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Post-infection erectile dysfunction risk - comparing COVID-19 with other common acute viral infections: a large national claims database analysis

International Journal of Impotence Research (2023)Cite this article

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Abstract

It is unknown if the risk of erectile dysfunction (ED) following Coronavirus-19 (COVID-19) infection is virus-specific. Our study assessed the risk of ED in COVID-19 patients as compared to patients with other common viral infections. The TriNetX COVID-19 Research Network was queried. We examined cohorts of men aged ≥18 years infected with: COVID-19, influenza, respiratory syncytial virus, enterovirus, acute viral hepatitis, mononucleosis, and herpes zoster. Men were included if they had at least one outpatient follow-up visit within 18 months and excluded if they had one of the other viruses of interest or a prior ED diagnosis or treatment, prostatectomy, pelvis radiation, or chronic hepatitis infection. Cohorts were propensity score matched and compared for differences in new ED diagnosis and/or prescription of phosphodiesterase-5 inhibitors (PDE5i). COVID-19 positive men were less likely to develop ED or have a PDE5i prescription than men with infected with herpes zoster [Relative Risk (RR): 0.37, 95% Confidence Interval (CI) 0.27–0.49] and more likely to develop ED or have a PDE5i prescription than men with no acute viral illness (RR: 1.33, 95% CI 1.25–1.42). In this national propensity-matched cohort study comparing post-infection ED risk and PDE5i prescriptions, we found that COVID-19 was no more likely to result in a diagnosis of ED or prescription of PDE5i when compared to all acute viral illnesses except herpes zoster, which was more likely to result in a diagnosis of ED or prescription of PDE5i when compared to COVID-19. These findings suggest an inflammatory etiology (perhaps due to cytokine release, endothelial dysfunction, or blunted hormone signaling) behind any acute infection can result in a heightened ED risk; however, further studies are required to investigate the connection between other viral infections and ED.

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Fig. 1: Study methodology detailing cohort construction.
Fig. 2: Association of viral illnesses with new erectile dysfunction (ED) or phosphodiesterase-5 inhibitor (PDE5i) prescriptions.

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Data availability

The data used in this study are from the TriNetX deidentified database, which is available from TriNetX, LLC (https://trinetx.com/). Third-party restrictions affect availability of these data that prevent it from being made publicly available or redistributed. Researchers can access the TriNetX database through TriNetX, LLC.

References

  1. Ziegler CGK, Allon SJ, Nyquist SK, Mbano IM, Miao VN, Tzouanas CN, et al. SARS-CoV-2 receptor ACE2 is an interferon-stimulated gene in human airway epithelial cells and is detected in specific cell subsets across tissues. Cell. 2020;181:1016–1035.e19. https://doi.org/10.1016/j.cell.2020.04.035

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Nägele MP, Haubner B, Tanner FC, Ruschitzka F, Flammer AJ. Endothelial dysfunction in COVID-19: Current findings and therapeutic implications. Atherosclerosis. 2020;314:58–62. https://doi.org/10.1016/j.atherosclerosis.2020.10.014

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Chu KY, Nackeeran S, Horodyski L, Masterson TA, Ramasamy R. COVID-19 infection is associated with new onset erectile dysfunction: insights from a national registry. Sex Med. 2022;10:100478 https://doi.org/10.1016/j.esxm.2021.100478

    Article  PubMed  Google Scholar 

  4. Hebert KJ, Matta R, Horns JJ, Paudel N, Das R, McCormick BJ, et al. Prior COVID-19 infection associated with increased risk of newly diagnosed erectile dysfunction. Int J Impot Res. 2023:1–5. https://doi.org/10.1038/s41443-023-00687-4

  5. Nassau DE, Best JC, Kresch E, Gonzalez DC, Khodamoradi K, Ramasamy R. Impact of the SARS-CoV-2 virus on male reproductive health. BJU Int. 2022;129:143–50. https://doi.org/10.1111/bju.15573

    Article  CAS  PubMed  Google Scholar 

  6. Sansone A, Mollaioli D, Ciocca G, Limoncin E, Colonnello E, Vena W, et al. Addressing male sexual and reproductive health in the wake of COVID-19 outbreak. J Endocrinol Invest. 2021;44:223–31. https://doi.org/10.1007/s40618-020-01350-1

    Article  CAS  PubMed  Google Scholar 

  7. Fusco F, D’Anzeo G, Rossi A, Sciorio C, Buonomo AR, d’Emmanuele di Villa Bianca R, et al. Erectile dysfunction in patients with chronic viral hepatitis: a systematic review of the literature. Expert Opin Pharmacother. 2013;14:2533–44. https://doi.org/10.1517/14656566.2013.850073

    Article  PubMed  Google Scholar 

  8. Klein RS, Lo Y, Santoro N, Dobs AS. Androgen levels in older men who have or who are at risk of acquiring HIV infection. Clin Infect Dis Publ Infect Dis Soc Am. 2005;41:1794–803. https://doi.org/10.1086/498311

    Article  CAS  Google Scholar 

  9. Mäkelä S, Jaatinen P, Miettinen M, Salmi J, Ala-Houhala I, Huhtala H, et al. Hormonal deficiencies during and after Puumala hantavirus infection. Eur J Clin Microbiol Infect Dis. 2010;29:705–13. https://doi.org/10.1007/s10096-010-0918-y

    Article  PubMed  Google Scholar 

  10. Kim J, Kim BE, Leung DYM. Pathophysiology of atopic dermatitis: clinical implications. Allergy Asthma Proc. 2019;40:84–92. https://doi.org/10.2500/aap.2019.40.4202

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Kaynar M, Gomes ALQ, Sokolakis I, Gül M. Tip of the iceberg: erectile dysfunction and COVID-19. Int J Impot Res. 2022;34:152–7. https://doi.org/10.1038/s41443-022-00540-0

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Kresch E, Achua J, Saltzman R, Khodamoradi K, Arora H, Ibrahim E, et al. COVID-19 endothelial dysfunction can cause erectile dysfunction: histopathological, immunohistochemical, and ultrastructural study of the human penis. World J Mens Health. 2021;39:466–9. https://doi.org/10.5534/wjmh.210055

    Article  PubMed  PubMed Central  Google Scholar 

  13. Golan R, Muthigi A, Ramasamy R. Pro: does COVID affect male reproductive health? J Urol. 2022;208:786–7. https://doi.org/10.1097/JU.0000000000002846

    Article  PubMed  Google Scholar 

  14. Pons S, Fodil S, Azoulay E, Zafrani L. The vascular endothelium: the cornerstone of organ dysfunction in severe SARS-CoV-2 infection. Crit Care. 2020;24:353 https://doi.org/10.1186/s13054-020-03062-7

    Article  PubMed  PubMed Central  Google Scholar 

  15. Marchenko V, Zelinskaya I, Toropova Y, Shmakova T, Podyacheva E, Lioznov D, et al. Influenza A virus causes histopathological changes and impairment in functional activity of blood vessels in different vascular beds. Viruses. 2022;14:396 https://doi.org/10.3390/v14020396

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Lee CG, Yoon HJ, Zhu Z, Link H, Wang Z, Galtney JM, et al. Respiratory syncytial virus stimulation of vascular endothelial cell growth Factor/Vascular permeability factor. Am J Respir Cell Mol Biol. 2000;23:662–9. https://doi.org/10.1165/ajrcmb.23.5.4188

    Article  CAS  PubMed  Google Scholar 

  17. Madjid M, Aboshady I, Awan I, Litovsky S, Casscells SW. Influenza and cardiovascular disease: is there a causal relationship? Tex Heart Inst J. 2004;31:4–13.

    PubMed  PubMed Central  Google Scholar 

  18. Paudel V. Erectile dysfunction secondary to herpes zoster. J Nepal Health Res Counc. 2020;17:556–7. https://doi.org/10.33314/jnhrc.v17i4.2174

    Article  PubMed  Google Scholar 

  19. Rix GH, Carroll DN, MacFarlane JR. Herpes zoster producing temporary erectile dysfunction. Int J Impot Res. 2001;13:352–3. https://doi.org/10.1038/sj.ijir.3900786

    Article  CAS  PubMed  Google Scholar 

  20. Erol B, Avci A, Eken C, Ozgok Y. Urinary retention, erectile dysfunction and meningitis due to sacral herpes zoster: a case report and review of the literature. Urol Int. 2009;82:238–41. https://doi.org/10.1159/000200807

    Article  CAS  PubMed  Google Scholar 

  21. Kim M, Kim SY, Rou WS, Hwang SW, Lee BS. Erectile dysfunction in patients with liver disease related to chronic hepatitis B. Clin Mol Hepatol. 2015;21:352–7. https://doi.org/10.3350/cmh.2015.21.4.352

    Article  PubMed  PubMed Central  Google Scholar 

  22. Chen Z, Jiang C, Cheng X, Ma L, Xin Y, Liu T, et al. Secondary hypogonadism following hand, foot, and mouth disease in an adult: a case report and review of literature. BMC Infect Dis. 2022;22:56 https://doi.org/10.1186/s12879-022-07030-0

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Hutt-Fletcher LM. The long and complicated relationship between epstein-barr virus and epithelial cells. J Virol. 2017;91:e01677–16. https://doi.org/10.1128/JVI.01677-16

    Article  PubMed  Google Scholar 

  24. DeLay KJ, Haney N, Hellstrom WJ. Modifying risk factors in the management of erectile dysfunction: a review. World J Mens Health. 2016;34:89–100. https://doi.org/10.5534/wjmh.2016.34.2.89

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Una E. Choi, Aurora J. Grutman, Ankith P. Maremanda, Ryan C. Nicholson, Andrew Gabrielson & Taylor P. Kohn

  2. Department of Urology, Division of Surgery, The University of Texas Medical Branch, Galveston, TX, USA

    Corey Able

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Contributions

CA and TK analyzed the data and UC, CA, AG, AM, and RN wrote the article. UC, AG, and TP provided substantial edits and guidance. All authors revised the article and approved the final manuscript.

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Correspondence to Taylor P. Kohn.

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Choi, U.E., Able, C., Grutman, A.J. et al. Post-infection erectile dysfunction risk - comparing COVID-19 with other common acute viral infections: a large national claims database analysis. Int J Impot Res (2023). https://doi.org/10.1038/s41443-023-00794-2

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