HIV-Positive Men Taking Erectile Dysfunction Drugs More Likely to Take Sexual Risks and Have Syphilis

HIV-positive men who had been prescribed medication for erectile dysfunction had a higher rate of syphilis and were more likely to have engaged in sexual risk behaviors than those who had not been prescribed such drugs, according to a study presented at IDWeek 2014.

The study, which was a retrospective cross-sectional sub-study within the larger AIDS Clinical Cohort study, evaluated 1,170 HIV-positive men at the University of Alabama at Birmingham HIV clinic, 269 (23%) of whom had been prescribed erectile dysfunction drugs (EDD).

Previous studies had established that EDD are used more often by HIV-positive men compared to the general population, and even more often by HIV-positive men who have sex with men (MSM) compared to HIV-positive heterosexual men. Increased rates of sexually-transmitted infections (STIs) among both HIV-positive and HIV-negative men in the year before and the year after starting EDD have also been documented.

This study sought to determine whether rates of STI screenings, as well as STIs, are different for HIV-positive men on prescription EDD -- who within that cohort is more likely to be prescribed such medications in the first place -- and how prevalent sexual risk behaviors and substance abuse are among HIV-positive men taking prescription EDD. The STIs considered were syphilis, Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT).

The study population consisted of mostly MSM (890, 76%). The mean age was 50 years, although 38% (441) were older than that. Almost half were African American (539, 46%), and 56% (657) had previously had an STI. More than three quarters (78%, 183) of those prescribed EDD completed a survey on current sexual risk behavior.

The likelihood of being prescribed EDD was similar for MSM and heterosexual men, as well as for African Americans and whites. However, an EDD prescription was more likely for those who were:

• Older than 50 years (P < .001)

• Reported current substance abuse (P < .03)

• Reported at least one sexual risk behavior (P < .001)

• Had previously had an STI (P < .03)

The most commonly reported sexual risk behavior was more than one sexual partner (67% of men on EDD), followed by sex after drinking alcohol or using street drugs (27%) and sex without a condom (21%). Interestingly, almost half the men surveyed (47%) did not report whether or not they had engaged in sex without a condom.

As a result of the screening protocol, almost all men who had been prescribed EDD (253, 94%) were tested for syphilis, but only 31% of heterosexual men and 28% of MSM in that group were tested for GC or CT. None of the heterosexual men tested positive for those two STIs, but 4 MSM did (3 GC and 1 CT).

Four percent (9) of the syphilis tests were positive, more than quadruple the rate among men in the general population. The U.S. Centers for Disease Control and Prevention reported 9.8 syphilis cases among men per 100,000 population in 2013, which corresponds to less than 1% (0.0098%).

As a result, study authors called for more GC and CT screenings in HIV-positive men, especially in MSM. They also concluded that, "Prescription of ED medication to HIV-positive men should be accompanied by assessment and counseling regarding sexual risk behaviors and illicit drug use."