Major Finding: The rate of STDs in the year before receiving a prescription was 214 per 100,000 ED drug users, compared with 106 per 100,000 nonusers, and the rate in the year after receiving a prescription was 105 per 100,000 ED drug users, compared with 65 per 100,000 (adjusted odds ratios of 2.80 and 2.65 for an STD in ED users in the year before and after a prescription, respectively).
Data Source: A retrospective cohort study of 1,410,806 men.
Disclosures: The Bing Study Center for Health Economics and the RAND Roybal Center for Health Policy Simulation sponsored the research for this study. Dr. Jena received support from the National Institutes of Health and the Agency for Healthcare Research and Quality.
Men who use pharmacologic treatment for erectile dysfunction have higher rates of sexually transmitted diseases than do nonusers both before and after they receive a prescription for ED drugs, according to the findings of a retrospective cohort study of 1,410,806 men over age 40.
The rate of sexually transmitted diseases in the year before receiving a prescription was 214 per 100,000 ED drug users, compared with 106 per 100,000 nonusers. In the year after receiving a prescription, the rate was 105/100,000 ED drug users, compared with 65/100,000. The adjusted odds ratios were 2.80 and 2.65 for an STD in ED users in the year before and after a prescription, respectively, Dr. Anupam B. Jena of Massachusetts General Hospital, Boston, and colleagues reported.
The finding of increased risk both before and after receiving a prescription suggests that the association seen in this study has more to do with the types of patients who use ED drugs, than with the actual use of ED drugs, the investigators said (Ann. Intern. Med. 2010;153:1-7).
“Risk assessment for STDs and counseling about safe sexual practices” should accompany the prescription of ED drugs, they wrote, citing their findings as well as those from prior studies showing that condom use declines with age Fue investigators also noted researchindnking ED druguse h high-risksexuavior in men who have sex with men.
For their study, the investigators used a database of insurance claims from 1997 to 2006, including data on 33,968 men with at least 1 filled prescription for an ED drug, and 1,376,838 men with no ED drug prescription. They adjusted for age and comorbid conditions, and found that the differences in STD rates between ED drug users and nonusers were due largely to HIV infection.
The adjusted odds ratios for HIV infection in the year before and after an ED drug prescription were 3.32 and 3.19, respectively.
They noted, however, thatalterall rates of STDs remain low, and the routine testing for STDs in men requesting ED treatment would probably not be cost effective.
My Take
Counsel About Safe Sex After Age 40
Sex after age 40 years remains safer than during adolescence, but the age-related differences in risk have been eroding in recent decades as the rate of STDs in older adults increased, Dr. Thomas Fekete wrote in an editorial.
The increase has occurred in tandem with dramatic increases in the use of the drugs for erectile dysfunction, at least in the last decade, and the findings of Dr. Jena and associates regarding an increased rate of STDs in men over age 40 who use ED drugs (as compared with nonusers) serve as a reminder that STD counseling should not stop at age 40 years (Ann. Intern. Med. 2010;153:49-50).
Indeed, the higher baseline risk for STDs among men who use ED drugs, as demonstrated in this study, must be addressed when prescribing the drugs to these patients and thus enhancing the opportunity for transmission of STDs, he said, noting that although counseling about safer sex practices should not wait until a patient requests ED treatment, “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.”
DR. FEKETE is professor of medicine and chief of infectious diseases at Temple University, Philadelphia.
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