Men Who Use Erectile Dysfunction Drugs Have Higher Rates of STDs

Laurie Barclay, MD

July 08, 2010

July 8, 2010 — Men who use drugs for erectile dysfunction (ED) have higher rates of sexually transmitted diseases (STDs), particularly HIV infection, both in the year before and the year after use of these drugs, according to the results of a retrospective cohort study reported in the July 5 issue of the Annals of Internal Medicine.

"Pharmacologic treatments for [ED] have gained popularity among middle-aged and older men," write Anupam B. Jena, MD, PhD, from Harvard Medical School in Boston, Massachusetts, and colleagues. "Increased sexual activity among those who use these drugs raises concerns about [STDs]."

Using a database of private, employer-based insurance claims from 44 large companies from 1997 to 2006, this study aimed to compare the rates of STDs in 1,410,806 men older than 40 years who either use or do not use ED drugs. The cohort included 33,968 men with at least 1 filled prescription for an ED drug and 1,376,838 patients with no such prescription.

During the year before and after starting ED drug treatment, men who used ED drugs had higher rates of STDs than did nonusers (year before, 214 vs 106 annually per 100,000 persons; P =.003; year after, 105 vs 65 annually per 100,000 persons; P = .004). Odds ratios (ORs) for an STD in users of ED drugs were 2.80 (95% confidence interval [CI], 2.10 - 3.75) in the year before starting drug treatment and 2.65 (95% CI, 1.84 - 3.81) in the year after starting drug treatment, after adjustment for age and other comorbid conditions.

Differences in rates of STDs for users vs nonusers of ED drugs were largely attributable to differences in rates of HIV infections. For HIV infection, the OR for men using ED drugs was 3.32 (95% CI, 2.38 - 4.36) in the year before an ED drug prescription was filled and 3.19 (95% CI, 2.11 - 4.83) in the year after.

From the year before to the year after the first ED drug prescription was filled, there were no significant changes documented in STD rates. The adjusted OR for STDs for users before vs after the first ED drug prescription was filled was 0.96 (95% CI, 0.87 - 1.06).

Limitations of this study include its retrospective design, lack of randomization, and selection bias preventing determination of whether use of ED treatments directly causes increases in STDs.

"Men who use ED drugs have higher rates of STDs, particularly HIV infection, both in the year before and after use of these drugs," the study authors write. "The observed association between ED drug use and STDs may have more to do with the types of patients using ED drugs rather than a direct effect of ED drug availability on STD rates. Counseling about safe sexual practices and screening for STDs should accompany the prescription of ED drugs."

In an accompanying editorial, Thomas Fekete, MD, from Temple University School of Medicine in Philadelphia, Pennsylvania, notes additional limitations, such as lack of data on sexual activity, possibly inaccurate identification of ED drug use, and underestimation of STD rates.

"From a public health perspective, prevention strategies might be best directed at the highest-risk younger age groups, but this most recent study reminds us that STD counseling should not stop at age 40 years," Dr. Fekete writes. "Clinicians should counsel all of their adult patients about sexual health and safety and remember that no sexually active population group is immune to STDs. Although counseling about safer sex practices should not wait until a patient requests ED medications and is already in a higher-risk group, the presence of higher rates of serious STDs, such as HIV infection, in men who use ED drugs compared with those who do not make it critical that all ED drug prescriptions be accompanied by assessment of STD risk and counseling about safe sex."

The RAND Roybal Center, National Institutes of Health, and Agency for Healthcare Research and Quality supported this study. Financial disclosures of the study authors are reported online. Dr. Fekete has disclosed no relevant financial relationships.

Ann Intern Med. 2010;153:1-7, 49-50.

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