Erectile Dysfunction Drug Use, Risk Behavior, and Sexually Transmitted Diseases

Introduction: Erectile dysfunction is a widespread disorder in the United States, most commonly affecting men ages 40-70. Erectile dysfunction drugs (EDDs) are the standard treatment, but because of their ability to intensify sexual activity, they are also used recreationally. EDD use may therefore be associated with high risk behaviors that can lead to sexually transmitted diseases (STDs). We sought to examine this association and identify characteristics associated with EDD use among men seeking care for nongonococcal urethritis (NGU) in an urban STD clinic. Methods: This cross-sectional analysis utilized baseline data from men attending the Public Health: Seattle & King County STD clinic who enrolled in the Mycoplasma genitalium Antibiotic Susceptibility and Treatment trial from January 2007 to July 2011. Men were eligible to participate if they were ≥ 16 years of age and were diagnosed with NGU (≥5 PMNs/HPF in a Gram stained urethral smear or visible urethral discharge). Patients completed a standard self-administered clinic electronic questionnaire collecting symptom, sexual behavior, and risk behavior data. Sociodemographic and clinical characteristics, STD diagnoses at enrollment, history of STD, and additional risk behavior data were abstracted from the clinic medical record. Study participants also completed a study specific computer-assisted self-interview collecting additional risk behavior data, including whether they had ever used any of 4 EDD drugs. Results: A total of 597 sexually active men with NGU and complete data on EDD use were included in the analysis. Median age was 32 (IQR 25.6-39.8), 57.4% were White, 66.7% were men who had sex exclusively with women (MSW), 97% were HIV-negative, and the median number of sex partners in the prior 60 days was 2 (IQR: 1-3). The prevalence of EDD use was 18.8%, and prevalence was higher in men who had sex with male partners (MSM) than in MSW (28.1% versus 14.1%). Although condom use was not significantly associated with EDD use, men ≥ 45 years old were significantly more likely to report EDD use (adjusted prevalence ratio (APR): 7.42, 95% CI: 3.01-18.29, compared to 17-24), as were MSM (APR: 1.41, 1.01-1.95), ecstasy users (APR: 2.17, 1.60-2.94), men reporting ≥ $30,000 yearly income (APR: 1.70, 1.11-2.59, compared to < $10,000), or men with multiple sex partners in the past 60 days (APR: 2.10, 1.33-3.32) . However, STDs were not associated with either detection of prevalent STDs or history of STDs. Conclusion: Among high risk men with NGU, EDD use was associated with older age and several sexual risk behaviors, but not unprotected sex. Despite these elevated risk behaviors, there was no significant association with increased risk of known sexually transmitted pathogens.