Increased risk of HIV and sexually transmitted disease transmission among gay or bisexual men who use Viagra, San Francisco 2000-2001

Increasing incidence of syphilis: A case report of non-resolving papulosquamous rash and role of a biopsy in the prevention of delayed diagnosis

Syphilis is a sexually transmitted infection that is undergoing a resurgence in Canada and around the world. If not diagnosed correctly, syphilis can progress to its secondary and tertiary stages, affecting numerous organ systems. We present a case of a 41-year-old female who developed a papulosquamous rash, initially diagnosed as varicella with progression to a widespread and painful rash over 3 months. Based on clinical, histological, and serological findings, she was later diagnosed with secondary syphilis and successfully treated with intramuscular penicillin. This case underscores the importance of accurate diagnosis and treatment of syphilis to prevent systemic complications. We advocate for increased awareness among frontline providers with a proactive approach to diagnosis and management, including thorough history and physical examination, low threshold for performing serological testing, biopsy for lesions that do not resolve as expected with management, and multidisciplinary involvement for complex presentations of syphilis.

Effects of Erectile Dysfunction Drugs Use on T-cells and Immune Markers on Men Who Have Sex with Men

Objective

Examine prospective relationships between erectile dysfunction (ED) drugs EDand CD4 and CD8 T-cells, and immune markers among men who have sex with men (MSM).

Methods

Data from Multicenter AIDS Cohort Study, an observational prospective cohort study, with semi-annual follow-ups conducted in four U.S. centers from 1998 onwards was used. Marginal structural models using g-computation was fitted to estimate the mean differences for the effects of self-reported ED drug use on CD4 and CD8 T-cell outcomes and immune biomarkers.

Results

Total of 1,391 men with HIV (MWH) and 307 men without HIV (MWOH) was included. Baseline mean CD4 cell count among MWH and MWOH was 499.9 cells/μL and 966.7 cells/μL, respectively. At baseline, 41.8% of MWH were virally suppressed. ED drug users reported a mean of 44.4 months of exposure to ED drugs. ED drug use was associated with increased CD4 cell outcomes among MWH but not MWOH. Mean differences in CD4 cell counts after 1 year of ED drug use was 57.6 cells/μL and increased to 117.7 after 10 years among MWH. CD8 counts were higher in ED drug users among MWH over 10 years than non-users; no consistent differences were found among MWOH. ED drug use appeared to reduce immune marker levels, such as IL-6 and increase markers, such as IL-10. We observed similar effects of ED drug use on biomarker levels among MWOH.

Conclusion

Long-term use of ED drugs do not adversely affect immune function among MWH or MWOH. Future studies on the relationships between different types of ED drugs and effects on T-cell subtypes are warranted.

Characteristics and Longitudinal Patterns of Erectile Dysfunction Drug Use Among Men Who Have Sex with Men in the U.S

We investigated the longitudinal relationship between erectile dysfunction (ED) drug use with behavioral factors, including substance use and sexual activities in men who have sex with men from the Multicenter AIDS Cohort Study during 1998-2016 (n = 1636). We used a bivariate random-intercept model to evaluate ED drug use along with other behavioral factors to assess relationships between the two outcomes over time on a population level and also at the individual level. Average ED drug use among men who have sex with men (MSM) with HIV was positively correlated with average use of marijuana (r = .19), poppers (r = .27), and stimulants (r = .25). In this group, testosterone use (r = .32), multiple partners (r = .41), insertive anal intercourse with condom (r = .40), and insertive anal intercourse without condom (r = .43) all showed moderate correlations over time with average ED use (p < .001). Associations among MSM without HIV were similar, with average marijuana use (r = .19) and stimulant use (r = .22) being positively correlated with average ED drug use, and were also correlated with having multiple partners (r = .36), insertive anal intercourse with condom (r = .22), and insertive anal intercourse without condom (r = .18) over time. Positive within-individual associations between ED drug use and multiple partners and insertive anal intercourse with and without condom were observed regardless of HIV serostatus. This study showed that MSM who reported use of ED drugs were also, on average, more likely to use recreational drugs and engage in sexual activities, such as having multiple partners and insertive anal intercourse. Within individuals, average ED drug use was also positively correlated with sexual behaviors.

Sildenafilo: Prevalencia y factores asociados a su consumo en estudiantes universitarios

Objetivo Determinar la prevalencia y los factores asociados al consumo de sildenafilo en estudiantes universitarios.

Métodos Se realizó un estudio observacional analítico, en estudiantes de la Facultad de Ciencias de la Salud de Instituciones de Educación Superior del municipio de Tunja. La variable dependiente fue el consumo de sildenafilo, las variables independientes fueron: edad, semestre, universidad, estrato, procedencia, pareja estable, actividad sexual actual, actividad física, inicio de las relaciones sexuales, uso de métodos de barrera, asesoría en planificación y disfunción eréctil.

Resultados La prevalencia de consumo de sildenafilo en universitarios fue del 19,25%. Los factores que aumentan el riesgo de consumo son: tener pareja estable, actividad sexual actual, inicio de relaciones sexuales antes de los 14 años y la presencia de disfunción eréctil; mientras se disminuye dicha probabilidad en: los primeros estratos socioeconómicos, no haber escuchado sobre el medicamento, asesoría del personal de salud, conocer las indicaciones, contraindicaciones, efectividad y reacciones adversas del medicamento.

Conclusiones Una quinta parte de los universitarios usan o han usado el sildenafilo. Casi el 80% de ellos han presentado efectos adversos. El consumo frecuente de ese fármaco amerita seguir estudiando esa población universitaria, puesto que no es usual que a esa edad se presente disfunción eréctil, para conllevar a la automedicación del sildenafil por lo tanto, esa conducta debe desencadenar intervenciones desde el área de bienestar universitario, específicamente médica para que se creen estrategias de intervención que apunten a una orientación de sexualidad responsable, y prevenir su uso indiscriminado que puede llevar a riesgos demasiado graves para la salud tanto física como mental.

Influence of Alcohol on Phosphodiesterase 5 inhibitors Use in Middle- to Old-Aged Men: A Comparative Study of Adverse Events

INTRODUCTION

Some previous studies reported recreational use of phosphodiesterase type 5 (PDE-5) inhibitors by ingesting the medicine with alcohol in patients with erectile dysfunction, but the rate of misuse in general population has never been researched.

AIM

To investigate the frequency of concomitant alcohol consumption with PDE-5 inhibitors in the general male population. We secondarily analyzed the influence of alcohol on PDE-5 inhibitor.

METHODS

325 men with erectile dysfunction (age 34-78) who received PDE-5 inhibitors at a single medical institution from January 2016-February 2018 were included in the study. All patients fulfilled a survey questionnaire assessing (i) average alcohol consumption amount, (ii) previous use of PDE-5 inhibitors with alcohol and purpose of concomitant alcohol use, (iii) and background knowledge about PDE-5 inhibitors' side effects.

MAIN OUTCOMES MEASURES

The main outcome measure was frequency of concomitant alcohol consumption with PDE-5 inhibitors in the general male population.

RESULTS

Overall 148 patients committed concomitant alcohol use (group 1), and 177 patients did not (group 2). No significant differences were observed between 2 groups regarding types of PDE-5 inhibitors used and underlying disease. Group 2 had significantly more patients with the correct knowledge concerning concomitant alcohol use than group 1 (24.9% vs 13.5%). Group 1 had more patients with average alcohol consumption >15 drinks/week (64.8% vs 14.1%). The reasons for concomitant alcohol use were curiosity (35.1%), enhancing sexual desire (27%) and recommendation from friends (16.9%). Group 1 showed significantly greater complications, including headache (23.6% vs 7.3%) and facial flushing (69.6% vs 12.4%), than group 2. 1 patient in group 1 experienced severe chest discomfort and underwent coronary artery angiography, but no severe obstructive lesion was observed.

CONCLUSION

45.5% of middle- to old-age men committed concomitant use of PDE-5 inhibitor with alcohol because of recreational purpose, and this alcohol abuse might lead to severe complications, including chest discomfort and dizziness. Kim JN, Oh JJ, Park DS, et al. Influence of Alcohol on Phosphodiesterase 5 inhibitors Use in Middle- to Old-Aged Men: A Comparative Study of Adverse Events. Sex Med 2019;7:425-432.

Self-identified sexual orientations and high-risk sexual behaviours among Chinese youth

PURPOSE

High-risk sexual behaviour is a factor affecting the health of sexual minority students, yet few related studies have been completed among Chinese students. This article explores the distribution of sexual minority groups and its association with high-risk sexual behaviours and symptoms of sexually transmitted infections(STIs) among Chinese college students.

METHODS

An internet-based questionnaire was applied, and a sample of 17 966 surveys from 130 Chinese colleges was collected. Based on their self-reports, participants were classified into the following groups: homosexual male or female, heterosexual, bisexual, and sexual orientation unknown. High-risk sexual behaviours were defined as having sexual intercourse before the age of 18 years, having one's sexual debut with a non-regular partner, having had more than four sexual partners before investigation, and having mostly had sexual intercourse without using condoms. Logistic regression models were constructed to analyse the associations.

RESULTS

The proportions of the homosexual males and females, and the bisexual groups were 1.62%, 0.88% and 5.07%, respectively. Homosexual males were more likely to have their sexual debut with a non-regular partner (OR 4.79, 95% CI 3.38 to 6.78), having more than four sexual partners (OR 5.81, 95% CI 4.06 to 8.32), having their sexual debut before the age of 18 years (OR 1.92, 95% CI 1.34 to 2.76), and not using condoms for most episodes of sexual intercourse (OR 1.47, 95% CI 1.00 to 2.17). Similar associations also existed among homosexual females. A positive association between sexual orientation and having symptoms of STIs (OR 1.49, 95% CI 1.02 to 2.18) was found among homosexual males.

CONCLUSIONS

Sexual minority groups among Chinese college students had a greater risk of engaging in high-risk sexual behaviours and having STI symptoms. Future studies and interventions should focus on this population.

Erectile Dysfunction Medication Prescription: STI and Risk Behavior in Men with HIV

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. 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.

Overall Mental Health and Misuse of Erectile Dysfunction Medication Among Sexual Minority Men

Background: Research has noted that rates of recreational use of erectile dysfunction medication (EDM) are particularly high among men who have sex with other men. Though previous research has investigated recreational EDM use in relation to substance use, its association with other general mental health symptoms and diagnoses remains unexamined. Objectives: To address the paucity of research on EDM misuse, the current study examined prevalence rates of EDM misuse among sexual minority men and its association with last 12-month and 30-day mental health symptoms and diagnoses. Method: A secondary analysis of 7,658 sexual minority undergraduate and graduate male students recruited as part of the American College of Health Association's National College Health Assessment was performed. Results: Results indicated that 2.2% of sexual minority men reported misuse of EDMs within the last 12 months. Last 12-month EDM misuse was significantly associated with a number of mental health symptoms and diagnoses in the last 12 months and last 30 days. Most notably, small to moderate effects were found for misuse of other prescribed medications, such as antidepressants, painkillers, and sedatives, and diagnosis of substance use within the last 12 months. Small effects were found for sedatives and steroid misuse in the last 30 days. Conclusion: Results suggest that worse mental health, particularly substance use, is associated with EDM misuse among sexual minority men. As such, further research in this area is needed.

An Update on the Global Epidemiology of Syphilis

PURPOSE OF REVIEW

Syphilis continues to cause morbidity and mortality worldwide. While syphilis infection is easily identifiable and treatable, rates of syphilis infection continue to increase among select populations in high-income countries and remain at endemic levels in low- and middle-income counties.

RECENT FINDINGS

World Health Organization recommended strategies have led to the dual elimination of mother-to-child transmission of syphilis and HIV in several countries, however outbreaks among select populations need to be adequately addressed.

SUMMARY

Continued vigilance and investment is needed to address syphilis worldwide. The epidemiology of syphilis differs in high-income and low- and middle-income counties.

Off-Label Use of Phosphodiesterase Type 5 Inhibitor Erectile Dysfunction Medication to Enhance Sex Among Gay and Bisexual Men in Australia: Results From the FLUX Study

BACKGROUND

Gay and bisexual men (GBM) use oral erectile dysfunction medications (EDMs) often with little evidence of medical indication necessitating their use.

AIM

To investigate the prevalence, contexts, and motivations for oral EDM use and its relation to sexual risk behavior.

METHODS

A total of 2,250 Australian GBM completed an online survey of licit and illicit drug use and their associated behaviors. Multivariate logistic regression analysis identified factors associated with use of EDMs in the previous 6 months and, for those who had used EDMs, factors associated with use on a weekly basis.

OUTCOMES

Any EDM use and at least weekly use in the previous 6 months.

RESULTS

The median age of the sample was 33.0 years (range = 16-81). Two thirds (67.7%) reported no lifetime history of EDM use. Approximately 1 in 10 participants (11.1%) had last used an EDM more than 6 months previously. In the previous 6 months, 11.5% reported using EDMs less than monthly, 5.3% reported using EDMs approximately monthly, and 4.5% reported using EDMs at least weekly. Of men who had used EDMs in the previous 6 months, common reasons cited for its use were to maintain an erection for longer (73.3%), to make it easier to "get hard" (67.3%), and difficulty in attaining or maintain an erection (53.5%). Use of EDMs in the previous 6 months was associated with illicit drug use and higher rates of sexual risk behavior. Weekly users were more likely to have severe anxiety than less frequent users.

CLINICAL TRANSLATION

The use of EDMs in the context of intensive sex partying, with the associated potential for increased risk of HIV transmission and illicit drug use, indicates a need to consider the use of EDMs among GBM in HIV prevention and minimizing harm.

STRENGTHS AND LIMITATIONS

This large-scale study of drug use among GBMs includes comprehensive detailed data on their history of use and rationales for use. Our online methodology potentially decreases social desirability bias in reporting illegal or stigmatized behaviors. This volunteer online convenience sample might not be representative of all GBMs in Australia.

CONCLUSION

GBMs who used an oral EDM in the previous 6 months often used it for recreational purposes, but many of those who used it on a weekly basis also might have used it for therapeutic reasons. GBMs often use EDMs to enhance their sexual experiences often in the context of intensive sex partying (which can include risky sexual behavior). Hammoud MA, Jin F, Lea T, et al. Off-Label Use of Phosphodiesterase Type 5 Inhibitor Erectile Dysfunction Medication to Enhance Sex Among Gay and Bisexual Men in Australia: Results From the FLUX Study. J Sex Med 2017;14:774-784.

Update on the Safety of Phosphodiesterase Type 5 Inhibitors for the Treatment of Erectile Dysfunction

INTRODUCTION

Phosphodiesterase type 5 inhibitors (PDE5Is) have demonstrated efficacy in the treatment of erectile dysfunction (ED). Although historically found to have limited drug-related adverse events, emerging data have suggested that PDE5Is might be associated with melanoma or recurrence of prostate cancer after radical prostatectomy.

AIM

To summarize the literature on the safety of PDE5Is.

METHODS

A literature review was performed through PubMed from 1990 through 2016 regarding ED. Keywords used for the search were erectile dysfunction, phosphodiesterase type 5 inhibitors, sildenafil, vardenafil, tadalafil, avanafil, safety, side effects, and adverse events, among others.

MAIN OUTCOME MEASURES

Visual, auditory, cardiovascular, renal, hepatic, priapic, and oncologic outcomes associated with the intake of PDE5Is for the treatment of ED, in addition to drug interactions, abuse, overdose, and the phenomenon of counterfeit medications.

RESULTS

PDE5Is are safe drugs for the management of ED. Although recent studies have shown an increased risk of non-arteritic ischemic optic neuropathy with PDE5Is, the magnitude of that risk is small. The possibility that PDE5Is cause sensorineural hearing loss remains uncertain. PDE5Is display a safe cardiovascular profile if used according to the Princeton III Consensus guidelines. There appears to be an association between PDE5I use and melanoma but the absence of a mechanism of causation raises doubt that the association is cause and effect. PDE5Is do not increase the risk of biochemical recurrence after prostate cancer management. PDE5I abuse and use of counterfeit medications present serious global health concerns.

CONCLUSION

Current data strongly support the efficacy, tolerability, and overall safety of PDE5Is for the treatment of ED. PDE5Is probably cause a small increase in the risk of non-arteritic ischemic optic neuropathy. Evidence on increased rates of melanoma and prostate cancer recurrence is weak and controversial. PDE5Is should still be considered first-line therapy for the treatment of most etiologies of ED. Yafi FA, Sharlip ID, Becher EF. Update on the Safety of Phosphodiesterase Type 5 Inhibitors for the Treatment of Erectile Dysfunction. Sex Med Rev 2018;6:242-252.

Erectile Dysfunction Medication Prescription and Condomless Intercourse in HIV-Infected Men Who have Sex with Men in the United States

Using nationally representative data, we assessed the prevalence of erectile dysfunction medication (EDM) prescription, and its association with insertive condomless anal intercourse (CAI) with an HIV-serodiscordant partner among sexually-active HIV-infected men who have sex with men (MSM) receiving medical care in the United States. Overall, 14 % (95 % CI 12-16) were prescribed EDM and 21 % (95 % CI 19-23) engaged in serodiscordant CAI. MSM who were prescribed EDM were more likely to engage in insertive CAI with a serodiscordant casual partner than those not prescribed EDM after adjusting for illicit drug use before or during sex (adjusted prevalence ratio = 1.38; 95 % CI 1.01-1.88). We found no association with main partners. Only 40 % (95 % CI 36-44) of MSM prescribed EDM received risk-reduction counseling from healthcare professionals. Risk-reduction counseling should be provided at least annually to all HIV-infected persons as recommended, especially at the time of EDM prescription.

Incidence of syphilis seroconversion among HIV-infected persons in Asia: results from the TREAT Asia HIV Observational Database

INTRODUCTION

Outbreaks of syphilis have been described among HIV-infected men who have sex with men (MSM) in Western communities, whereas reports in Asian countries are limited. We aimed to characterize the incidence and temporal trends of syphilis among HIV-infected MSM compared with HIV-infected non-MSM in Asian countries.

METHODS

Patients enrolled in the TREAT Asia HIV Observational Database cohort and with a negative non-treponemal test since enrolment were analyzed. Incidence of syphilis seroconversion, defined as a positive non-treponemal test after previously testing negative, was evaluated among patients at sites performing non-treponemal tests at least annually. Factors associated with syphilis seroconversion were investigated at sites doing non-treponemal testing in all new patients and subsequently testing routinely or when patients were suspected of having syphilis.

RESULTS

We included 1010 patients from five sites that performed non-treponemal tests in all new patients; those included had negative non-treponemal test results during enrolment and subsequent follow-ups. Among them, 657 patients were from three sites conducting regular non-treponemal testing. The incidence of syphilis seroconversion was 5.38/100 person-years (PY). Incidence was higher in MSM than non-MSM (7.64/100 PY vs. 2.44/100 PY, p<0.001). Among MSM, the incidence rate ratio (IRR) for every additional year from 2009 was 1.19 (p=0.051). MSM status (IRR 3.48, 95% confidence interval (CI) 1.88-6.47), past syphilis diagnosis (IRR 5.15, 95% CI 3.69-7.17) and younger age (IRR 0.84 for every additional 10 years, 95% CI 0.706-0.997) were significantly associated with syphilis seroconversion.

CONCLUSIONS

We observed a higher incidence of syphilis seroconversion among HIV-infected MSM and a trend to increasing annual incidence. Regular screening for syphilis and targeted interventions to limit transmission are needed in this population.

Phosphodiesterase type 5 inhibitors: Irrational use in Saudi Arabia

Objective

To identify the criteria of phosphodiesterase type 5 inhibitor (PDE5i) users and to analyse the knowledge, attitude, and practices of PDE5i use amongst Saudi men.

Subjects and methods

A web-based, cross-sectional survey was conducted in Saudi Arabia between January and April 2015. Sexually active adult men were interviewed using a website questionnaire designed by the authors. Descriptive statistics were used to analyse the data.

Results

In all, 1008 men participated in the survey with 378 (37.5%) reporting use of PDE5i. Of those using PDE5i, 144 (38.1%) reported erectile dysfunction and 234 (61.9%) reported normal erection (recreational users). We found several demographic features, including high education level, health field occupation, high income, smoking, and increased frequency of sexual intercourse amongst the PDE5i users. Most of the PDE5i users (92.3%) had knowledge about PDE5i and 84.1% of them bought it without medical prescription. The most commonly used PDE5i was tadalafil (46.1%) and most of the users (79.9%) reported improvement in their sexual activity after PDE5i usage. Amongst the recreational users, the main reasons for PDE5i usage were curiosity (38.5%) and improving self-confidence (25.6%). Of them, 69.2% reported benefits from PDE5i usage, mainly in the form of enhancement of erection (36.7%) and increasing erection duration (31.2%).

Conclusion

PDE5i use appears to be frequent in Saudi Arabia. Most of the users had knowledge about PDE5i and claimed to get benefits from it, even if used as a recreational drug.

Seroprevalence and risk factors of syphilis among HIV/AIDS patients in Istanbul, Turkey

OBJECTIVE

Data on syphilis seroprevalence among human immunodeficiency virus (HIV)/Acquired immunodeficiency syndrome (AIDS) patients are unavailable in Turkey although they have common transmission routes. Our study is oriented towards the assessment of the seroprevalence of syphilis and the related risk factors in the HIV/AIDS patients followed in our outpatient clinic.

MATERIALS

Newly diagnosed HIV/AIDS cases (n = 308) who attended our outpatient clinic between January 2006 and April 2013 were included in the study. Patient characteristics, medical history, physical examination findings, CD4+ T lymphocyte count, HIV RNA level, rapid plasma reagent (RPR) and Treponema pallidum hemagglutination (TPHA) test results were analyzed retrospectively. TPHA positivity was considered indicative of syphilis-causing T pallidum exposure.

RESULTS

HIV infection was transmitted through heterosexual (n = 176) or homosexual (n =131) contact (266 male, 86.3%; age 38.3 ± 11.7 years; CD4+ T lymphocyte count, 330.6 ± 15.17/mm3). 50.7% of the patients attained only primary education. Out of the 245 cases, who were asked about the number of their sexual partners, 40 patients (26 women) lived in a monogamous relationship. Condom usage was not practiced (57.2%) or was only occasional (34.4% - particularly with their legal spouses and for contraception). Physical exam revealed no signs of syphilis or other STIs. TPHA (+/- RPR) positivity was determined in 40 patients (12.9%), indicating T pallidum exposure. All patients with positive syphilis serology were male (p= 0.0026). T pallidum exposure was determined in 21.3% of homosexual and 6.8% of heterosexual cases (p = 0.0003).

CONCLUSION

Since sexual contact is the most common route of transmission for both infections, syphilis seroprevalence was relatively high in our HIV/AIDS patients. Male and homosexual HIV/AIDS patients constituted a group at the highest risk for syphilis.

Medicated sex in Britain: evidence from the third National Survey of Sexual Attitudes and Lifestyles

OBJECTIVES

To describe the prevalence of medication use to assist sexual performance in Britain and to identify associated factors.

METHODS

Cross-sectional probability sample, undertaken in 2010-2012, of 15 162 people aged 16-74 years, resident in Britain, of whom, 5617 men and 8095 women reported sexual experience (ever) and 4817 men were sexually-active (reported sex in the last year).

RESULTS

Ever use of medication to assist sexual performance (medicated sex) was more commonly reported by men than women (12.9% (95% CI 11.9% to 13.9%) vs 1.9% (95% CI 1.7% to 2.3%)) and associated with older age in men and younger age in women. It was associated with reporting smoking, and use of alcohol and recreational drugs, as well as unsafe sex (≥2 partners and no condom use in the last year) in both men and women. Among men, the proportion reporting medicated sex in the last year was higher among those reporting erectile difficulties (ED) than those not doing so (28.4% (95% CI 24.4% to 32.8%) vs 4.1% (95% CI 3.4% to 4.9%)). In all men, medicated sex was associated with more frequent sexual activity, meeting a partner on the internet, unsafe sex and recent sexually transmitted infections diagnosis; associations that persisted after adjusting for same-sex behaviour and ED. However, there were significant interactions with reporting ED, indicating that among men with ED, medicated sex is not associated with same-sex behaviour and ever use of recreational drugs.

CONCLUSIONS

A substantial minority of people in Britain report medicated sex, and the association between medicated sex and risky sexual behaviour is not confined to high-risk groups.

Sexual history taking and sexually transmitted infection screening in patients initiating erectile dysfunction medication therapy

BACKGROUND

Erectile dysfunction medications are being prescribed frequently; however, little is known about the amount of sexual health screening occurring in this setting.

METHODS

A retrospective cohort study evaluating sexual health and sexually transmitted infection screening occurring in veterans receiving initial erectile dysfunction medication prescription was conducted.

RESULTS

A total of 252 patients received initial erectile dysfunction medication prescriptions between October 1, 2009, and December 31, 2009; had at least 1 health care provider visit 12 months before the date of initial prescription; and had no documentation of previous erectile dysfunction medication use. Approximately 3% of these patients had any aspect of a sexual history recorded in the 24 months surrounding initial erectile dysfunction medication prescription. Sexually transmitted infection screening was 9.9% for syphilis, 4.8% for HIV, and 4.3% for gonorrhea/chlamydia before prescription, with only a slight increase in HIV screening after prescription.

CONCLUSIONS

Minimal sexual health assessment is being performed during the time surrounding initial prescription of erectile dysfunction medication. Further work needs to evaluate patient and provider barriers to basic elements of sexual health care, such as taking sexual histories or screening for sexually transmitted infections.

Health and social problems associated with prescription opioid misuse among a diverse sample of substance-using MSM

This study examines associations between prescription opioid misuse and demographics, substance use, sexual behavior, and related health and social problems. Baseline data were collected between 2008 and 2010 from 515 high risk men who have sex with men, ages 18-55, in the Miami-Ft. Lauderdale metropolitan area who reported heavy substance use and HIV risk in the past 90 days. Prescription opioid misuse was associated with other substance use, drug injection, substance dependence, and history of arrest. Implications, limitations, and directions for future study are discussed.

Prevalence and characteristics of sexual functioning among sexually experienced middle to late adolescents

INTRODUCTION

Little is known about problems in sexual functioning among young people, despite the high rates found in adult samples. It is unclear which problems are most prevalent or how common sexual distress is for young people experiencing problems.

AIMS

This study aims to assess the prevalence, range, and correlates of sexual problems and distress among a sample of adolescents (16-21 years).

METHODS

Participants (mean age 19.2) were recruited from community and area high schools. Male adolescents (n = 114) completed online the International Index of Erectile Function (IIEF) and Premature Ejaculation Diagnostic Tool (PEDT). Female adolescents (n = 144) completed the Female Sexual Function Index (FSFI). Both completed the Female Sexual Distress Scale (FSDS) and the measures of background, relationship characteristics, and sexual histories.

MAIN OUTCOMES MEASURES

Clinical cutoff scores on the IIEF, PEDT, FSFI, and FSDS were used to determine whether there was a significant sexual problem.

RESULTS

Adolescents reported extensive sexual experience, most in relationship contexts. Half of the sample (51.1%) reported a sexual problem; 50.0% reported clinically significant levels of distress associated with it. Similar rates of problems and distress were found among male and female adolescents. For the most part, adolescent characteristics, backgrounds, and experience were not associated with adolescents' sexual problems.

CONCLUSION

Sexual problems are clearly prevalent among adolescents, and distressing to many who experience them, emphasizing a strong need to develop programs to address this issue.

Condom Attitudes of Heterosexual Men Ages 50 and Older Using Prescribed Drugs (Viagra, Cialis, Levitra) to Treat Erectile Dysfunction

The purpose of this study was to explore attitudes about condoms that may affect condom use by heterosexual men ages 50 and older who were sexually active and currently using prescribed oral phosphodiesterase type 5 inhibitor medications (Viagra®, Cialis®, or Levitra®) for treatment of erectile dysfunction. The study was part of a larger study that explored the need for safer-sex health promotion and education for these men. Fifty men completed factor subscales of the Condom Attitude Scale. Subscales were scored and analyzed. Positive factors were found with regard to the Interpersonal Impact, Inhibition, Perceived Risk, Perceived Seriousness, and Global Attitudes subscales. Factors with negative or neutral responses included the Effect on Sexual Experience, Relationship Safety, and Promiscuity subscales. Independent t tests revealed no differences between married and nonmarried men for the mean score on any of the subscales, but there was a difference on the Global Attitude Scale, with younger men having a more positive global attitude than older men. Study findings can be used in the development of health promotion educational activities on condom use as a safer-sex practice.

Prescription drug misuse and sexual risk taking among HIV-negative MSM

Men who have sex with men (MSM) misuse prescription drugs at high rates. Little research has examined the connection between prescription drug misuse and HIV risk in this population. With a community sample of MSM, the authors assessed prescription drug misuse-not including erectile dysfunction medications-and sexual risk behaviors among HIV-negative MSM. The findings indicate that recent prescription drug misusers had higher odds of engaging in unprotected anal intercourse (UAI; OR = 1.63), specifically receptive UAI (OR = 1.58), and more likely to have UAI with a higher number of seroconcordant partners (b = 0.268). MSM who reported recently misusing prescription drugs during sexual encounters were more likely to engage in UAI (OR = 2.02), specifically insertive UAI (OR = 1.86). There was no association between prescription drug misuse and identification as a barebacker. This research indicates that prescription drug misusing MSM are a risk group who may benefit from HIV prevention and intervention efforts.

A pilot study of HIV/STI risk among men having sex with men using erectile dysfunction medications: challenges and opportunities for sexual medicine physicians

INTRODUCTION

A growing literature suggests relationships between erectile dysfunction medications (EDM) and riskier sexual behavior among men who have sex with men (MSM). Questions remain concerning EDM use and related HIV/sexually transmitted infections (STI) risk among older MSM, particularly those 40 years and over, for whom EDM may be medically warranted.

AIM

This exploratory pilot study explores the relationship between EDM and risky sexual behavior in a convenience sample of MSM using EDM and attending historic sex-on-premises venues.

METHODS

We examined anonymous surveys from 139 MSM. Bivariate relationships were examined. We then fit a multiple logistic regression model to determine predictors of engaging in unprotected anal intercourse (UAI) at last EDM, using variables identified as being significantly related to UAI in the bivariate analyses. Potential predictors entered the model in a stepwise fashion.

MAIN OUTCOME MEASURES

The primary outcome measure was engaging in UAI at last EDM use.

RESULTS

MSM participating in the study ranged from 27 to 77 years and averaged 52.0 years (standard deviation = 10.73 years). These participants were primarily older MSM; fewer were younger MSM (12.12%), under age 40. Participants reporting UAI at last EDM use (N = 41) were significantly younger (P < 0.01). Men visiting bars within the last 6 months reported less UAI (P < 0.01). Both variables were independent predictors of UAI in the logistic regression model (P < 0.01).

CONCLUSIONS

Similar to reports from younger MSM, our findings suggest older MSM using EDM and reporting UAI are also recreational drug users. We include recommendations for urologists and other sexual medicine physicians treating MSM who may be at elevated risk for HIV/STI infection because of joint EDM and club drug use.

Acute hepatitis C virus in an HIV clinic: a screening strategy, risk factors, and perception of risk

Acute hepatitis C virus (HCV) infection is being acquired undetected among HIV-infected individuals. A practical way to regularly screen HIV-infected patients for acute HCV irrespective of perceived risk or symptoms is needed. We piloted implementation of an acute HCV screening strategy using routine HIV clinical care schedules and the least costly blood tests, in a Rhode Island HIV care center. Study participants had ongoing HCV risk, completed questionnaires encompassing risk behaviors and perception of risk, and were screened with quarterly alanine aminotransferase (ALT). ALT rise triggered HCV RNA testing, with pooled rather than individual specimen HCV RNA testing for underinsured participants. Participants were primarily older, college-educated men who have sex with men (MSM) with history of sexually transmitted infection other than HIV. One of 58 participants developed acute HCV in 50 person-years of observation for an annual incidence of 2.0% per year (95% confidence interval [CI] 0.05-11.1%). The majority (54%) of MSM did not perceive that traumatic sexual and drug practices they were engaging in put them at risk for HCV. Unprotected sex often occurred under the influence of drugs or alcohol. Self-reported HCV risk and participation in several risk behaviors declined during the study. It was possible to collect frequent ALTs in a busy HIV clinic with 71% of total projected ALTs obtained and 88% of participants having at least one ALT during the 9-month follow-up period. All instances of ALT rise led to reflexive HCV RNA testing. Tracking quarterly ALT for elevation to systematically prompt HCV RNA testing before seroconversion is a promising approach to screen for acute HCV in a real-world HIV clinical setting.

Recreational use of erectile dysfunction medications in undergraduate men in the United States: characteristics and associated risk factors

Mounting evidence indicates that erectile dysfunction medications (EDMs) have become increasingly used as a sexual enhancement aid among men without a medical indication. Recreational EDM use has been associated with increased sexual risk behaviors, an increased risk for STIs, including incident HIV infection, and high rates of concomitant illicit drug use. The aim of the present study was to investigate the characteristics and associated risk factors for recreational EDM use among young, healthy, undergraduate men. A cross-sectional sample of 1,944 men were recruited from 497 undergraduate institutions within the Unites States between January 2006 and May 2007. The survey assessed patterns of EDM use, as well as demographic, substance use, and sexual behavior characteristics. Four percent of participants had recreationally used an EDM at some point in their lives, with 1.4% reporting current use. The majority of recreational EDM users reported mixing EDMs with illicit drugs and particularly during risky sexual behaviors. Recreational EDM use was independently associated with increased age, gay, or bisexual sexual orientation, drug abuse, lifetime number of sex partners, and lifetime number of "one-night stands." Recreational EDM users also reported a 2.5-fold rate of erectile difficulties compared to nonusers. Overall, recreational use of EDMs was associated with sexual risk behaviors and substance abuse; however, a relatively small proportion of undergraduates reported using EDMs. Results also suggest that a sizable portion of recreational EDM users are heterosexual men, and that use does not solely occur within the environments of venues that cater to men having sex with men.

HIV in young men who have sex with men: a review of epidemiology, risk and protective factors, and interventions

Epidemiological studies have found that young men who have sex with men (YMSM) represent the majority of young people infected with HIV annually in the United States. Further, they are one of the few risk groups to show an increase in the rate of infections in recent years. In addition to these disparities in prevalence and infection rates, there is an inequity in prevention and intervention research on this population. The purpose of this article is to review the existing YMSM literature on HIV epidemiology, correlates of risk, and intervention research. The article concludes that promising future directions for basic research include a focus on multiple clustering health issues, processes that promote resiliency, the role of family influences, and the development of parsimonious models of risk. In terms of intervention research, the article suggests that promising future directions include Internet-based intervention delivery, integration of biomedical and behavioral approaches, and interventions that go beyond the individual level to address partnership, structural, community, and network factors.

Recreational use of phosphodiesterase type 5 inhibitors by healthy young men

INTRODUCTION

In recent years, PDE5 inhibitors (PDE5i) use has become more popular among men without ED to enhance sexual performance. However, reports in the literature are scarce.

AIM

The aim of this study was to evaluate the recreational use of PDE5i in healthy young men.

MAIN OUTCOME MEASURES

We evaluated the recreational use of PDE5i among young and healthy men, their main reasons for use, how they were obtained these drugs, and the combination with alcohol or other drugs.

METHODS

Descriptive, transversal study consisting in 400 brief surveys with structured multiple choice and open questions. Nonprobability samples (quota samples) included young men between 18 and 30 years of age in a public area (high schools, universities, and gyms) between August and November 2009. Collecting the questionnaires in a sealed box enforced confidentiality. The survey included demographic and sexual health data and PDE5i use characteristics. For statistical analysis we used Fisher's exact and Mann-Whitney tests.

RESULTS

A total of 321 questionnaires were appropriate for the purposes of evaluation. Mean age and standard deviation were 25.1±3.3 years old. Regarding PDE5i use, 69 men (21.5%) mentioned trying the pill (being sildenafil the most commonly used one) at least one time in their lives and 37 (53.4%) men combined it with alcohol or drugs. Referred sources of acquisition PDE5i were 75.4% (N=52) from a friend, 17.4% (N=15) from a pharmacy/drugstore without a medical prescription, 4.3% (N=3) prescribed by a physician and 2.9% (N=2) through Internet. There were several reasons for taking PDE5i related to sexual confidence, erection quality, and better sexual performance.

CONCLUSION

According to our results, 21.5% of healthy men between 18 and 30 years old used PDE5i as a recreational drug, mostly associated with alcohol or other drugs without medical control. This could have led to misuse and a public health problem. Further studies are needed to evaluate not only PDE5i recreational use prevalence, but also psychosocial determinants, long term safety, misuse, and abuse related to it.

Sexually transmitted diseases among users of erectile dysfunction drugs: analysis of claims data

BACKGROUND

Pharmacologic treatments for erectile dysfunction (ED) have gained popularity among middle-aged and older men. Increased sexual activity among those who use these drugs raises concerns about sexually transmitted diseases (STDs).

OBJECTIVE

To examine the rates of STDs in men who use and do not use ED drugs.

DESIGN

Retrospective cohort study.

SETTING

Database of claims from 1997 to 2006 for 1,410,806 men older than age 40 years with private, employer-based insurance from 44 large companies.

PATIENTS

33,968 men with at least 1 filled prescription for an ED drug and 1,376,838 patients with no prescription.

MEASUREMENTS

STD prevalence among users and nonusers of ED drugs.

RESULTS

Users of ED drugs had higher rates of STDs than nonusers the year before initiating ED drug therapy (214 vs. 106 annually per 100,000 persons; P = 0.003) and the year after (105 vs. 65; P = 0.004). After adjustment for age and other comorbid conditions, users of ED drugs had an odds ratio (OR) for an STD of 2.80 (95% CI, 2.10 to 3.75) in the year before initiating drug therapy; the OR was 2.65 (CI, 1.84 to 3.81) in the year after. These differences were largely due to infections with HIV. The OR for HIV infection was 3.32 (CI, 2.38 to 4.36) in the year before and 3.19 (CI, 2.11 to 4.83) in the year after an ED drug prescription was filled. Significant changes in STD rates from the year before to the year after the first ED drug prescription was filled were not documented (adjusted OR for STD for users before vs. after the first ED drug prescription was filled, 0.96 [CI, 0.87 to 1.06]).

LIMITATION

Selection bias precludes conclusions about whether use of ED treatments directly leads to increases in STDs.

CONCLUSION

Men who use ED drugs have higher rates of STDs, particularly HIV infection, both in the year before and after use of these drugs. The observed association between ED drug use and STDs may have more to do with the types of patients using ED drugs rather than a direct effect of ED drug availability on STD rates. Counseling about safe sexual practices and screening for STDs should accompany the prescription of ED drugs.

PRIMARY FUNDING SOURCE

RAND Roybal Center, National Institutes of Health, and Agency for Healthcare Research and Quality.

Revisiting obesity and condom use in men who have sex with men

The incidence of both eating disorders and sexually transmitted diseases (STD) is relatively high among men who have sex with men (MSM). Yet, only one study has explored the influence of body mass index (BMI) on sexual risk-taking behaviors in this population. The objective of this study was to reexamine the practice of anal intercourse among overweight and obese MSM and to assess the consistency with which condoms were used. MSM who had placed same-sex sexual advertisements were asked to complete a brief online survey. A total of 576 MSM completed the survey, which assessed: age, HIV-status, height, weight, rejection of sexual partners, number of anal intercourse partners, and condom use during anal intercourse. Increased BMI was associated with a lowered likelihood of rejecting sexual partners and decreased number of actual anal intercourse partners. Increased BMI was also associated with decreased condom use. In addition to cardiovascular disease, obese MSM may be at a higher risk for STDs relative to normal weight MSM. There was some evidence to suggest that inconsistent condom use in such men may be an expression of the overexcitement concomitant with the comparatively rare event of acquiring an anal intercourse partner.

Prevalence and predictors of non-medical prescription drug use among men who have sex with men

Although non-medical prescription drug use has dramatically increased in many populations during the past decade, this phenomenon remains understudied among men who have sex with men (MSM). Using a community-based sample of MSM, we provide data on the high prevalence of lifetime and recent non-medical prescription drug use among MSM for a range of prescription drug classes such as pain killers, sedatives, sleep aids, stimulants, and erectile dysfunction medications. The paper also highlights differences in rates of recent non-medical prescription drug use within this population, noting that White MSM, HIV-positive MSM, gay-identified MSM, and MSM over 40 were typically more likely to have recently used a range of prescription drugs than their counterparts. After controlling for various factors, the findings demonstrate that age, HIV-positive status, gay identity, low educational level, and White race are significant correlates of both lifetime and recent non-medical prescription drug use among MSM. The data suggest that prevention and treatment efforts for this population are likely to require some tailoring, particularly for HIV-positive MSM who may have different needs than other MSM given their health concerns and medication regimens.

Conducting drug abuse investigations in natural environments: potential directions for medical toxicology research

Physician-scientists, in the eyes of the National Institutes of Health (NIH), are crucial to the biomedical research enterprise since the development of evidence-based practice based on cutting-edge research. At the same time, NIH has heightened the importance of research mentorship by permitting investigators to revise an application a single time. The current NIH approach, therefore, narrows the margin of error allowable in a proposal and requires that investigators fully develop research protocols for initial submission. The purpose of this manuscript, therefore, is to provide medical toxicologists with a proven research methodology that can be applied to substance abuse investigations. A secondary aim is to provide successful grant language that can be used in subsequent applications for research funding.

Sildenafil (Viagra) and club drug use in gay and bisexual men: the role of drug combinations and context

Data ascertained in a study of club drug use among 450 gay and bisexual men indicate that at least one class of PDE-5 (phosphodiesterase type 5 inhibitor, sildenafil [Viagra]) is used frequently in combination with club drugs such as methamphetamine, MDMA (3,4 methylenedioxymethamphetamine [ecstasy]), ketamine, cocaine, and GHB (gamma hydroxy butyrate). Patterns of sildenafil use in combination with each of the club drugs differ among key demographics including race and age. Multivariate models, controlling for demographic factors, suggest that contextual factors are key to understanding why men mix sildenafil with club drugs, although age may still be an important issue to consider. Of particular importance is the fact that use of club drugs in combination with sildenafil is strongly associated with circuit and sex parties, where a centerpiece of these environments focuses on sexual exchange. These models imply interplay between person-level and contextual factors in explaining drug use patterns and further indicate that interventions aimed at addressing illicit substance use must carefully consider the role of environmental factors in explaining behavior.

Sexual risk behaviors among men who have sex with men using erectile dysfunction medications

This study examined relationships between use of the phosphodiesterase type-5 (PDE-5) inhibitors (erectile dysfunction medications) sildenafil (Viagra), Pfizer, New York, NY), tadalafil (Cialis), Eli Lily, Indianapolis, IN), and/or vardenafil (Levitra), Bayer, Berlin, Germany), substance use, perceptions of risk, and sexual behavior in men who have sex with men (MSM). MSM (N = 342) attending a gay pride festival completed a brief survey assessing sexual behavior, risk perceptions, and substance use, including the use and the source of PDE-5 inhibitors. More than a quarter of the sample (26.3%, n = 89) reported having ever used a PDE-5 inhibitor. Those reporting use of PDE-5 inhibitors had higher rates of sexual risk behaviors and differed in their assessment of the risk of HIV transmission for unprotected anal sex. Users who received PDE-5 inhibitors from their doctors did not report sexual behaviors that differed significantly from those who received PDE-5 inhibitors from nonphysician sources. In a sequential logistic regression analysis, recent PDE-5 inhibitor use was associated with unprotected anal sex after accounting for the influence of age, education, ethnic identity, and substance use. Many MSM users of erectile dysfunction drugs report behaviors that may place their and others' health at risk. Interventions to reduce risk among MSM PDE-5 inhibitor users should be explored.

Risky sexual practices among men who have sex with men in Northeast Brazil: results from four sequential surveys

This paper focuses on recent trends in risky sexual practices for HIV/AIDS among men who have sex with men (MSM) in Fortaleza, Ceará State, Brazil. Four cross-sectional surveys were conducted (1995, 1998, 2002, and 2005) among MSM 14 years or older who reported oral or anal sex in the previous 12 months. Sexual practices were considered risky whenever the respondent reported unprotected receptive or insertive anal intercourse in the six months preceding the interview. Different selection techniques were used to recruit the study population: snowball (1995, 1998, 2002 - 32%); time-space sampling (2002 - 68%); and respondent-driven sampling (2005). Analyses were based on the comparison between proportions. High rates of risky sexual practices were reported in 1995 (49.9%), decreasing in 1998 (32.6%), increasing again in 2002 (51.3%), and showing the lowest level in 2005 (31.4%). Participants with more schooling increased their risky practices from 1998 to 2002, decreasing in 2005. Among individuals with medium or low schooling, risky behavior declined from 2002 to 2005. The article highlights the need for behavioral surveillance to properly address STD/HIV prevention.

Managing Erectile Dysfunction in Patients With Cardiovascular Diseases: The Efficacy and Safety of Phosphodiesterase-5 Inhibitors

Patients with cardiovascular disease have a high prevalence of erectile dysfunction. Recent evidence demonstrated that erectile dysfunction is an early indication of coronary artery disease. Phosphodiesterase-5 (PDE-5) inhibitors are effective in managing erectile dysfunction due to cardiovascular disease. However, when used together with nitrates or other vasodilators such as alpha-antagonists, they may cause hypotension. Clinical studies demonstrated that in patients with stable coronary artery disease, heart failure, and hypertension controlled by medications who were not receiving nitrates, PDE-5 inhibitors were well tolerated. Therefore, it is important for clinicians to carefully evaluate each patient before initiating PDE-5 inhibitors. PDE-5 inhibitors are absolutely contraindicated with concurrent nitrate use. No PDE-5 inhibitors should be administered within 12 hours after the last nitrate dose. If a patient develops chest pain while taking PDE-5 inhibitors, nitrates should be administered only after the PDE-5 inhibitors have been washed out of the system, based on the half-life of individual agents (washed-out period for sildenafil ∽20 hours; vardenafil ∽ 24 hours; tadalafil ∽88 hours [or 3-4 days]). If symptomatic hypotension occurs, patients should be put in a Trendelenburg position. Fluid resuscitation therapy and alpha-agonists should be used to support blood pressure, if necessary. PDE-5 inhibitors have not been studied in patients with severe and unstable cardiac conditions.

Associations between substance use, erectile dysfunction medication and recent HIV infection among men who have sex with men

We conducted a case-control study to compare illicit substance and erectile dysfunction medication (EDM) use between recently HIV-infected and uninfected men who have sex with men (MSM). Eighty-six recently (previous 12 months) HIV-infected MSM (cases) and 59 MSM who recently tested HIV-negative (controls) completed computer-assisted self-interviews. There were no statistical differences in demographics or number of sexual partners by HIV status. Cases were more likely than controls to report methamphetamine or nitrite use, but not EDM, gamma hydroxybutyrate, 3,4 methylenedioxymethamphetamine, cocaine, or marijuana use, in the previous 12 months and with their last three sexual partners in multivariate logistic regression models. Use of nitrites and amphetamine may increase HIV risk among MSM.

Secondary syphilis with ocular manifestations in older adults

We describe 4 patients (age, >50 years) with secondary syphilis. All patients presented with ocular syphilis, and 2 presented with syphilis-negative rapid plasma reagin titers due to a prozone phenomenon. Three male patients reported sildenafil use. The presentation of these patients with ocular syphilis suggests the need for additional clinical studies involving older patients.

Self-reported sexual dysfunction is frequent among HIV-infected persons and is associated with suboptimal adherence to antiretrovirals

Increased occurrence of sexual dysfunction (SD) among patients treated with highly active antiretroviral therapy (HAART) has been reported. To assess prevalence of self-reported SD and to identify factors related to this alteration with special focus to its relationship with adherence behavior, we conducted an intercohort analysis among HIV-infected persons treated with HAART. In an anonymous questionnaire investigating HAART nonadherence, patients were asked to report the occurrence of dysfunction in sexual activity over the previous 4 weeks. Among 612 participants, 125 (21%) reported some degree of SD. "Moderate"/"severe" alterations were reported in 6% and were independently associated with self-reported worsening of viro-immunological parameters (OR 3.90; 95% CI 1.08-14.18), higher symptom score (OR 1.13; 95% CI 1.05-1.22), and reporting abnormal fat accumulation (OR 4.33; 95% CI 1.55-12.11). Furthermore, nonadherent persons had an increased risk of SD (OR 3.44; 95% CI 1.30-9.08). In conclusion, patients' perceived SD represents a relevant problem for HIV-infected persons treated with antiretrovirals and is strongly associated with suboptimal HAART adherence.

Recreational use of PDE5 inhibitors by young healthy men: recognizing this issue among medical students

INTRODUCTION

In recent years, recreational use of phosphodiesterase type 5 (PDE5) inhibitors has become popular as a sexual enhancement aid among some men without erectile dysfunction (ED) and even among women.

AIM

The aim of the present study, therefore, was to investigate the recreational use of PDE5 among young and healthy men.

MAIN OUTCOME MEASURES

We evaluated the use of PDE5 inhibitors among young and healthy men, their main reasons for using these drugs, and their expectations regarding its effects.

METHODS

A survey was carried out among 167 male medical students (21.2 +/- 2.3 years, range 17-31). The surveys were divided into domains, assessing epidemiological data, use of PDE5 inhibitor, and the simplified International Index of Erectile Function (IIEF-5).

RESULTS

All men considered themselves with perfect erectile function. However, 9% reported previous use of PDE5 inhibitors. Of these, 46.7% had used PDE5 inhibitors more than three times, and 71.4% had mixed them with alcohol. Among this group of men, 13.3% had ED according to the IIEF-5. ED occurring with condom use, however, was twice more common, and 71.4% of the men who had taken PDE5 inhibitors thought that the drug had potential to facilitate condom use.

CONCLUSION

In conclusion, the use of PDE5 inhibitors by young men is more frequent than previously reported. Condom-related ED seems to be an underestimated problem, frequently solved with PDE5 inhibitors. However, potential deleterious effects might exist. Because PDE5 inhibitors are being used as non-prescribed drugs by as much as 9% of young men, further studies must evaluate the effects of these drugs in young and healthy men.

Erectile dysfunction medication use among men seeking substance abuse treatment

Few studies of erectile dysfunction (ED) medications use among heterosexual drug using or abusing men have been conducted. The aims of this study were to provide information on ED medication use prevalence, method of acquisition, and sexual effects among men seeking substance abuse treatment. A single time point cross-sectional anonymous survey was completed by 297 men over the age of 18 seeking substance abuse treatment at an outpatient clinic at a Veterans Affairs Medical Center in the Pacific Northwest. Mean age of participants was 49.7 years and 59.4% self-identified as Caucasian. Alcohol (56.7%) and cocaine (26.1%) were the primary drugs of abuse. Lifetime use of ED medications was reported by 24% (95%CI = 8.6%, 39.4%) of men. Almost 69% of ED medication users reported obtaining ED medications from a physician. Fifty-nine percent of ED medication users reported taking the medications to enhance their sexual experience rather than to treat ED, which was marginally associated with stimulant use (OR = 3.86, 95%CI = 0.96, 15.54, p = .057). These results add to an emerging recognition of the need to address the health implications of ED medication use among heterosexual drug using populations.

HIV treatment adherence and sexual functioning

To our knowledge, no studies have considered the bidirectional relationship between HIV infected patients' social/sexual lives and HAART adherence. To determine it's potential impact the study sample consisted of 135 men starting HAART and being followed for 6 months. Twenty percent of men enrolled in the study self-reported non-adherence. Non-adherent patients reported a greater number and severity of adverse effects such as gastrointestinal and body changes. All participants were aware of these risks, requested support, and were advised by the health care providers. As many as 26% of the HIV infected men, at the second visit, reported sexual dysfunction and none received information regarding the possibility of this side effect. Of importance, patients reporting sexual dysfunction, were more likely to report not being fully adherent to the medication (RR=2.46 95% CI 1.3-4.7; P=0.04). Of most concern, none of the men reported looking for medical advice.

Viagra, methamphetamine, and HIV risk: results from a probability sample of MSM, San Francisco

OBJECTIVES

To determine the prevalence and factors of Viagra use in combination with crystal methamphetamine and its association with HIV risk behavior in a probability sample of men who have sex with men (MSM).

STUDY DESIGN

A cross-sectional, random-digit dial telephone survey of MSM in San Francisco conducted between June 2002 and January 2003.

RESULTS

Of the 1976 MSM, 13.5% used Viagra alone, 7.1% used methamphetamine without Viagra, 9.6% used Viagra with a mood-altering substance (excluding methamphetamine), and 5.1% used Viagra with methamphetamine. Of the MSM using Viagra with methamphetamine, 57% were HIV-infected and 24% of these men reported serodiscordant unprotected insertive intercourse. Viagra used with methamphetamine was independently associated with a higher risk of serodiscordant unprotected insertive intercourse, serodiscordant unprotected receptive intercourse, and a recent diagnosis of a sexually transmitted disease.

CONCLUSION

MSM who use Viagra with crystal methamphetamine have high prevalence rates of HIV and engage in HIV risk behaviors.

Diagnosis and management of acute HIV infection

HIV infection starts as an acute, systemic infection, followed by a chronic period of clinical latency, usually lasting 3 to 10 years, which precedes the eventual collapse of the immune system. It is increasingly recognized that events occurring during acute HIV infection may determine the natural course of the disease. The very dynamic events of acute HIV infection provide multiple opportunities for biologic interventions, such as anti-retroviral or immune-based therapies. Similarly, the implementation of public health measures during acute HIV infection could help control epidemics or outbreaks. Many of the dramatic possibilities for intervention in acute HIV infection remain unproved, not the least because of traditional difficulty of diagnosing patients during this early period. This article reviews the natural history, pathogenesis and clinical presentation of acute HIV infection, and suggests a diagnostic and therapeutic approach to guide clinicians dealing with patients with suspected or confirmed acute HIV infection.

Recreational use of erectile dysfunction medication may decrease confidence in ability to gain and hold erections in young males

We aimed to estimate the frequency of recreational use of erectile dysfunction medication (EDM) and to identify any adverse effects on confidence in gaining and holding erections resulting from such use. In addition, we explored differences in erectile function and sexual behavior between recreational and medicinal users of EDM to control for the possibility of recreational users having but not admitting erectile dysfunction. A subset from the Genetics of Sex and Aggression population-based sample of 4428 males with a mean age of 29.51 (s.d.=6.77) years provided information on their use of EDM, erectile function during first intercourse and currently, sexual behavior and confidence in their ability to gain and hold erections. There were 2.6% (n=115) recreational and 0.9% (n=39) medicinal users of EDM. Recreational users had currently significantly lower confidence in their erectile ability than non-users even though they had significantly better erectile function and significantly more unrestricted sexual behavior as well as had more confidence when initiating sexual activity. More frequent use of EDM was associated with significantly less confidence in erectile ability among the recreational users. We conclude that recreational users of EDM may be vulnerable for becoming psychologically dependent on pharmacologically induced erection.

Differences between HIV-positive gay men who 'frequently', 'sometimes' or 'never' engage in unprotected anal intercourse with serononconcordant casual partners: positive Health cohort, Australia

By measuring the actual number of risk acts engaged in by HIV-positive men participating in the Positive Health (PH) cohort study, this paper sets out to document the distribution of risk acts, to report on the proportion of acts of unprotected anal intercourse with casual (UAIC) partners that occurred between HIV-positive men (i.e. seroconcordant positive) and to examine the factors that differentiated men who 'frequently' compared with 'sometimes' or 'never' engaged in unsafe UAIC (i.e. UAIC with serononconcordant partners: partners who have not tested positive for HIV). The findings show that 42.6% of all UAIC acts occurred between seroconcordant HIV-positive partners, posing no risk of HIV infection to an HIV-negative person. A minority of participants (10%) accounted for the majority (70.7%) of the unsafe acts of UAIC. The HIV-positive men who 'sometimes' engaged in unsafe UAIC had higher treatment optimism scores and were more likely to use Viagra in comparison with those who did not engage in such risk. Those who reported 'frequent' engagement in unsafe UAIC were more likely to engage in a range of esoteric sexual practices, be slightly less well educated and be taking antiretroviral therapy compared with HIV-positive men who 'sometimes' engaged in unsafe UAIC. As such, taking ART but not viral load, predicted frequent unsafe UAIC. When considered alongside earlier studies, these results suggest that HIV-negative men who engage in esoteric sexual practices may be at increased risk of HIV transmission, not necessarily because they engage in esoteric sex practices but because of the sub-cultural milieu in which esoteric sex is occurring. The findings from this study also endorse the measurement of UAIC acts as a useful gauge of risk.

Drogues, médicaments et sexualité

De nombreux travaux ethnologiques et psychologiques ont porté sur les répercussions des usages de drogues et, plus récemment, des médicaments sur les fonctions sexuelles. Nous présentons dans cet article les principales dimensions dégagées sur cette question. Dans un premier temps, les substances aphrodisiaques principales sont envisagées à partir des perspectives ethnologiques et expérimentales. Cette recension montre la diversité des contextes et des produits employés, de même que la variabilité des effets. La seconde section porte sur les drogues de synthèse contemporaines, à leurs contextes d’utilisation ainsi qu’aux conséquences sur la sexualité et la prise de risques face aux infections transmissibles sexuellement (ITS) et au VIH/sida. La troisième partie porte sur les développements pharmacologiques qui modulent la fonction sexuelle de même que sur les usages détournés des médicaments à des fins sexuelles récréatives. Ce survol des recherches contemporaines met en évidence la place importante de l’érotisme dans la consommation des différentes substances et l’intérêt de développer un programme d’études plus précis dans ce domaine.