Although the drugs used to treat Erectile Dysfunction, Sildenafil (Viagra), Tadalafil (Cialis) and Vardenafil (Levitra), have generally been proven safe, recreational use of these drugs is associated with higher risks of sexually-transmitted diseases (STD's), including HIV. In a study in the current issue of The American Journal of Medicine, researchers from the San Francisco Department of Public Health evaluated 14 studies of Sildenafil use among men who have sex with men (MSM).

Sildenafil users engaged in unprotected sex with partners of unknown HIV status from twice as often to almost six times as often as non-users. HIV-positive MSM were almost twice as likely to be diagnosed with an STD if they were also Sildenafil users and the newly HIV infected were 2.5 times as likely to be users.

Further complicating the situation, 54% of users mixed Sildenafil with other drugs to enhance the sexual experience. One study reported that 36% of all Sildenafil users combined its use with other drugs, including methamphetamines (23%), ecstasy (18%), poppers (15%), ketamine (11%), and GHB (8%). A study among MSM seeking STD clinic services in San Francisco found Sildenafil to be used concurrently with ecstasy (43%), methamphetamines (28%), and amyl nitrate (15%).

Writing in the article, Jeffrey D. Klausner, MD, MPH, suggests that "Focused action is needed to target this ongoing public health problem. Although the current evidence of association exists only for Sildenafil, likely due to the relatively recent approval of Tadalafil and Vardenafil, the needed action should focus on all three phosphodiesterase inhibitors (PDIs), as the observed associations with Sildenafil use most likely would occur with drugs of identical nature. The labeling for PDIs should be modified to warn users of an increased risk for STDs, including HIV infection. Educational programs, particularly among physicians, MSM, and methamphetamine users, should be implemented to increase a
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Contact: Pamela Poppalardo
p.poppalardo@elsevier.com
212-633-3944
Elsevier Health Sciences
26-May-2005

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