1998-08-11 Contraceptive Release System with an Antibacterial Action and/or an Antiviral Action This invention relates to the combination of at least one compound with (a) a contraceptive action and/or a compound with (b) an antibacterial action and/or (c) an antiviral action, whereby a compound can also have all three properties for incorporation into/application to an intravaginal, intrauterine, or intracervical release system.
Sexually transmitted diseases (STD) represent a serious, growing medical and socioeconomic problem.
A large number of different diseases can be transmitted during sexual intercourse. A distinction is made between bacterial diseases (chlamydia, gonorrhea, syphilis) and viral diseases (cytomegalovirus = CMV, genital herpes simplex = HSV, human papillomavirus = HPV, and human immunodeficiency =
HIV/AIDS).
In the USA, about 12 million individuals ages 15-29 are affected by STDs. Altogether, some type of STDs, excluding AIDS
or HIV, is found in 56 million Americans. New WHO studies show that, at 315 million cases estimated worldwide referred to as "major reproductive health concerns," STDs represent a major health problem. In particular, the estimated 30-40 million HIV
infections with an expected 12-18 million AIDS (acquired immunodeficiency syndrome) cases by the year 2000 (Achieving Reproductive Health for All. The Role of WHO (WHO/FHE/95.6, World Health Organization, Geneva, 1995)) represent a serious threat to world health. Here, especially the precipitously CA 0224~920 1998-08-11 rising numbers of new HIV infections in developing countries can be mentioned, whereby in these countries a major increase in infections in the heterosexual population can be observed.
Estimates suggest that 60~ of HIV infections worldwide are transmitted by heterosexual contact. Also in the USA, there is a growing number o~ HIV infections, which are transmitted via the heterosexual pathway, whereby transmission takes place from male to female in most cases.
In addition to condoms, various antibacterial and antiviral substances (tetracyclines, chlorohexidine, sulfonamides, interferons) are now available for the prevention of STDs. At this time, ISIS2105 (an antisense oligonucleotide) has been tested in clinical trials for treating HPV. The spermicide nonoxynol-9 (N9) inhibits the transmission of gonorrhea and chlamydia. There are indications that N9 inhibits HIV
transmission. The data that are published on this subject are contradictory, however; irritations of the vaginal epithelium can occur with N9; this could promote transmission of STDs.
In addition, the use of so-called aminosterols, such as squalamine, for treating STDs was described in the literature (Aminosterol Antibiotics, Current Opin. Ther. Pat. 3, 1369-1370, 1993; Cohen J. Women: Absent Term in the AIDS Research Equation, Science, 269, 777-780, 1995). Squalamine has a broad range of antibiotic activity (Moore, K., Wehrli, S. et al. Squalamine:
An Aminosterol Antibiotic from the Shark. Proc. Natl. Acad. Sci.
90, 1354-1358, 1992).

CA 0224~920 1998-08-11 In most cases, these substances are used just before intercourse in the form of suppositories, which are inserted into the vagina.
Another approach is based on influencing the pH in the vagina. Studies have shown that HIV is inactivated in an acid medium. In this approach, the pH value, which rises during ejaculation, is kept in the acid range. By inhibiting sodium/hydrogen ion exchange on the cell surface, the pH value can be lowered. Inhibitors of Na/H ion exchange would thus lead to a decline in pH and reduce the chance of infection by HIV, without damaging the vagina or cells of the reproductive tract.
Compounds that inhibit sodium/hydrogen-ion exchange have been described in the literature as possible therapy for the treatment of cardiovascular diseases (Scholz, Albus U. Potential of Selective Sodium-hydrogen Exchange Inhibitors in Cardiovascular Therapy, Cardiovasc. Res. 29, 184-188, 1995). Substances that have this action are mentioned in DE 93/4318756 (Schwark Jan-Robert), DE 93-120374 (Weichert, A.), EP 93-110195 (Weichert, A.) and US4423069 (Zanverid, L.).
All the previously described uses for the prevention of STDs offer only temporary one-time protection, which is to be used in each case before sexual intercourse. As with any one-time application, in this case intake errors and compliance problems can occur. In such a case, the risks of STD-transmission and contraception continue to exist. In the case of purely contraceptive methods, therefore, methods that have a long-term action -- such as, e.g., IUDs, implants, vaginal rings, CA 0224~920 1998-08-11 injections -- are preferred by a large number of women. This is especially true for women in developing countries.
There is therefore an urgent need to make available a system that continuously offers combined protection against STDs and simultaneously more reliable contraceptive protection.
The object of this invention is to provide a system that simultaneously offers contraceptive protection, continuously prevents diseases that are transmitted by sexual intercourse over a long period, and is used by women.
It has now been found that the combination of a compound with (a) a contraceptive action and/or a compound with (b) an antibacterial action and/or (c) an antiviral action, whereby a compound can also have all three properties, offers contraceptive protection for incorporation into/introduction to an intravaginal, intrauterine, or intracervical release system and at the same time prevents diseases that are transmitted by sexual intercourse.
In an especially preferred embodiment of the combination according to the invention, compound (a) with a contraceptive action is levonorgestrel and the compound with (b) an antibacterial action and/or (c) an antiviral action is squalamine, and the release system is an IUD, an intracervical system, or a vaginal ring.
In another embodiment, the invention relates to the use of an intravaginal, intrauterine, or intracervical release system that contains at least one compound with a contraceptive action and/or a compound with an antibacterial action and/or an CA 0224~920 1998-08-11 antiviral action for the prevention of diseases that are transmitted by sexual intercourse.
As release systems, IUDs (Figures 1 and 2), vaginal rings (Figure 3), and cervical systems (Figure 4) according to this invention are suitable.
Intrauterine active ingredient-containing contraceptives are dispensing devices with a reservoir from which active ingredients are released by diffusion. The devices comprise a core that consists of a solid or liquid vehicle that is permeable to a lipophilic pharmaceutical substance in which an excess of pharmaceutical substance is dispersed, and a polymer wall surrounding this core that is permeable to the pharmaceutical substance. The wall is less permeable to the pharmaceutical substance than the vehicle, so that the wall determines the dispensing speed of the pharmaceutical substance into the environs during use. A hydrophilic active ingredient can be partially applied to the device as a mixture with a polar polymer in order to achieve the desired release rates, or the surface of the device is partially coated with a mixture of the hydrophilic pharmaceutical substance and soluble polymers, such as, e.g., polyvinyl alcohol, polyethylene oxide, hydroxypropylmethyl cellulose, and/or carboxymethyl cellulose, in different layers, depending on which release rate is to be achieved. With release systems as described above, the pharmaceutical substances that are contained are dispensed at basically constant speeds.
The use of intrauterine devices (IUDs) for contraception is described in the literature (Speroff, L. and Darney, P. The ~ CA 0224~920 1998-08-11 - Intrauterine Device (Intrauterine). In a Clinical Guide for Contraception, eds. M. Fisher, Williams & Wilkins, Baltimore, Maryland pp. 157-185, 1992). Gestagen-containing IUDs are also already on the market in several countries (Luukkainen, T., Allonen, H., Haukkamaa, M. et al. Five Years' Experience with Levonorgestrel-releasing IUDs. Contraception 33: 139-145, 1986). The contraceptive reliability of IUDs is high. When copper IUDs are used, however, increased menstrual blood loss can occur. An increased risk of infection (Buchan, H., Villard-Mackintosh, L. et al. Epidemiology of Pelvic Inflammatory Disease in Parous Women with Special Reference to Intrauterine Device Use. Br. J. Obstet. Gynecol. 97:780-786, 1990) and the occurrence of ectopic pregnancies are also described in the literature.
IUDs that are loaded with a gestagen seem to prevent elevated menstrual blood loss and even to reduce it significantly; in addition, they combine mechanical contraception with hormonal contraception (e.g., thickening of cervical mucous as a barrier for sperm), which enhances contraceptive protection (Speroff, L.
and Darney, P., The Intrauterine Device (IUD). In a Clinical Guide for Contraception. Eds. M. Fisher, Williams & Wilkins, Baltimore, Maryland, pp. 157-185, 1992).
As antibacterial or antiviral compounds, according to this invention, all compounds are suitable that can be used in an intravaginal, intrauterine, or intracervical release system and have an antibacterial action or an antiviral action.

CA 0224~920 1998-08-11 - In all embodiments of the invention, the antibacterial or antiviral compound is preferably selected from the group of the following compounds:
Squalamine (3B-[3-[(4-aminobutyl)amino]propyl]amino]-5~-cholestane-7~,24-diol-24-sulfate) 3-acetyl-4-hydroxybenzoylguanidine nonoxynol-9 cytokines, such as, for example, the interferons etc.
Peptide antibiotics such as, e.g., magainin:
PGLa (Gly-Met-Ala-Ser-Lys-Ala-Gly-Ala-Ile-Ala-Gly-Lys-Ile-Ala-Lys-Val-Ala-Leu-Lys-Ala-Leu-NHz) Magainin 2 and its analogs:
(Gly-Ile-Gly-Lys-Phe-Leu-His-Ser-Ala-Lys-Lys-Phe-Gly-Lys-Ala--Phe--Val--Gly--Glu--Ile--Met--Asn--Ser--NH2) 1-aryl-2-imidazolyl-alkyl(thio)ether C3lG (mixture that consists of alkyldimethylglycine and alkyldimethylaminoxide (US-P-5,314,917)) or a mixture thereof.
In addition to the antibacterial action and/or antiviral action, some of the above-mentioned substances also have a spermatocidal action.
In a special embodiment, the compound with an antibacterial action and/or an antiviral action is: squalamine (3~-[3-[(4-aminobutyl)amino]propyl]amino]-5~-cholestane-7~,24-diol-24-sulfate) at an effective dosage of 0.01-1 g per release system.

CA 0224~920 1998-08-11 In another preferred embodiment, the compound with an antibacterial action and/or an antiviral action is interferon B.
As contraceptively effective substances, gestagens, antigestagens, etc., such as, e.g., antiestrogens (raloxifen), aromatase inhibitors (fadrozole, atamestane), spermicides, and cytokine-antagonists (interleukins) are suitable.
In all embodiments of the invention, the gestagen is preferably selected from the group of compounds gestodene, progesterone, levonorgestrel, cyproterone acetate, chlormadinone acetate;
drospirenone (dihydrospirorenone), norethisterone, norethisterone acetate, norgestimate desogestrel 3-ketodesogestrel or a mixture thereof.
In an especially preferred embodiment, the gestagen is:
gestodene, levonorgestrel, or 3-ketodesogestrel.
In another especially preferred embodiment, the gestagen is levonorgestrel at a dosage of 0.01 g - 1.0 g per release system.
As competitive progesterone antagonists according to this invention, all compounds are suitable that themselves or whose metabolic products block the action of the progesterone on its CA 0224~920 1998 - 08 -11 receptor. As typical competitive progesterone antagonists, we can mention here as examples 17~-Ethinyl-17B-hydroxy-llB-(4-methoxyphenyl)-estra-4,9-dien-3-one llB-(4-acetylphenyl)-17B-hydroxy-17~-(1-propinyl)estra-4,9-dien-3-one (Z)-llB-(4-acetylphenyl)-17B-hydroxy-17~-(3-hydroxy-1-propenyl)estra-4,9-dien-3-one llB-[4-(dimethylamino)phenyl]-17B-hydroxy-17~-(1-propinyl)estra-4,9-dien-3-one (RU 38 486) (Z)-9,lla-dihydro-17B-hydroxy-17~-(3-hydroxy-1-propenyl)-6'-(3-pyridinyl)-4'H-naphth[3',2',1':10,9,11]estra-4,9(11)-dien-3-one (Z)-llB-[4-(dimethylamino)phenyl]-17B-hydroxy-17~-(3-hydroxy-1-propenyl)estr-4-en-3-one 4',5'-dihydro-llB-[4-(dimethylamino)phenyl]-6B-methylspiro[estra-4,9-diene-17B,2'(3'H)-furan]-3-one llB-(4-acetylphenyl)-19,24-dinor-17,23-epoxy-17~-chola-4,9,20-trien-3-one 4',5'-dihydro-llB-[4-(dimethylamino)phenyl]-7B-methylspiro[estra-4,9-diene-17B,2'(3'H)-furan]-3-one and l9,11B-bridged steroids from EP-A-0 283 428 and lOB-H steroids from EP-A-0 404 283.
In an especially preferred embodiment of the invention, the competitive progesterone antagonist is the compound (Z)-llB-[4-(dimethylamino)phenyl]-17B-hydroxy-17~-(3-hydroxy-1-CA 0224~920 1998-08-11 propenyl)estr-4-en-3-one or a compound that is comparable in its profile.
This list is not exhaustive; other competitive progesterone antagonists that are described in the above-mentioned publications and in publications that are not mentioned are also suitable.
In addition to the maximum amount of contraceptive protection, at the same time the transmission of various STDs is effectively prevented by the combination according to the invention of a contraceptively effective compound and/or an antivirally effective and/or antibacterially effective compound in a release system since both active components are released locally (uterus, cervix, vagina) uniformly at a desired dose over a desired period. By local administration (IUD, vaginal ring, cervix system), a local effect in the endometrium is achieved.
The inventive combination thus makes available effective protection against pregnancy and the transmission of STDs, which acts continuously over a specific period at the desired site of action.

CA 0224~920 1998-08-11 Examples The invention is explained in greater detail by the following nonlimiting examples:
In this case, the relative proportions of active ingredient and polymer vehicle in devices 1, 2, and 3 can vary within broad limits, depending on the effectiveness of the active ingredients, the speed with which they are dispensed from the device, and the duration of the dispensing. In this respect, the devices according to the invention are provided to dispense one or more active ingredients over a prolonged period, and therefore the proportion of active ingredient or active ingredients is generally considerable, i.e., it constitutes approximately 40 to 70% by volume of the mixtures of vehicle and active ingredient.

Example 1 T-shaped IUD (Figure 2) A dispensing device for two pharmaceutical substances of the type that is shown in Figure 1 is produced as follows:
0.075 g of levonorgestrel is processed with a silicone-based polymer by extruding in such a way that the active ingredient is embedded in the plastic material and the two form the core of the device. The mixture of levonorgestrel to silicone polymer that is used is 70:30. The core is coated with a silicone-based polymer wall and poured into the known T-shape in another process step. 0.1 g of squalamine is applied as a mixture with 0.05 g of a polyacrylate-based polymer at a ratio of 40:60 partially on rod-shaped parent substance (1). In this case, the proportion of CA 0224~920 1998 - 08 -11 the polymer in the mixture is defined by the release rates that are to be achieved.
Usually, such a tubular container has a diameter of several millimeters and a length of several centimeters.

~xample 2 Ball-and-rod-shaped IUD
While they are in use, all T-shaped intrauterine contraceptives can lead to undesirable side-effects such as bleeding and pain. A device that offers a way to avoid these risk factors is described in laid-open specification No. 24 02 882.
The device consists of a round-rod combination of several balls that are made of plastic and have high elasticity, tensile strength, and moderate hardness with a maximum weight of 0.5 g.
It can contain one or more pharmaceutical substances.
Based on this fundamental idea, devices in modified form were produced which, in addition to a lipophilic pharmaceutical substance, preferably a hormone with a gestagenic action, contain a hydrophilic pharmaceutical substance with an antiviral action.
The embodiment of the contraceptive according to the invention and the applicator are shown in Figure 1. A Y-like outline is shown with a total length of 3 to 4 cm. Starting from a central ball (1) with a diameter of 2.5 to 3.0 mm, three round rods (2-4) of different lengths that extend into balls with a diameter of 1.0 to 1.5 mm are arranged. Round rods (3) and (4) end at a length of 0.8 to 1.2 cm (3) or 0.5 to 0.8 cm (4) in -CA 0224~920 l998-08-ll balls (5) and (6) with a diameter of 4 to 5 mm (5) or a diameter of 1.5 to 2.0 mm (6) and are arranged at an obtuse angle to third round rod (2). Third round rod (2) continues in three-round-rod-combination (7, 8, 9) of balls (10-13) with a diameter of 2 to 3 mm in a bean-like end piece (14) with a length of 4 to 5 mm and a diameter of 2 to 3 mm with a central hole (15) with a diameter of 0.5 to 1.5 mm. The eye is provided for fastening a thread (18) that is made of a suitable material, such as, e.g., nylon or polyester. This thread is used as an indicator thread to make it simple to check for the presence of the contraceptive.
To produce the plastic body for the contraceptive according to the invention, plastics that are known in the art are used which, on the one hand, dispense again pharmaceutical substances and, on the other, have adequate mechanical properties, such as tensile strength, elasticity, and cold-drawability and can easily be molded into suitable shapes. For example, polyethylene, polyethylene/vinyl acetate, ionomer resins that are derived from polyethylene, polyamides, polyether-ester-elastomers based on terephthalate, polyethylene glycol terephthalate, and silicone rubber can be mentioned in this connection. The plastics can be used individually or else combined by, e.g., shaping in layers.
The pharmaceutical substances that are included in the contraceptives that have an intrauterine application according to the invention are contained in the plastic base (lipophilic, e.g., levonorgestrel) or attached to the surface of the plastic body (hydrophilic, e.g., squalamine).

CA 0224~920 1998-08-11 Lipophilic pharmaceutical substances can be dispersed homogeneously in the plastic body, optionally also with the aid of adjuvants, or can be contained in individual portions of the contraceptive with or without these adjuvants, e.g., as a core part in a portion of the plastic body, in a suitable quantity.
Adjuvants are, for example, surfactants, highly dispersed silicon dioxide, anti-foaming agents, solubilizers, and resorption-retarding agents.
To a~; n; fiter this contraceptive, insertion tubes that are made of sui~able plastics that are known in the art can be used.
The contraceptive is inserted under aseptic conditions until ball (5) attaches with thread (18) that is fastened to eye (15) and associated connecting and push rods (17). Ball (5) of the device in this case forms a ball closure for the application unit that consists of the contraceptive and applicator. Since the end of the insertion tube is covered, primary injuries during application are impossible. In addition, the ball-shaped end with a diameter of 4 to 5 mm prevents the fundus uteri from being penetrated during application. The application of the contraceptive is easy for one skilled in the art to perform. It can be done without triggering cramp-like pains under aseptic conditions without anesthesia or the use of additional pharmaceutical agents or dilation of the cervical canal itself in women who have ~ot given birth.

CA 0224~920 l998-08-ll Example 2.1 Moldings with a diameter of 2 mm and with a radius of curvature of 3 mm are pressed from a mixture of 50.0 g of micronized levonorgestrel and 49.1 g of lactose, with a 0.1 g of lubricant additive. The levonorgestrel moldings are inserted as cores into ball-shaped parts (5) and alternately into balls (10-13) of an intrauterine contraceptive, whose parent substance and dimensions appear as shown in Figure 1 and which is produced from a mixture of 5.0 g of barium sulfate, 35.0 g of highly dispersed silicon dioxide, and 60.0 g of catalyzed low-temperature-vulcanizing type (LTV) silicone rubber-two-component mass by vulcanization for one hour at 100~C after forming.
The surfaces of the balls of the plastic body are partially coated with the aid of an adhesive base and alternately with a mixture that consists of 0.1 g of squalamine and 0.05 g of a polyacrylate-based polymer (alternately with the loading in of levonorgestrel moldings) to achieve the desired release rates for this pharmaceutical substance.

Example 2.2 The device is produc~d as described in Example 2.1.
The surfaces of the balls are coated with a mixture that consists of 0.1 g of squalamine and 0.06 g of hydroxypropylcellulose/carboxymethylcellulose in various layers to achieve the necessary release rate for the pharmaceutical substance.

. CA 0224~920 1998-08-11 - The polymers that are used are present in solid form before use and dissolve only in the body at body temperature and moisture and, in so doing, dispense the active ingredient at the desired time and dose.

Example 3 Vaginal ring (Figure 3) The vaginal ring represents another variant, which is also modified, as Figure 3 shows. The vaginal ring consists of a carrying ring 1, without active ingredient, a layer 2, which contains a lipophilic active ingredient, e.g., a steroid hormone, and is put into a continuous groove of the carrying ring. This layer 2 is coated with an active ingredient-free third layer.
All components are preferably produced from a silicone base. The ratio of the layer thicknesses of active ingredient-containing layer 2 to active ingredient-free layer 3 is approximately 5-50:1. As a result, a long-lasting uniform release rate for the lipophilic pharmaceutical substance can be achieved. This makes the vaginal ring according to the invention advantageous relative to the vaginal rings that are known to one skilled in the art.
As a mixture with a relatively polar polymer, a hydrophilic pharmaceutical substance can be partially applied on layer 3 as a fourth layer.

CA 0224~920 1998 - 08 -11 ExaDlple 3 .1 The following components are thoroughly mixed to produce carrying ring 1:
232.6 g of vinylpolydimethylsiloxane, molecular weight of M = 5854 17.4 g of tetramethyltetravinylcyclotetrasiloxane 25.0 mg of platinum (mixture A1~
193.8 g of vinylpolydimethylsiloxane 56.2 g of polydimethylhydrosiloxane (mixture B1).
Two mixtures A1 and B1 are homogenized in a static mixer, introduced into an injection-molding device, and vulcanized for a period of 60 sec at 100~C to form rings with a circular cross-section.
The hardness is 45, and the elongation at rupture is 50~.
For the production of layer 2, which contains the lipophilic pharmaceutical substance, the following components are mixed intensively:
49.9 g of vinylpolydimethylsiloxane, M = 8170 0.1 g of tetramethyltetravinylcyclotetrasiloxane 5.0 mg of platinum 0.05 g of levonorgestrel (mixture A2) 48.6 g of vinylpolydimethylsiloxane, M = 8170 1.4 g of polydimethylhydrosiloxane 0.05 g of levonorgestrel (mixture B2) The two mixtures A2 and B2 are homogenized in a static mixer, introduced into an injection-molding device that contains CA 0224~920 l998-08-ll carrying ring 1, and vulcanized over a period of 60 sec at 100~C
on the outside edge of carrying ring 1.
The vaginal rings that are thus produced are sprayed in the region of layer 2 that contains the lipophilic pharmaceutical substance, with a silicone elastomer-based layer 3. The layer thickness of layer 3 is about 200 ~m. This layer forms a mixed vulcanizate with layer 2, which is arranged below.
The pharmaceutical substance-free silicone elastomer mixture consists of:
42.5 g of vinylpolydimethylsiloxane, M = 4561 5.7 g of polydimethylhydrosiloxane 1.8 g of tetramethyltetravinylcyclotetrasiloxane 50 ppm of platinum.
For the production of layer 4, which contains the hydrophilic pharmaceutical substance, the following components are intensively mixed and sprayed partially onto layer 3:
0.05 g of polyacrylate polymer o.l g of squalamine ExamPle 3.2 The vaginal ring is produced as under Example 3.1.
The fourth layer is produced from a mixture of squalamine and hydroxypropylmethylcellulose/carboxymethylcellulose and applied.
0.06 g of hydroxypropylmethylcellulose/
carboxymethylcellulose 0.1 g of squalamine CA 0224~920 1998-08-11 ExamplQ 4 Cervical application system (Figure 4) This is a two-layer, mucous-membrane-adhering system (see Figure 4), which controls a lipophilic pharmaceutical substance from core (1) and dispenses a hydrophilic pharmaceutical substance from outside layer (2).
To this end, a core is produced from a mixture of 0.025 g of micronized levonorgestrel and a silicone-based polymer by extrusion. The mixture of levonorgestrel to silicone polymer that is used is 50:50.
In another process step, a mixture that consists of 0.1 g of squalamine and 0.05 g of a mucoadhesive polymer mixture based on carboxymethylcellulose/polyacrylate or hydroxypropylcellulose/carboxyvinylpolymer and other polymers is partially applied as a second layer with the aid of an adhesive base, in such a way that the desired release rates for these pharmaceutical substances over the desired period are achieved.
Such a container has a diameter of several millimeters and a length of 1-2 centimeters.

Claims (14)

Claims:

1. Combination of at least one compound with (a) contraceptive action and/or a compound with (b) an antibacterial action and/or (c) an antiviral action, whereby a compound can also have all three properties, for incorporation into/application to an intravaginal, intrauterine, or intracervical release system.

2. Combination of at least one compound with (a) contraceptive action and a compound with (b) an antibacterial and/or (c) an antiviral action for incorporation into/application to an intravaginal, intrauterine, or intracervical release system.

3. Combination according to claim 1, in which the release system is an IUD, an intracervical system, or a vaginal ring.

4. Combination according to claim 1, in which the compound with contraceptive action is a gestagen and/or a competitive progesterone antagonist.

5. Combination according to claim 4, in which the compound with contraceptive action is a gestagen that is selected from the group of compounds gestodene, progesterone, levonorgestrel, cyproterone acetate, chlormadinone acetate;
drospirenone (dihydrospirorenone), norethisterone, norethisterone acetate, norgestimate, desogestrel, 3-ketodesogestrel or a mixture thereof, and the competitive progesterone antagonist is selected from the group of compounds:
17.alpha.-Ethinyl-17.beta.-hydroxy-11.beta.-(4-methoxyphenyl)estra-4,9-dien-3-one 11.beta.-(4-acetylphenyl)-17.beta.-hydroxy-17.alpha.-(1-propinyl)estra-4,9-dien-3-one (Z)-11.beta.-(4-acetylphenyl)-17.beta.-hydroxy-17.alpha.-(3-hydroxy-1-propenyl)estra-4,9-dien-3-one 11.beta.-[4-(dimethylamino)phenyl]-17.beta.-hydroxy-17.alpha.-(1-propinyl)estra-4,9-dien-3-one (RU 38 486) (Z)-9,11.alpha.-dihydro-17.beta.-hydroxy-17.alpha.-(3-hydroxy-1-propenyl)-6'-(3-pyridinyl)-4'H-naphth[3',2',1':10,9,11]estra-4,9(11)-dien-3-one (Z)-11.beta.-[4-(dimethylamino)phenyl]-17.beta.-hydroxy-17.alpha.-(3-hydroxy-1-propenyl)estr-4-en-3-one 4',5'-dihydro-11.beta.-[4-(dimethylamino)phenyl]-6.beta.-methylspiro[estra-4,9-diene-17.beta.,2'(3'H)-furan]-3-one 11.beta.-(4-acetylphenyl)-19,24-dinor-17,23-epoxy-17.alpha.-chola-4,9,20-trien-3-one 4',5'-dihydro-11.beta.-[4-(dimethylamino)phenyl]-7.beta.-methylspiro[estra-4,9-diene-17.beta.,2'(3'H)-furan]-3-one or a mixture thereof.

6. Combination according to claim 1, in which the compound with an antibacterial action and/or antiviral action is selected from the group of compounds:
Squalamine (3.beta.-[3-[(4-aminobutyl)amino]propyl]amino]-5.alpha.-cholestane-7.alpha.,24-diol-24-sulfate) 3-acetyl-4-hydroxybenzoylguanidine nonoxyno1-9 cytokines peptide antibiotics 1-aryl-2-imidazolyl-alkyl(thio)ether C31G (mixture that consists of alkyldimethylglycine and alkyldimethylaminoxide or a mixture thereof.

7. Combination according to claim 1, in which compound (a) with a contraceptive action is levonorgestrel, and the compound with (b) an antibacterial action and/or (c) a viral action is squalamine (3.beta.-[3-[(4-aminobutyl)amino]propyl]amino]-5.alpha.-cholestane-7.alpha.,24-diol-24-sulfate)-7, and the release system is an IUD, a cervical system, or a vaginal ring.

8. Use of an intravaginal, intrauterine, or intracervical release system that contains at least one compound with (a) a contraceptive action and/or with (b) an antibacterial action and/or (c) an antiviral action, whereby a compound can also have all three properties to prevent sexually transmitted diseases.

9. Use of an intravaginal, intrauterine, or intracervical release system that contains at least one compound with (a) a contraceptive action in combination with a compound with (b) an antibacterial action and/or (c) an antiviral action for preventing sexually transmitted diseases.

10. Use according to claim 8, in which the release system is an IUD, a cervical system, or a vaginal ring.

11. Use according to claim 8, in which the compound with contraceptive action is a gestagen and/or a competitive progesterone antagonist.

12. Use according to claim 8, in which the compound with contraceptive action is a gestagen that is selected from the group of compounds gestodene, progesterone, levonorgestrel, cyproterone acetate, chlormadinone acetate;
drospirenone (dihydrospirorenone), norethisterone, norethisterone acetate, norgestimate, desogestrel, 3-ketodesogestrel or a mixture thereof, and the competitive progesterone antagonist is selected from the group of compounds:
17.alpha.-Ethinyl-17.beta.-hydroxy-11.beta.-(4-methoxyphenyl)-estra-4,9-dien-3-one 11.beta.-(4-acetylphenyl)-17.beta.-hydroxy-17.alpha.-(1-propinyl)estra-4,9-dien-3-one (Z)-11.beta.-(4-acetylphenyl)-17.beta.-hydroxy-17.alpha.-(3-hydroxy-1-propenyl)estra-4,9-dien-3-one 11.beta.-[4-(dimethylamino)phenyl]-17.beta.-hydroxy-17.alpha.-(1-propinyl)estra-4,9-dien-3-one (RU 38 486) (Z)-9,11.alpha.-dihydro-17.beta.-hydroxy-17.alpha.-(3-hydroxy-1-propenyl)-6'-(3-pyridinyl)-4'H-naphth[3',2',1':10,9,11]estra-4,9(11)-dien-3-one (Z)-11.beta.-[4-(dimethylamino)phenyl]-17.beta.-hydroxy-17.alpha.-(3-hydroxy-1-propenyl)estr-4-en-3-one 4',5'-dihydro-11.beta.-[4-(dimethylamino)phenyl]-6.beta.-methylspiro[estra-4,9-diene-17.beta.,2'(3'H)-furan]-3-one 11.beta.-(4-acetylphenyl)-19,24-dinor-17,23-epoxy-17.alpha.-chola-4,9,20-trien-3-one 4',5'-dihydro-11.beta.-[4-(dimethylamino)phenyl]-7.beta.-methylspiro[estra-4,9-diene-17.beta.,2'(3'H)-furan]-3-one or a mixture thereof.

13. Combination according to claim 8, in which the compound with an antibacterial action and/or an antiviral action is selected from the group of compounds:
Squalamine (3.beta.-t3-[(4-aminobutyl)amino]propyl]amino]-5.alpha.-cholestane-7.alpha.,24-diol-24-sulfate) 3-acetyl-4-hydroxybenzoylguanidine nonoxynol-9 cytokines peptide antibiotics 1-aryl-2-imidazolyl-alkyl(thio)ether C31G (mixture that consists of alkyldimethylglycine and alkyldimethylaminoxide or a mixture thereof.

14. Combination according to claim 8, in which compound (a) with contraceptive action is levonorgestrel, and the compound with (b) an antibacterial action and/or (c) a viral action is squalamine (3.beta.-[3-[(4-aminobutyl)amino]propyl]amino]-5.alpha.-cholestane-7.alpha.,24-diol-24-sulfate), and the release system is an IUD or a vaginal ring.