Men’s health centre

Men on ED treatment get more STIs

6th July 2010 - Men who are prescribed medication for erectile dysfunction are two to three times more likely to contract sexually transmitted infections (STIs), particularly HIV or chlamydia, than men who are not prescribed ED treatments, researchers report.

An analysis of medical records of 1.4 million men in the US 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 counselling.

"Anyone who does not practice safer sex, no matter their age, can contract an STD," says study author Dr Anupam Jena of the Massachusetts General Hospital department of medicine. "Even though STDs [STIs] are quite rare among older men - in the order of one per 1,000 individuals [in the US] - 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 emphasise safe-sex practices that reduce risk of infection.

ED medication and STIs

Jena and colleagues looked at medical insurance claims from 1997 to 2006 from men over 40 years old who had private medical insurance through 44 employers across the US. They looked at data on 33,968 who had at least one prescription for erectile dysfunction medication and compared them with 1,376,838 men who did not have a prescription for ED medication. The records did not include information about the study participants’ sexual behaviours or practices.

In men with ED drug prescriptions, sexually transmitted infections 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.

The NHS says ED is a very common condition, particularly in older men. It estimates that half of all men between 40 and 70 years of age will experience ED at least once.
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 Dr Dana Goldman, study author and director of the Schaeffer Centre 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, Dr Thomas Fekete, 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 medical 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."