Taking medication for erectile dysfunction (ED) does not appear to change risky sexual behaviors in men living with HIV, according to a recent Journal of Sexual Medicine study.
However, bacterial sexually transmitted infections (STIs) were still common, the authors reported.
ED is a frequent problem for men with HIV, and prevalence rates of up to 50% have been estimated. Past studies have shown a link to risky sexual behavior among men who take ED medications, especially in men who have sex with men (MSM). However, less is known about men with HIV.
Because the likelihood of HIV transmission increases with STI coinfection, and STI rates are at “peak levels” in the United States, the authors investigated whether prescriptions for ED medications changed sexual behavior, bacterial STI testing rates, and STI diagnosis rates.
The study began with 2,924 men with HIV who were receiving care at Alabama’s largest HIV clinic between 2008 and 2016. Twenty percent of the group (589 men) were prescribed sildenafil, tadalafil, or vardenafil for the treatment of ED. Sixty-nine percent of the men were MSM; the rest were men who had sex with women (MSW). The men’s overall average age was 48 years.
The researchers looked at screening and diagnosis information for three STIs – chlamydia, gonorrhea, and syphilis – for 12 months before and 12 months after ED medication was prescribed.
Screening rates for chlamydia and gonorrhea were low, the authors reported. Almost half the men were not tested in the year before or after their ED prescription, and less than 20% were screened during both time periods. Syphilis screening was steadier, with 59% of the men tested in both periods.
Forty-three STIs (25 syphilis, 10 chlamydia, and 8 gonorrhea) were diagnosed. Only one MSW had an STI; the rest of the infections occurred in MSM. Testing was less common among MSM.
Information on sexual behavior was available for about 40% of the participants. Of these, 77% were sexually active before and after their ED prescription. Condom use information was available for 68% of the sexually-active men, but only 7% said they used condoms consistently during both time periods. Just over 40% of the men reported having sex after drug or alcohol use.
Several limitations were acknowledged. For example, the participants were from the Southeastern United States, an area that has high rates of HIV and STIs. Their results would not necessarily apply to populations outside this area. In addition, the findings couldn’t be generalized to younger men, men without HIV infection, and men who took ED drugs without a prescription.
The authors recommended more research on when, where, and how frequently ED drugs are used by men with HIV infection.
“The management of ED in HIV clinic provides an excellent opportunity to discuss risk reduction, safer sex practices and the importance of routine STI screening to prevent HIV/STI transmission,” they concluded.
The Journal of Sexual Medicine
Heudebert, Jose Pablo, MPH, et al.
“Erectile Dysfunction Medication Prescription: STI and Risk Behavior in Men with HIV”
(Full-text. Published online: March 26, 2019)