Erectile Dysfunction Medication Prescription: STI and Risk Behavior in Men with HIV
Erectile dysfunction (ED) is a common diagnosis in up to 50% of men with HIV and prescription of erectile dysfunction medication (EDM) has been variably associated with increased risk behaviors and acquisition of sexually transmitted infections (STIs). We measured the association of EDM prescription...
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Published in | Journal of sexual medicine Vol. 16; no. 5; pp. 691 - 700 |
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Main Authors | , , , |
Format | Journal Article |
Language | English |
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Elsevier Inc
01.05.2019
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Abstract | Erectile dysfunction (ED) is a common diagnosis in up to 50% of men with HIV and prescription of erectile dysfunction medication (EDM) has been variably associated with increased risk behaviors and acquisition of sexually transmitted infections (STIs).
We measured the association of EDM prescription with bacterial STI testing, STI infection and sexual behavior among men engaged in HIV care.
A retrospective cohort study was conducted among HIV-infected men in care at an urban HIV clinic in Birmingham, Alabama between 2008 and 2016. Paired data analysis was used to compare STI testing and behavioral outcomes during the 12-month period before and after EDM prescription.
Our study outcomes were STI testing and infection rates for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (GC) and incident syphilis as well as risk behaviors before and after EDM prescription.
Of 2924 HIV-infected men engaged in care, 589 (20%) initiated EDM with a new prescription from a clinic provider during the study period. During the year after EDM prescription, all STI testing rates decreased: CT (OR = 0.76; 95% CI: 0.58 - 1.01; P = .06), GC (OR = 0.76; 95% CI: 0.58 - 1.01; P = .06), and syphilis (OR = 0.28; 95% CI: 0.20 - 0.38; P < .001). A total of 43 STIs were detected in this study (10 CT, 8 GC, and 25 syphilis) and 42/43 occurred among men who have sex with men (MSM). Sexual activity rates were high before and after EDM (87.6% vs 82.9%; P = .08), and consistent condom use was rare (6.6% in both time periods). After EDM prescription, the median number of sexual partners in the past 6 months decreased from 2 to 1 among MSM and was stable at 1 among men who have sex with women.
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.
This study provides insight into a common but understudied clinical scenario-ED in men with HIV-in an urban clinic population that is representative of the Southeastern United States. Adherence for ED medication was not assessed and STI risk behaviors were self-reported.
EDM prescription did not lead to any detectable change in risk behavior in this setting but bacterial STI was common among MSM who were tested.
Heudebert JP, Tamhane A, Burkholder GA, Dionne-Odom J. Erectile Dysfunction Medication Prescription: STI and Risk Behavior in Men with HIV. J Sex Med 2019;16:691–700. |
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AbstractList | Erectile dysfunction (ED) is a common diagnosis in up to 50% of men with HIV and prescription of erectile dysfunction medication (EDM) has been variably associated with increased risk behaviors and acquisition of sexually transmitted infections (STIs).
We measured the association of EDM prescription with bacterial STI testing, STI infection and sexual behavior among men engaged in HIV care.
A retrospective cohort study was conducted among HIV-infected men in care at an urban HIV clinic in Birmingham, Alabama between 2008 and 2016. Paired data analysis was used to compare STI testing and behavioral outcomes during the 12-month period before and after EDM prescription.
Our study outcomes were STI testing and infection rates for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (GC) and incident syphilis as well as risk behaviors before and after EDM prescription.
Of 2924 HIV-infected men engaged in care, 589 (20%) initiated EDM with a new prescription from a clinic provider during the study period. During the year after EDM prescription, all STI testing rates decreased: CT (OR = 0.76; 95% CI: 0.58 - 1.01; P = .06), GC (OR = 0.76; 95% CI: 0.58 - 1.01; P = .06), and syphilis (OR = 0.28; 95% CI: 0.20 - 0.38; P < .001). A total of 43 STIs were detected in this study (10 CT, 8 GC, and 25 syphilis) and 42/43 occurred among men who have sex with men (MSM). Sexual activity rates were high before and after EDM (87.6% vs 82.9%; P = .08), and consistent condom use was rare (6.6% in both time periods). After EDM prescription, the median number of sexual partners in the past 6 months decreased from 2 to 1 among MSM and was stable at 1 among men who have sex with women.
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.
This study provides insight into a common but understudied clinical scenario-ED in men with HIV-in an urban clinic population that is representative of the Southeastern United States. Adherence for ED medication was not assessed and STI risk behaviors were self-reported.
EDM prescription did not lead to any detectable change in risk behavior in this setting but bacterial STI was common among MSM who were tested.
Heudebert JP, Tamhane A, Burkholder GA, Dionne-Odom J. Erectile Dysfunction Medication Prescription: STI and Risk Behavior in Men with HIV. J Sex Med 2019;16:691–700. ABSTRACT Introduction Erectile dysfunction (ED) is a common diagnosis in up to 50% of men with HIV and prescription of erectile dysfunction medication (EDM) has been variably associated with increased risk behaviors and acquisition of sexually transmitted infections (STIs). Aim We measured the association of EDM prescription with bacterial STI testing, STI infection and sexual behavior among men engaged in HIV care. Methods A retrospective cohort study was conducted among HIV-infected men in care at an urban HIV clinic in Birmingham, Alabama between 2008 and 2016. Paired data analysis was used to compare STI testing and behavioral outcomes during the 12-month period before and after EDM prescription. Main Outcome Measures Our study outcomes were STI testing and infection rates for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (GC) and incident syphilis as well as risk behaviors before and after EDM prescription. Results Of 2924 HIV-infected men engaged in care, 589 (20%) initiated EDM with a new prescription from a clinic provider during the study period. During the year after EDM prescription, all STI testing rates decreased: CT (OR = 0.76; 95% CI: 0.58 - 1.01; P = .06), GC (OR = 0.76; 95% CI: 0.58 - 1.01; P = .06), and syphilis (OR = 0.28; 95% CI: 0.20 - 0.38; P < .001). A total of 43 STIs were detected in this study (10 CT, 8 GC, and 25 syphilis) and 42/43 occurred among men who have sex with men (MSM). Sexual activity rates were high before and after EDM (87.6% vs 82.9%; P = .08), and consistent condom use was rare (6.6% in both time periods). After EDM prescription, the median number of sexual partners in the past 6 months decreased from 2 to 1 among MSM and was stable at 1 among men who have sex with women. Clinical Implication 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. Strength & Limitations This study provides insight into a common but understudied clinical scenario-ED in men with HIV-in an urban clinic population that is representative of the Southeastern United States. Adherence for ED medication was not assessed and STI risk behaviors were self-reported. Conclusion EDM prescription did not lead to any detectable change in risk behavior in this setting but bacterial STI was common among MSM who were tested. Erectile dysfunction (ED) is a common diagnosis in up to 50% of men with HIV and prescription of erectile dysfunction medication (EDM) has been variably associated with increased risk behaviors and acquisition of sexually transmitted infections (STIs).INTRODUCTIONErectile dysfunction (ED) is a common diagnosis in up to 50% of men with HIV and prescription of erectile dysfunction medication (EDM) has been variably associated with increased risk behaviors and acquisition of sexually transmitted infections (STIs).We measured the association of EDM prescription with bacterial STI testing, STI infection and sexual behavior among men engaged in HIV care.AIMWe measured the association of EDM prescription with bacterial STI testing, STI infection and sexual behavior among men engaged in HIV care.A retrospective cohort study was conducted among HIV-infected men in care at an urban HIV clinic in Birmingham, Alabama between 2008 and 2016. Paired data analysis was used to compare STI testing and behavioral outcomes during the 12-month period before and after EDM prescription.METHODSA retrospective cohort study was conducted among HIV-infected men in care at an urban HIV clinic in Birmingham, Alabama between 2008 and 2016. Paired data analysis was used to compare STI testing and behavioral outcomes during the 12-month period before and after EDM prescription.Our study outcomes were STI testing and infection rates for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (GC) and incident syphilis as well as risk behaviors before and after EDM prescription.MAIN OUTCOME MEASURESOur study outcomes were STI testing and infection rates for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (GC) and incident syphilis as well as risk behaviors before and after EDM prescription.Of 2924 HIV-infected men engaged in care, 589 (20%) initiated EDM with a new prescription from a clinic provider during the study period. During the year after EDM prescription, all STI testing rates decreased: CT (OR = 0.76; 95% CI: 0.58 - 1.01; P = .06), GC (OR = 0.76; 95% CI: 0.58 - 1.01; P = .06), and syphilis (OR = 0.28; 95% CI: 0.20 - 0.38; P < .001). A total of 43 STIs were detected in this study (10 CT, 8 GC, and 25 syphilis) and 42/43 occurred among men who have sex with men (MSM). Sexual activity rates were high before and after EDM (87.6% vs 82.9%; P = .08), and consistent condom use was rare (6.6% in both time periods). After EDM prescription, the median number of sexual partners in the past 6 months decreased from 2 to 1 among MSM and was stable at 1 among men who have sex with women.RESULTSOf 2924 HIV-infected men engaged in care, 589 (20%) initiated EDM with a new prescription from a clinic provider during the study period. During the year after EDM prescription, all STI testing rates decreased: CT (OR = 0.76; 95% CI: 0.58 - 1.01; P = .06), GC (OR = 0.76; 95% CI: 0.58 - 1.01; P = .06), and syphilis (OR = 0.28; 95% CI: 0.20 - 0.38; P < .001). A total of 43 STIs were detected in this study (10 CT, 8 GC, and 25 syphilis) and 42/43 occurred among men who have sex with men (MSM). Sexual activity rates were high before and after EDM (87.6% vs 82.9%; P = .08), and consistent condom use was rare (6.6% in both time periods). After EDM prescription, the median number of sexual partners in the past 6 months decreased from 2 to 1 among MSM and was stable at 1 among men who have sex with women.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.CLINICAL IMPLICATIONManagement 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.This study provides insight into a common but understudied clinical scenario-ED in men with HIV-in an urban clinic population that is representative of the Southeastern United States. Adherence for ED medication was not assessed and STI risk behaviors were self-reported.STRENGTH & LIMITATIONSThis study provides insight into a common but understudied clinical scenario-ED in men with HIV-in an urban clinic population that is representative of the Southeastern United States. Adherence for ED medication was not assessed and STI risk behaviors were self-reported.EDM prescription did not lead to any detectable change in risk behavior in this setting but bacterial STI was common among MSM who were tested. Heudebert JP, Tamhane A, Burkholder GA, Dionne-Odom J. Erectile Dysfunction Medication Prescription: STI and Risk Behavior in Men with HIV. J Sex Med 2019;16:691-700.CONCLUSIONEDM prescription did not lead to any detectable change in risk behavior in this setting but bacterial STI was common among MSM who were tested. Heudebert JP, Tamhane A, Burkholder GA, Dionne-Odom J. Erectile Dysfunction Medication Prescription: STI and Risk Behavior in Men with HIV. J Sex Med 2019;16:691-700. Erectile dysfunction (ED) is a common diagnosis in up to 50% of men with HIV and prescription of erectile dysfunction medication (EDM) has been variably associated with increased risk behaviors and acquisition of sexually transmitted infections (STIs). We measured the association of EDM prescription with bacterial STI testing, STI infection and sexual behavior among men engaged in HIV care. A retrospective cohort study was conducted among HIV-infected men in care at an urban HIV clinic in Birmingham, Alabama between 2008 and 2016. Paired data analysis was used to compare STI testing and behavioral outcomes during the 12-month period before and after EDM prescription. Our study outcomes were STI testing and infection rates for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (GC) and incident syphilis as well as risk behaviors before and after EDM prescription. Of 2924 HIV-infected men engaged in care, 589 (20%) initiated EDM with a new prescription from a clinic provider during the study period. During the year after EDM prescription, all STI testing rates decreased: CT (OR = 0.76; 95% CI: 0.58 - 1.01; P = .06), GC (OR = 0.76; 95% CI: 0.58 - 1.01; P = .06), and syphilis (OR = 0.28; 95% CI: 0.20 - 0.38; P < .001). A total of 43 STIs were detected in this study (10 CT, 8 GC, and 25 syphilis) and 42/43 occurred among men who have sex with men (MSM). Sexual activity rates were high before and after EDM (87.6% vs 82.9%; P = .08), and consistent condom use was rare (6.6% in both time periods). After EDM prescription, the median number of sexual partners in the past 6 months decreased from 2 to 1 among MSM and was stable at 1 among men who have sex with women. 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. This study provides insight into a common but understudied clinical scenario-ED in men with HIV-in an urban clinic population that is representative of the Southeastern United States. Adherence for ED medication was not assessed and STI risk behaviors were self-reported. EDM prescription did not lead to any detectable change in risk behavior in this setting but bacterial STI was common among MSM who were tested. Heudebert JP, Tamhane A, Burkholder GA, Dionne-Odom J. Erectile Dysfunction Medication Prescription: STI and Risk Behavior in Men with HIV. J Sex Med 2019;16:691-700. |
Author | Tamhane, Ashutosh Dionne-Odom, Jodie Heudebert, Jose Pablo Burkholder, Greer A. |
AuthorAffiliation | a Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, 1900 University Boulevard, Birmingham, Al, USA, 35295 b Research and Informatics Services Center, University of Alabama at Birmingham, 1720 2 nd Avenue South, Birmingham, Al, USA, 35294 |
AuthorAffiliation_xml | – name: b Research and Informatics Services Center, University of Alabama at Birmingham, 1720 2 nd Avenue South, Birmingham, Al, USA, 35294 – name: a Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, 1900 University Boulevard, Birmingham, Al, USA, 35295 |
Author_xml | – sequence: 1 givenname: Jose Pablo surname: Heudebert fullname: Heudebert, Jose Pablo email: jheudebert@uabmc.edu organization: Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA – sequence: 2 givenname: Ashutosh surname: Tamhane fullname: Tamhane, Ashutosh organization: Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA – sequence: 3 givenname: Greer A. surname: Burkholder fullname: Burkholder, Greer A. organization: Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA – sequence: 4 givenname: Jodie surname: Dionne-Odom fullname: Dionne-Odom, Jodie organization: Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA |
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Keywords | Screening HIV Men who have sex with men Erectile dysfunction Sildenafil Men who have sex with women Sexual health |
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Snippet | Erectile dysfunction (ED) is a common diagnosis in up to 50% of men with HIV and prescription of erectile dysfunction medication (EDM) has been variably... ABSTRACT Introduction Erectile dysfunction (ED) is a common diagnosis in up to 50% of men with HIV and prescription of erectile dysfunction medication (EDM)... |
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SubjectTerms | Adolescent Adult Chlamydia Infections - epidemiology Erectile dysfunction Erectile Dysfunction - drug therapy Gonorrhea - epidemiology HIV HIV Infections - epidemiology Homosexuality, Male Humans Male Mass Screening Men who have sex with men Men who have sex with women Middle Aged Retrospective Studies Risk-Taking Safe Sex Screening Sexual Behavior - statistics & numerical data Sexual health Sexual Partners Sexually Transmitted Diseases - epidemiology Sildenafil Syphilis - diagnosis Syphilis - epidemiology Young Adult |
Title | Erectile Dysfunction Medication Prescription: STI and Risk Behavior in Men with HIV |
URI | https://dx.doi.org/10.1016/j.jsxm.2019.02.007 https://www.ncbi.nlm.nih.gov/pubmed/30926519 https://www.proquest.com/docview/2200805225/abstract/ https://pubmed.ncbi.nlm.nih.gov/PMC6487224 |
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