July 6, 2010 -- Men prescribed drugs for erectile dysfunction are two to three times more likely to contract sexually transmitted diseases (STDs), particularly HIV or chlamydia, than men who are not prescribed ED treatments, researchers report.
An analysis of insurance records of 1.4 million men shows that there may be a population at risk for contracting and spreading sexually transmitted diseases and that this group should be targeted for safe-sex counseling.
"Anyone who does not practice safer sex, no matter their age, can contract an STD," says study author Anupam B. Jena, MD, PhD, of the Massachusetts General Hospital department of medicine. "Even though STDs are quite rare among older men -- on the order of 1 per 1,000 individuals -- we found that STD rates in men who used ED drugs were two to three times higher, both before and after they filled their first prescription."
There is no cause-and-effect association between erectile dysfunction treatments and sexually transmitted diseases, but the findings do suggest that people who use such treatments could benefit from interventions that emphasize safe-sex practices that reduce risk of infection.
ED Drugs and STDs
Jena and colleagues looked at insurance claims from 1997 through 2006 from men over 40 years old who had private insurance through 44 employers across the United States. They analyzed billing code data on 33,968 who had at least one prescription for erectile dysfunction drug filled and compared them with 1,376,838 men who did not have a prescription for an ED drug. The insurance records did not include information about the study participants’ sexual behaviors or practices.
In men with ED drug prescriptions, sexually transmitted diseases were higher during the year before beginning ED treatment and the year immediately after, compared to men without a prescription. HIV was the most common infection, followed by chlamydia. The findings are reported in the July issue of Annals of Internal Medicine.
About 40% of men ages 57 to 85 have some erectile dysfunction, researchers cite. The blockbuster impotence drug Viagra, one of the most popular treatments for erectile dysfunction, was approved by the FDA in 1998. As early as 2002 it was estimated that up to 20% of U.S. men over 40 had tried a drug to treat erectile dysfunction. From 1998 to 2003, Viagra use increased from 4.3% to 6.3% among this study sample. Two other ED drugs, Cialis and Levitra, were approved in 2003.
Earlier research has found that people aged 50 and older are one-sixth less likely to use a condom and one-fifth less likely to be tested for HIV compared with people in their 20s.
“Health care providers need to recognize that their older adult patients who are on erectile dysfunction drugs are already at a higher risk of having or acquiring a sexually transmitted disease,” says Dana Goldman, PhD, study author and director of the Schaeffer Center for Health Policy and Economics at the University of Southern California (USC). “Both the physicians who prescribe these drugs and the pharmacists who fill those prescriptions should counsel all patients on the importance of safer sexual practices.”
Safe Sex at Every Age
In an accompanying editorial, Thomas Fekete, MD, section chief of infectious diseases at Temple University School of Medicine in Philadelphia, writes that “this study serves as a reminder that sex after age 40 years isn’t necessarily safe.”
Fekete also noted the limitations of using insurance data to capture what is happening clinically. “The study is powerful, but not elegant,” he writes. “The study could not account for the participants’ frequency of sexual encounters, sexual practices, or the number or sex of their partners. Having this kind of information from a large general population would have great value."