sildenafil-citrate and Gonorrhea

With the advent of effective pharmacotherapy for erectile dysfunction, the risk of sexually transmitted diseases is a possible consequence, especially in the older population. We wanted to review the incidence of sexually transmitted diseases in the older population in an attempt to correlate this with the advent of these new drugs.. Publicly available information on the incidence of HIV, AIDS and gonorrhea was retrieved from the websites of the Centers for Disease Control (CDC), the State of Florida Department of Health, the Senior HIV Intervention Project and the National Association on HIV Over Fifty. National case incidences of HIV and AIDS in men between 1996 and 2000 were examined for trends. National and Florida state trends were compared and, in Florida, Palm Beach, Broward and Dade counties in particular were selected because of their traditionally large retiree population. In addition, the national and Florida state incidences of gonorrheal infection were examined for trends. Statistics on national sildenafil (Viagra) prescriptions were obtained via a personal communication with a regional healthcare representative from Pfizer.. According to the CDC, at the end of 1998 >10% of new AIDS cases nationally were in individuals aged >50 years. In the late 1990s, new AIDS cases rose faster in middle-aged and older adults than in people aged >40 years. Many of the newly diagnosed cases of AIDS may have contracted HIV before the age of 50 years; however, many individuals are newly becoming infected above the age of 50 years. Of the reported AIDS cases in 1996 in individuals aged >/= 50 years, 48% were aged 50-54 years, 26% were aged 55-59 years, 14% were aged 60-64 years and 12% were aged >/= 65 years; 84% of these cases were male, and blacks accounted for the greatest proportion of cases (43%). In the US, 7.5 million prescriptions for sildenafil were written in 1998, 9.5 million in 1999, 12 million in 2000 and 15.5 million in 2001. The age breakdown for these prescriptions was as follows: 40-49 years, 23%; 50-59 years, 35%; and 60-69 years, 25%.. The past decade saw rises in heterosexual transmission of HIV and i.v. drug use, especially in the population aged >50 years. The CDC reports that the incidence of new HIV infection is stabilizing in men aged 30-39 years and even falling in men aged 20-29 years. Gonorrhea is well known to increase infectivity for HIV and other STDs. Although the rates of gonorrhea infection fell throughout the early 1990s, they increased by 9% between 1997 and 1999. The number of sildenafil prescriptions has increased by almost 80% over the last few years. Although there may be multiple contributory factors for these findings, to our knowledge this is the first paper in the urologic literature to examine such trends in the older male population, especially in the light of newly available medications for erectile dysfunction.

Topics: Acquired Immunodeficiency Syndrome; Adult; Age Distribution; Age Factors; Aged; Drug Prescriptions; Erectile Dysfunction; Gonorrhea; Humans; Incidence; Male; Middle Aged; Piperazines; Purines; Sildenafil Citrate; Sulfones; United States; Vasodilator Agents

The study aims were to evaluate the prevalence and predictors of sexual risk behaviors and urethral sexually transmitted disease (STD) among males entering care for HIV infection and to examine if sildenafil prescriptions are associated with potentially transmitting sexual risk behavior (PTSRB). The research design included (1) self-administered questionnaire of symptoms of sexually transmitted infection (STI), number of recent sex partners, unprotected sexual risk behaviors, use of drugs/alcohol during sex, and HIV disclosure; (2) urine gonorrhea/chlamydia polymerase chain reaction (PCR); and (3) record review for sildenafil prescriptions. A PTSRB was defined as insertive anal, vaginal, or oral sex without a condom. Between March 2001 and March 2002, 413 entrants were surveyed. The prevalence of positive urine PCR among those with and without urethral symptoms was 16.7% and 2.4%, respectively. Fifty-one percent met criteria for PTSRB during the preceding month. Those reporting PTSRB were more likely to report multiple partners. In a multiple logistic regression model, the following were significant (p < 0.05) predictors of PTSRB: drug or alcohol use during sex; white race; only male partners, and sildenafil use. Drug use during sex was associated both with more sex partners and more sexual risk behaviors. Always disclosing HIV status was associated with fewer partners. There was a high prevalence of PTSRB among HIV-infected males entering care. Men who have sex with men (MSM), white race, drug/alcohol use during sex, and sildenafil use were independent risk factors. PTSRB was associated with having multiple partners. Physicians should discuss risk behaviors before prescribing sildenafil.

Topics: Adult; California; Chlamydia Infections; Gonorrhea; HIV Infections; Humans; Logistic Models; Male; Mass Screening; Middle Aged; Multivariate Analysis; Phosphodiesterase Inhibitors; Piperazines; Prevalence; Prospective Studies; Purines; Risk Factors; Risk-Taking; Sexual Behavior; Sexually Transmitted Diseases; Sildenafil Citrate; Sulfones; Urethral Diseases