Review
Sildenafil use, sexual risk behavior, and risk for sexually transmitted diseases, including HIV infection

https://doi.org/10.1016/j.amjmed.2005.01.042Get rights and content

Abstract

Purpose

To determine the rates of sildenafil (Viagra) use among different populations, primarily among men who have sex with men, and to measure the association of sildenafil use with increased sexual risk behavior and sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV) infection.

Methods

The National Center for Biotechnology Information PubMed was searched using a variety of terms for relevant publications from January 1999 to July 2004. In addition, all scientific abstracts from national and international conferences on STDs from January 1999 to July 2004 were searched. Relevant journal articles and scientific abstracts presenting original data and meeting given criteria were included.

Results

Fourteen studies met the inclusion criteria. Seven of the 11 studies in men who have sex with men showed sildenafil use rates >10% (range 3%–32%). Increased odds of unprotected anal sex with a partner of unknown or serodiscordant HIV status ranged from 2.0 to 5.7 times (mean = 3.9) for sildenafil users versus nonusers. The risk of sildenafil use and STD diagnosis among HIV-positive men who have sex with men was 1.92 (P = 0.05), and the odds of sildenafil use among those newly HIV infected was 2.5 (95% CI 1.1–4.1).

Conclusions

Most studies reported frequent sildenafil use in men who have sex with men, and several showed independent associations between use of the drug and sexual risk behavior, as well as an increased risk for STDs, including incident HIV infection. Although future research among more varied participants is needed, these results warrant a multi-faceted response to reduce the misuse of sildenafil and its consequences, particularly among men who have sex with men.

Section snippets

Methods

To begin our review, we searched for available articles in the National Center for Biotechnology Information PubMed2 using a variety of terms to maximize article return, including “Viagra and use,” “Viagra and human immunodeficiency virus,” and “Viagra and sexually transmitted disease.” Similar searches were done using the terms Cialis and Levitra, as well as with generic drug terminology and abbreviated terms (sildenafil, tadalafil, vardenafil, HIV, STD). The search was limited to articles

Results

Our initial search of PubMed returned 1543 articles for “Viagra and use,” 38 articles for “Viagra and HIV,” and 4 articles for “Viagra and STD.” Similar searches using the other ED treatment drugs returned 18 articles for “Cialis and use,” 88 articles for “Levitra and use,” 1 identical article for both “Cialis and HIV” and “Levitra and HIV,” and no articles for both “Cialis and STD” and “Levitra and STD.” Numerous duplicates were found among the various search terms. Of these, 7 publications3, 4

Discussion

In several geographical locations, the reviewed studies establish a substantial level of sildenafil use among a variety of samples of men who have sex with men. In these studies, sildenafil was often obtained without a prescription, and use of sildenafil was often combined with other recreational drugs, including methamphetamines and ecstasy. Numerous studies established an association between sildenafil use and increased sexual risk behavior, including unprotected anal sex with a partner of

Acknowledgment

The authors thank Devon Brewer, PhD, Sabina Hirshfield, PhD, Samuel Mitchell, MD, PhD, David Purcell, JD, PhD, Frank Romanelli, PharmD, BCPS, and William Wong, MD, for their assistance in the review of their studies and for providing additional data and information when necessary. We also thank Charlotte Kent, MPH, and Kate Scott, MPH, for their critical review of the manuscript.

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