30 May 2005
Recreational Erectile Dysfunction Drug Use A Risk
by George Atkinson

Drugs used to treat erectile dysfunction such as Sildenafil (Viagra), Tadalafil (Cialis) and Vardenafil (Levitra) have generally been established as safe, but recreational use of these drugs is linked to a higher risk of sexually-transmitted diseases, including HIV. A study in The American Journal of Medicine, by researchers from the San Francisco Department of Public Health uncovered some alarming statistics relating to men who have sex with men.

The study found:

• 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 men who have sex with men were almost twice as likely to be diagnosed with an STD if they were also Sildenafil users.
• A little over half of recreational Sildenafil users mixed it with other drugs to enhance the sexual experience. These other drugs included:
  • methamphetamines (23%)
  • ecstasy (18%)
  • ketamine (11%)
  • and GHB (8%).

"Focused action is needed to target this ongoing public health problem. The labeling for erectile dysfunction drugs should be modified to warn users of an increased risk for STDs, including HIV infection. Educational programs, particularly among physicians, men who have sex with men, and methamphetamine users, should be implemented to increase awareness as to the use of these medications and their association with STDs, including HIV infection," said Dr. Jeffrey D. Klausner.

Dr. Joseph S. Alpert, writing in an accompanying commentary, flagged his concerns about the public health implications when Sildenafil and its relatives are used recreationally with illegal drugs. He drew attention to an article in The Lancet in which investigators from Rockefeller University reported on a patient who presented with a new strain of HIV virus that was considerably more virulent than any HIV virus previously found. "This patient had been abusing both Sildenafil and methamphetamine. The question that immediately leapt to mind was: What effect did the combined abuse of these drugs have on the patient? Could this have resulted in the development of the highly virulent HIV mutant? Does this combination drug abuse increase the likelihood of STD transmission and/or the propensity for unsafe sex," questioned Alpert. He concluded by pointing to the need for increased physician and patient education and further exploration of the implications surrounding the abuse of erectile dysfunction drugs.

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