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Erectile dysfunction drug use, STD rate eyed
Check for use of erectile dysfunction (ED) drugs among older male patients; a new analysis of insurance records of more than 1.4 million U.S. men over 40 found that those who used ED drugs were more likely to have sexually transmitted diseases (STDs) than were non-users.1
To perform the study, researchers used a database of insurance claims from 1997 to 2006 to look at 33,968 men with at least one prescription for an ED drug and more than 1 million men without a prescription. They analyzed information from the database to determine the frequency of STDs in men with and without a prescription for an ED drug, looking at billing codes for STDs in the year before and after a patient received the first prescription for an ED drug.
The research indicates that both in the year before and after drug initiation, men
with a prescription had higher rates of STDs than those with no prescription. What were the STDs that accounted for these differences? Predominantly HIV and chlamydia, the scientists report.1
Since the first ED drug sildenafil (Viagra, Pfizer, New York City) was introduced in the United States in 1998, use of such drugs has increased. Why? Statistics indicate nearly 40% of men ages 57 to 85 years have some degree of ED.2 Viagra has been followed by similar drugs such as tadalafil (Eli Lilly, Indianapolis) and vardenafil (Levitra, Bayer Health Care, Berlin, Germany). Another drug soon will join the list. The Food and Drug Administration gave approval in June 2010 to Bayer's Staxyn, a 10 mg vardenafil tablet. The drug, to be marketed later this year by Bayer's U.S. marketing partners, GlaxoSmithKline and Merck & Co., is offered in an orodispersible formulation, meaning that it disintegrates on the tongue without liquid.
Researchers in the current paper note that selection bias precludes conclusions about whether use of ED treatments directly leads to increases in STDs. The researchers plan to further examine the issue, says Anupam Jena, MD, PhD, a resident physician at Massachusetts General Hospital Department of Medicine in Boston. The team is looking at changes around the time that sildenafil was introduced, says Jena, who served as lead author for the current study. Analysis is focusing on those at highest risk of having ED (such as those with diabetes) and comparing them with others with chronic diseases that are not predisposed to the condition, he says.
The scientists also are searching for changes within health plans over time, tracking changes following coverage of ED drugs. By looking for increases in STD rates following drug coverage, the researchers hope to remove selection bias, Jena notes.
When prescriptions for ED drugs are being considered, clinicians and patients should discuss the risk for STDs and ways to prevent getting them and transmitting them to others, says researchers.
Health care providers need to recognize that their older adult patients who are on ED drugs already are at a higher risk of having or acquiring an STD, says Dana Goldman, PhD, director of the Schaeffer Center for Health Policy and Economics at the University of Southern California in Los Angeles, the current study's senior author. 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, he states.
Such counseling is important. Research indicates people over age 50 are one-sixth as likely to use condoms during sex and one-fifth as likely to have been tested for HIV compared with persons in their 20s.3
"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," states an accompanying editorial by Thomas Fekete, MD, professor of medicine and section chief of infectious diseases at the Temple University School of Medicine in Philadelphia. "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."4