Sexual Health News

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Scientists develop new antibiotic for gonorrhoea
Published: Thursday 5 January 2017
http://www.medicalnewstoday.com/releases/315038.php


Scientists at the University of York have harnessed the therapeutic effects of carbon monoxide-releasing molecules to develop a new antibiotic which could be used to treat the sexually transmitted infection gonorrhoea.

The infection, which is caused by the bacteria Neisseria gonorrhoeae, has developed a highly drug-resistant strain in recent years with new cases reported in the north of England and Japan.

There are concerns that gonorrhea, which is the second most common sexually transmitted infection in England, is becoming untreatable.

Almost 35,000 cases were reported in England during 2014, with most cases affecting young men and women under the age of 25.

The interdisciplinary team, from the University of York's Departments of Biology and Chemistry, targeted the "engine room" of the bacteria using carbon monoxide-releasing molecules (CO-RMs).

CO is produced naturally in the body, but there is increasing evidence that carbon monoxide enhances antibiotic action with huge potential for treating bacterial infections.

The scientists found that Neisseria gonorrhoeae is more sensitive to CO-based toxicity than other model bacterial pathogens, and may serve as a viable candidate for antimicrobial therapy using CO-RMs.

The CO molecule works by binding to the bacteria, preventing them from producing energy.

Scientists believe the breakthrough, published in the journal MedChemComm, could pave the way for new treatments.

Professor Ian Fairlamb, from the University's Department of Chemistry, said: "The carbon monoxide molecule targets the engine room, stopping the bacteria from respiring. Gonorrhoea only has one enzyme that needs inhibiting and then it can't respire oxygen and it dies.

"People will be well aware that CO is a toxic molecule but that is at high concentrations. Here we are using very low concentrations which we know the bacteria are sensitive to.

"We are looking at a molecule that can be released in a safe and controlled way to where it is needed."

The team say the next stage is to develop a drug, either in the form of a pill or cream, so that the fundamental research findings can be translated on to future clinical trials.

Professor Fairlamb added: "We think our study is an important breakthrough. It isn't the final drug yet but it is pretty close to it."

"People might perceive gonorrhoea as a trivial bacterial infection, but the disease is becoming more dangerous and resistant to antibiotics."

The team worked with Professor James Moir from the University's Department of Biology. He added: "Antimicrobial resistance is a massive global problem which isn't going away. We need to use many different approaches, and the development of new drugs using bioinorganic chemistry is one crucial way we can tackle this problem, to control important bacterial pathogens before the current therapies stop working."

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Natural Treatments for Vaginal Atrophy
http://www.medicalnewstoday.com/articles/315089.php

Vaginal atrophy is inflammation, dryness, and thinning of the vaginal walls. The condition is also known as atrophic vaginitis.

There are many forms of treatment for vaginal atrophy. This article examines some natural remedies, lifestyle changes, and medical treatments that can help.

Natural remedies that may help with vaginal atrophy

There are several lifestyle changes that could help people to relieve the symptoms of vaginal atrophy.

Giving up smoking: Smoking decreases estrogen levels and increases the risk of developing vaginal atrophy, as well as other conditions such as osteoporosis.

Staying sexually active: Sexual activity increases the flow of blood to the genitals, which in turn helps keep them healthy. It is important for a woman to allow herself enough time to become sexually aroused.

Avoiding perfumed products such as powders, soaps, and deodorants. It is important to also note that certain lubricants and spermicides can irritate the vagina and cause dryness.

Getting regular exercise and physical activity aids hormone balance.
Keeping well hydrated.

Diet and vaginal atrophy

A number of diet tips and supplements have been suggested as alternative treatments for vaginal atrophy. At present, there is little evidence from scientific research to support these claims.

People with vaginal atrophy should discuss any herbal supplements or dietary changes with their doctor before making any lifestyle changes.

Natural lubricants

A number of natural lubricants may help to relieve the symptoms of vaginal atrophy. These include:

Jojoba
Coconut oil
Aloe vera
Vitamin E suppositories stimulate the normal vaginal mucosa and help prevent infections

Complementary treatments

Probiotics are bacteria that are considered healthy for the human body. Research suggests that probiotics may help relieve the symptoms of vaginal atrophy.

Some women with vaginal atrophy may also develop urinary problems and probiotics are also thought to be helpful in alleviating these symptoms.


Causes of vaginal atrophy

Vaginal atrophy can happen at any age, although it most commonly affects women during and after menopause, when the ovaries begin to produce less estrogen.

Estrogen is a female hormone that is responsible for a woman's sexual development and helps control her menstrual cycle. It helps support bone health and can affect the skin and other tissues in the body. Estrogen can also affect the brain and impact on a person's mood.

Pre-menopausal women with medical conditions that affect the levels of estrogen in the body can also develop vaginal atrophy.

The main cause of vaginal atrophy is reduced estrogen levels. Estrogen levels can be reduced by:

Certain types of contraceptives, including the contraceptive injection and the combined pill
A lack of arousal prior to intercourse leading to nonproduction of a woman's natural lubricant
Breastfeeding or childbirth
Hormonal cancer treatments, chemotherapy, and radiotherapy to the pelvic area
Diabetes or Sjögren's syndrome, in which the glands in the body that produce fluid are attacked by the immune system

Medical treatments for vaginal atrophy

As well as natural remedies and lifestyle changes, there are several medications for treating vaginal atrophy. Many of the following are available over the counter:

Water-based, glycerine-free lubricants help reduce discomfort during sex.
Vaginal moisturizers can be applied every 2 to 3 days. Their effect lasts longer than a lubricant.
Topical estrogen cream applied directly inside the vagina relieves symptoms more quickly than if taken orally. It also reduces the bloodstream's exposure to estrogen.
Oral estrogen.
An estrogen ring inserted into the vagina releases estrogen.
Systemic estrogen therapy is available as a skin patch, an implant under the skin, tablets, or a gel applied directly to the skin.

Systemic estrogen therapy has some potential side effects.

These include:

Breast tenderness
Headaches
Nausea
Indigestion
Stomach pain
Vaginal bleeding

There may also be an increase in the risk of developing blood clots and breast cancer with this type of treatment. However, the benefits usually outweigh the risks.

What effect does a history of breast cancer have on treatment options?

A woman with a history of breast cancer should consult her doctor regarding any potential treatment.

Estrogen can be harmful for women with a history of breast cancer. If the cancer is hormone-sensitive, estrogen may increase the risk of it coming back. For this reason, systemic estrogen therapy is not usually recommended.

Treatments that can be used by women who have or have had breast cancer include:

Nonhormonal treatments, such as moisturizers and lubricants
Low-dose vaginal estrogen may be used if nonhormonal treatments have failed to relieve the symptoms of vaginal atrophy

Symptoms of vaginal atrophy

The symptoms of vaginal atrophy can vary and a woman will not necessarily experience all of them at the same time. They include:

Vaginal dryness or itchiness
Vaginal discharge
Loss of libido
Discomfort during intercourse
Decreased lubrication during intercourse
Bleeding after intercourse
Frequent urinary tract infections
Pale and thin appearance of the vagina
Tightening or shortening of the vagina
Needing to urinate more often

When to see a doctor

Many women are embarrassed about vaginal atrophy. However, it is a very common condition that can be treated in a number of ways with good results.

Medical advice should be sought if:

Symptoms are severe and interfering with day-to-day life
Pain is experienced during intercourse, which is not relieved by vaginal lubricants
There is any bleeding, burning, or discharge is present
Other symptoms, such as night sweats and hot flushes are present

Written by Silvana Montoya

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CDC guidelines for HIV prevention regimen may not go far enough, study suggests
Published: Wednesday 11 January 2017

http://www.medicalnewstoday.com/releases/315163.php

A new study from the UCLA Fielding School of Public Health suggests modifying federal health guidelines related to the use of pre-exposure prophylaxis to prevent HIV transmission because current standards could miss some people who should be on it.

Pre-exposure prophylaxis, or PrEP, is a measure that has proven to be highly effective in preventing HIV transmission during unprotected sex. While not entirely foolproof, studies have shown taking daily doses of tenofovir disoproxil-emtricitabine, or Truvada, is 92 percent effective in preventing HIV infection when taken correctly and consistently.

Since 2012, the U.S. Centers for Disease Control and Prevention has recommended PrEP for gay or bisexual men who have had condomless anal sex or been diagnosed with a sexually transmitted infection in the past six months. The CDC also has recommended PrEP for HIV-negative men who have sex with men (MSM) and who are in a relationship with an HIV-positive partner.

The UCLA study, which was published in the January issue of Sexually Transmitted Diseases, suggests that those guidelines do not go far enough, because they omit important characteristics that could put someone at high risk for becoming infected with the virus that causes AIDS. Working with the Los Angeles LGBT Center, the researchers have developed an online risk assessment calculator, available today, which could fill that gap.

"To the best of our knowledge, this PrEP Calculator is the first of its kind to be based on real-world data," said Robert Weiss, co-author of the study and a professor of biostatistics at the Fielding School. "We hope that our PrEP calculator will allow more MSM to make a more-informed decision before deciding whether or not PrEP is right for them."

The Los Angeles LGBT Center is one of the largest HIV testing providers in Los Angeles County for gay, bisexual and MSM, with approximately 13,000 individual clients served annually, said lead author Matthew Beymer, a post-doctoral scholar in the department of medicine, division of infectious diseases, at the David Geffen School of Medicine at UCLA.

Between January 2009 and June 2014 the center collected data on various behavioral risk factors for HIV among clients at each visit. Center personnel used behavioral data and HIV test results to determine what characteristics distinguished MSM who were HIV-negative when the study began and subsequently tested positive for HIV during a follow-up visit from those who remained HIV-negative through the follow-up visits.

Using these data the researchers built an HIV-risk algorithm, which they use as a standardized mechanism for recommending PrEP to clients of the Los Angeles LGBT Center. Unlike the CDC guidelines, they asked important questions about a number of factors that could put one at higher risk for becoming infected, including substance use, number of sex partners, age and race or ethnicity, and other partner-level factors.

The researchers found that if all individuals who had a risk score greater than or equal to five on the test's scale - 51 percent of those who used the calculator - had been given PrEP, then 75 percent of HIV infections would be averted during follow-up, assuming adequate regimen adherence and near complete effectiveness.

This made the researchers' model better than the CDC guidelines because it took into account behaviors that aren't considered in the current guidelines.

Based on these findings, they developed the risk calculator. The researchers will then assess whether men who have sex with men find it useful in determining if they should start taking PrEP. Even as late as September 2016, 20 percent of the Los Angeles LGBT Center's clients were unsure if PrEP was right for them, Beymer said.

"The findings from this study will allow MSM to determine their overall risk for HIV based on their own data and previous data collected at the Los Angeles LGBT Center," Beymer said. "Ultimately, this HIV risk score can be used by the client to determine if PrEP is right for them."

Beymer said that a limitation of this calculator is that it may not be appropriate for heterosexual and trans individuals, injection drug users, or people living outside of Los Angeles. In addition, it does not consider situations in which HIV-negative men are in long-term relationships with HIV-positive men.

This work was supported by the Center for HIV Identification, Prevention, and Treatment; the National Institute of Mental Health (grant P30MH058107), the UCLA Center for AIDS Research (grant 5P30AI028697) and a UCLA Postdoctoral Fellowship Training Program in Global HIV Prevention Research (T32MH080634).

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HIV risk influenced by specific vaginal bacteria
Written by Honor Whiteman
Published: Wednesday 11 January 2017

http://www.medicalnewstoday.com/articles/315128.php

Sexual activity is one of the most common ways by which HIV can be passed from one person to another. In a new study, researchers have identified certain types of vaginal bacteria that might increase a woman's susceptibility to sexually transmitted HIV.

First study author Christina Gosmann - a postdoctoral research fellow at the Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology, and Harvard Medical School - and colleagues report their findings in the journal Immunity.

HIV is a virus that attacks the body's CD4 cells, or T cells, which are a type of white blood cell that helps to protect the body from infection.

Worldwide, there are around 36.7 million people living with HIV or AIDS. AIDS is the final stage of HIV infection, whereby the immune system is severely damaged.

HIV is most commonly transmitted through sexual activity and needle-sharing. A person can contract HIV through contact with the blood, semen, pre-seminal fluid, or the rectal and vaginal fluids of infected individuals.

According to Gosmann and colleagues, in Africa - where HIV is most prevalent - young women are up to eight times more likely to develop sexually transmitted HIV than men, "emphasizing the need for a better understanding of the factors in the female genital tract (FGT) that influence HIV acquisition."

Previous research has indicated that vaginal bacteria may play a role in the acquisition of HIV. For example, one study published in 2013 found that women deficient in vaginal Lactobacillus - a type of "friendly" bacteria - were more susceptible to HIV.

However, Gosmann and team note that that majority of studies that have found such a link have been conducted in high-income countries with lower burdens of HIV.

HIV risk four times higher for women with specific bacterial communities

For their study, the researchers analyzed the data of 236 healthy women aged 18-32 who were a part of the Females Rising through Education, Support, and Health study.

The women were from the KwaZulu-Natal province of Durban in South Africa, which has one of the highest burdens of HIV in the country.

At study baseline, all women were free of HIV. Vaginal swabs were retrieved from each of the women and analyzed for bacterial and viral microbes.

During a median follow-up period of 336 days, 31 of the women acquired HIV.

Compared with women who had "healthy" vaginal bacteria, the researchers found that those with high levels of specific pro-inflammatory bacteria, such as Prevotella and Sneathia, but low levels of Lactobacillus were four times more likely to acquire HIV.

Women whose FGT was dominated by these high-risk bacterial communities also had high levels of CD4 cells, which are the main target of HIV.

Additionally, on introducing these pro-inflammatory bacterial species to the FGT of female, germ-free mice, the researchers identified an increase in active mucosal CD4 T cells. The team says that this provides "direct evidence of the impact of these bacteria on the recruitment of activated CD4 T cells to the FGT."

"Seventy percent of our volunteers had diverse bacterial communities with low Lactobacillus abundance. Here we show that not only are those more diverse communities associated with higher levels of genital inflammation but also with significantly increased HIV acquisition."

Senior author Douglas Kwon, Ragon Institute

Prebiotics and probiotics might reduce HIV risk for women

The researchers say that the precise reasons for the differences in vaginal bacteria among the women in their study are unclear; they could find no evidence that environmental or behavioral factors play a role.

However, the team notes that an individual's genes might influence which bacterial species reside in the FGT, causing some women to have naturally low levels of Lactobacillus and increased levels of high-risk bacteria.

While further studies are needed to pinpoint what influences the development of certain vaginal bacteria, the team believes that this current study paves the way for a new strategy that might reduce women's risk of HIV: increasing levels of Lactobacillus and reducing levels of pro-inflammatory bacteria.

The researchers suggest that this could be achieved with the use of prebiotics or probiotics.

"We're very excited about these findings. [...] There is a direct translational application that comes from this work. By identifying bacterial species and communities associated with HIV risk, we provide specific targets that may be leveraged to develop new preventive strategies and to improve the effectiveness of existing preventive measures."

Christina Gosmann

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Genital Psoriasis: Symptoms and Treatment
http://www.medicalnewstoday.com/articles/315217.php

Psoriasis is an autoimmune skin disease that is marked by raised, red, scaly patches on the skin area. The condition can occur anywhere on the body, including the genitals.

It can range from mild to severe in terms of seriousness.

Contents of this article:

Symptoms of genital psoriasis
Treatments and sexual health
Causes of psoriasis

Symptoms of genital psoriasis

Genital psoriasis is one of the most uncomfortable forms of psoriasis because the genital area is so sensitive. Inverse psoriasis is the most common type of psoriasis found in the groin and genital area. A person who has inverse psoriasis, will usually develop smooth, dry, and red patches on their skin. Inverse psoriasis is often more painful than other types of psoriasis and the areas may be sore and itchy.

Various regions of the genital area may be affected by psoriasis:

Pubis: Region on male and females above the genitals.
Upper thighs: Psoriasis consists of many small round patches that are red and scaly. Psoriasis in this area is easily irritated, especially in those people whose thighs rub together when they walk or run.
Creases between thigh and groin: Psoriasis appears as nonscaly and reddish-white in the creases between the thigh and groin. The skin may have fissures or cracks. Those who are overweight or athletic may also develop an infection that resembles a yeast infection in the folds of the skin.

Psoriasis can affect the genital area of both men and women.

Psoriasis of the vulva typically has a smooth appearance and nonscaly redness. Scratching the area can cause an infection and create dryness, which can result in thickening of the skin and additional itching. Genital psoriasis typically affects the outer skin of the vagina. In most cases, psoriasis does not affect mucous membranes.

Psoriasis of the penis may present as many small, red patches on the glans or shaft. The skin may appear scaly or be smooth and shiny.

The condition can also affect the anus and surrounding skin. Psoriasis on or near the anus is red, nonscaly, and is commonly prone to itchiness. Symptoms can be confused with yeast infections, hemorrhoidal itching, and pinworm infestations.

If any of these other conditions are present, they can complicate psoriasis treatment. Rectal examinations and skin cultures can help to confirm these conditions. Psoriasis in the buttocks crease may be red and nonscaly, or red with very heavy scales.

Treatments and sexual health
Genital psoriasis can be difficult to treat in some cases, but typically it responds well to most treatment options. Skin in the genital area tends to be very thin and sensitive, so people with genital psoriasis should take special care when considering treatment options. Individuals should use topical creams carefully to avoid the skin becoming thinner and prevent stretch marks forming.

t is easy to relieve the itching and discomfort but treating lesions is more difficult. The affected area must be kept moisturized, and topical treatments or ultraviolet (UV) light may be used.

Treatments for genital psoriasis include:

Topical medications: Low-strength corticosteroids are used in the genital area. Prolonged use of topical corticosteroids can lead to permanently thin skin and stretch marks. Over-the-counter moisturizers can be helpful in keeping the area moisturized. People should avoid moisturizers with fragrances and perfumes as they may cause irritation. Vitamin D creams and ointments are less likely to cause irritation.
UV light: Used in special circumstances to treat genital psoriasis. Doses must be lower than those usually used to treat psoriasis in other parts of the body. Overexposure can burn the genital skin.
Emollients. Applying emollients will cover the skin with a protective layer and prevent water loss.
Calcineurin inhibitors: Tacrolimus and pimecrolimus are helpful in treating genital psoriasis and do not cause the adverse side effects such as thinning of the skin. They can, however, cause an uncomfortable burning sensation and reactivate sexually transmitted infections, such as herpes or viral warts.

In some cases, doctors may prescribe oral medication. Genital psoriasis medications can cause some adverse side effects, such as irritation, headache, insomnia, fever, and diarrhea. A person with genital psoriasis or any symptoms related to it should always talk to a doctor. This is to not only to ensure proper treatment but also to rule out other conditions including sexually transmitted diseases.

Genital psoriasis may get worse as a result of friction during sexual intercourse. Contact with certain irritants may also cause a flare up.

These irritants include:

Urine
Feces
Tight-fitting clothes

Sexual health

Using a condom during intercourse may help to reduce potential discomfort. It also forms a barrier to avoid skin-to-skin and fluid-to-skin contact, which reduces irritation further.

After intercourse, people with genital psoriasis should cleanse the area and reapply any medications to help with recovery.

Since the area can look different and the person may experience some irritation, it is best for those suffering from genital psoriasis to be honest and explain their condition to their partner. Though sexual intercourse can cause irritation, genital psoriasis cannot be transmitted and should not interfere with a person having a healthy sex life.

Causes of psoriasis

There are several different types of psoriasis and it typically occurs after something has triggered it. It is not known exactly what causes psoriasis, but defects in the immune system as well as a person's genetics play a key role in the development.

The immune system leads to an increase in healthy skin cells, T cells, and other white blood cells. This ongoing cycle causes new skin cells to move to the outermost layer of the skin in days rather than weeks. The body doesn't have time to shed the old cells, so the layers build up.

According to The National Psoriasis Foundation at least 10 percent of people inherit one or more genes that could eventually lead to psoriasis. Only 2-3 percent of the population develops the disease but one-third of people with psoriasis have a family member that also has the disease.

It is thought that a person who develops psoriasis has a certain combination of the genes and has been exposed to specific external triggers.

Psoriasis triggers include:

Infections such as strep throat or skin infections
Injury to the skin, such as a cut or scrape, bug bite, or severe sunburn
Stress and other environmental factors
Cold weather
Smoking
Heavy alcohol consumption
Some medications including lithium, high blood pressure medications, such as beta blockers, antimalarial drugs, and iodides

Actual symptoms of psoriasis vary from person to person but a few common signs include:

Red patches of skin covered with silvery scales
Small scaling spots, which are commonly seen in children
Dry, cracked skin that may be prone to bleeding
Itching, burning, or soreness
Thickened, pitted, or ridged nails
Swollen and stiff joints

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Study: HIV therapy could be contributing to syphilis outbreak
http://www.medicalnewstoday.com/releases/315308.php

Drugs used to treat HIV could affect how the body responds to syphilis, inadvertently contributing to a current outbreak, a new study suggests.

Syphilis cases in several countries have risen sharply in recent years, primarily affecting men who have sex with men. In this study, researchers investigating the outbreak hypothesize that medications used in highly active antiretroviral therapy (HAART), the gold standard for treating HIV infection, could reduce the body's immune responses to particular diseases, including syphilis.

"After reading about the astounding increase in syphilis cases, I also noticed a huge gap between syphilis and other sexually transmitted infections like chlamydia and gonorrhea," said Michael Rekart, lead author and clinical professor in UBC's school of population and public health. "That led me to believe there must be something else going on."

Until now, research and clinical communities have suggested that the outbreak could be a result of more risky sexual behaviour, such as people having sex without condoms, springing from the perception that the risk of HIV infection is low due to the availability and effectiveness of HAART.

However, the study points to evidence showing that many men with HIV do not practice high-risk sexual behaviour and that new syphilis cases are commonly observed in people on HAART. It also suggests there are plausible biological explanations for HAART effects on the body's immune response to certain diseases, says Caroline Cameron, a microbiologist at the University of Victoria who was part of the study team.

Rekart and his colleagues used mathematical modeling to predict syphilis rates based on the premise that risky sexual behaviour was the sole cause, and calculated a rate of increase lower than today's actual rate. When they considered both behaviour changes and possible immunity effects, their model predicted a rate that closely approximated the actual incidence of syphilis in B.C. and several other countries. Researchers have not yet compared data of people on HAART who contract syphilis with those not on HAART who contract the infection to establish a link.

While the findings suggest that researchers and health-care professionals should look more closely at this issue, Rekart said it is vital for people to continue to take their HAART. He said people can use information from this study to make behaviour decisions such as always using condoms and reducing the number of sexual partners.

"HAART drugs are life-saving; syphilis is curable," he said. "HAART drugs bring people with HIV back to a normal state of immunity, they can have a normal life, they don't get most opportunistic infections such as tuberculosis."

As a next step, researchers will need to look more closely at the relationship between HAART and infectious and non-infectious diseases and whether there are specific drugs in the HAART medication cocktail that impair immunity.

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Male contraceptive proves effective as alternative to vasectomy
http://www.medicalnewstoday.com/articles/315682.php

From birth control pills to non-hormonal injections, researchers have recently been investigating more and more options for male contraception. New research tests a contraceptive gel in monkeys as an alternative to vasectomy.

Almost half of all pregnancies are unintended, according to the latest statistics from the Centers for Disease Control and Prevention (CDC).

While women have traditionally had a wide range of contraceptives available to them, the medical research community has only recently taken an interest in developing male contraceptives.

In 2016, the male non-hormonal contraceptive gel Vasalgel was successfully tested in rabbits, showing promise as a long-term contraceptive for males.

Vasalgel is a high molecular weight polymer that could work as a potentially reversible alternative to vasectomies.

In the new trial, researchers - led by Dr. Catherine VandeVoort, from the California National Primate Research Centre (CNPRC) - tested the drug in primates. The findings were published in the journal Basic and Clinical Andrology.

How Vasalgel works in monkeys

Vasalgel is injected into the so-called vas deferens - the thick-walled tube that transports sperm from the testicles to the urethra.

Inside the cavity of the vas deferens, the gel forms a barrier that puts a stop to the movement of the sperm.

In this study, Dr. VandeVoort selected a test group of 16 adult male rhesus monkeys housed at the CNPRC, and a control group of 16 age-matched monkeys that had been previously vasectomized.

The animals were sedated with Ketamine for the duration of the surgery and administered approximately 100 microliters of Vasalgel with the help of a syringe through a small incision.

This dose of Vasalgel formed a barrier of approximately 2 centimeters in length inside the vas deferens. The animals were administered analgesics postoperatively to help with the pain, and were monitored daily for 7 days after the surgery.

After that, researchers returned the monkeys to their normal group housing, where they cohabitated with females for a minimum of one breeding season of around 6 months. Seven males lived almost continuously with females for 2 years.

The paternity of all the offspring was tested via blood samples and genetic testing. The researchers report that the treated males had no conceptions after the Vasalgel injections.

In similar housing conditions, sexually mature females are expected to have a pregnancy rate of 80 percent per breeding season.

Vasalgel is 'safe' and produces 'fewer complications' than vasectomies

The authors report a few minor complications, similar to those commonly associated with traditional vasectomies. One monkey in the group developed sperm granuloma after the injection. This complication - consisting of a lumpy buildup of sperm in the vas deferens - occurs in around 60 percent of human vasectomy cases, according to the authors. As they explain, there are typically no serious side effects resulting from sperm granuloma.

The rate of sperm granuloma in vasectomized male rhesus monkeys is typically around 15 percent, whereas 1 in 32 - as was the case in this study - amounts to little over 3 percent.

In the age-matched control group, 5 out of 16 (or over 32 percent) of the vasectomized male rhesus monkeys developed a form of sperm granuloma.

"Our research shows that Vasalgel placement into the vas deferens produces reliable contraception in mature male rhesus monkeys as shown by the lack of pregnancies in reproductively viable females with which the males were housed. Importantly, we show that the method of Vasalgel placement is safe and produced fewer complications than usually occur with a vasectomy."

Dr. Catherine VandeVoort

Dr. VandeVoort and her colleagues recommend that future research investigates the reversibility of Vasalgel in monkeys before the gel can become a valid alternative to vasectomy in human males.

"Vasalgel shows real promise as an alternative to vasectomy because research in rabbits has previously shown the product to be reversible," she adds. "Although it is possible to reverse a vasectomy, it is a technically challenging procedure and patients often have very low rates of fertility following reversal."

[Big Sexy]

New genital herpes vaccine candidate provides powerful protection in preclinical tests
http://www.medicalnewstoday.com/releases/315392.php

Approximately 500 million people around the world are infected with the genital herpes virus known as herpes simplex virus 2 (HSV2). A vaccine that could bring an end to this global pandemic is needed desperately, yet no candidate vaccine has ever performed well in clinical trials. Now scientists in the Perelman School of Medicine at the University of Pennsylvania have shown that a new type of vaccine provides powerful protection in standard guinea pig and monkey models of HSV2 infection.

The new "trivalent" vaccine induces antibodies against three different parts of the virus, including two components that normally help HSV2 evade immune attack.

"It's a novel strategy, and it works beautifully," said senior investigator Harvey M. Friedman, MD, a professor of Infectious Diseases at Penn. "I know of no other HSV2 vaccine candidate with published results that are as promising as this study."

The findings, reported in PLOS Pathogens, are likely to lead to human clinical trials of the vaccine.

The public health burden from HSV2 is enormous. In the United States alone, researchers estimate that approximately one in six people age 15 to 49 have HSV2 infection. In some parts of Africa, more than half the adult population is thought to be infected. Aside from the direct burden on adults, HSV2 can cause devastating and often lethal infections of infants born to infected mothers. HSV2 infection also greatly increases the likelihood of HIV transmission and thus accounts for much of the HIV public health burden as well.

Candidate HSV2 vaccines developed in recent years have largely targeted gD2, a glycoprotein (a protein coated with sugar-like molecules) that is mounted on the virus's outer envelope and helps it break into host cells. However, vaccines targeting gD2 alone have not shown very robust protection in animal and human trials.

Friedman and his team, therefore, designed their new vaccine to induce an immune response against not only gD2 but also two other viral glycoproteins, gC2 and gE2. The latter are known to block elements of the immune response, helping HSV2 to survive long-term in its hosts.

"In essence, we're stimulating the immune system to attack the virus and at the same time preventing the virus from using some of the tools it has to thwart that immune attack," Friedman said.

Working with the Tulane National Primate Center in Louisiana, Friedman and his group showed that the trivalent vaccine - given three times at monthly intervals--induced a strong immune response in macaque monkeys, whose immune system closely resembles the human version. The response included antibodies against gC2, gD2, and gE2 in both blood and vaginal secretions. In the lab dish, these antibodies potently neutralized HSV's ability to spread from cell to cell. The vaccine also induced a sharp rise in CD4 T-cells, whose job is to mobilize the antibody response and other immune elements against viral infections.

The researchers also showed that the antibodies induced by the trivalent vaccine potently neutralized four isolates of HSV2 from sub-Saharan Africa, where infection prevalence is very high.

Macaques do not usually develop genital lesions when infected with HSV2, but in this case, the unvaccinated monkeys showed signs of mild vaginal inflammation soon after exposure to the virus, whereas the vaccinated monkeys showed none.

In a second set of experiments, guinea pigs, which normally develop a more severe genital infection when infected with HSV2, were almost completely protected from genital lesions by the vaccine. The scientists were still able to detect a small amount of viral DNA in the genital secretions of the animals, but only a tiny fraction of this viral DNA was capable of replicating in cells.

"We are pleased to have demonstrated such a potent and durable immune response to the vaccine," said the study's lead author, Sita Awasthi, PhD, a research associate professor of Infectious Diseases at Penn. "If found effective in clinical trials, the vaccine will have a huge impact on reducing the overall prevalence of genital herpes infections and could reduce new HIV infections as well, especially in high-burden regions of sub-Saharan Africa."

"If the vaccine behaves like this in people, it would limit lesions to appearing only about one day in 100, and the virus would be potentially contagious only about two in every 1,000 days," Friedman said.

In principle, he added, that would virtually shut down HSV2's ability to spread in the population.

Friedman and colleagues are now in discussions with pharmaceutical companies to move the vaccine, or an optimized version of it, into initial clinical trials.

If the vaccine does emerge successfully from clinical trials, it would probably be given on a schedule of three inoculations, at 0, 1 and 6 months.

The study was funded by grants from the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health (RO1- AI104854, P30-AI45008).

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HPV vs Pap test for cervical cancer screening: Strong evidence calls for new protocols, say experts
http://www.medicalnewstoday.com/releases/315698.php

For many years, cytology has been the established method used for cervical cancer screening. Commonly known as the Pap test, cytology and its regular use in yearly exams has been credited with significantly reducing the number of deaths from cervical cancer. Evidence now shows that sexually transmitted human papillomavirus (HPV) infection is almost always responsible for cases of cervical cancer with two HPV types responsible for 70% of all cases. Many members of the health care community are now calling for a shift in screening procedures to reflect our improved understanding of cervical cancer development. In a special issue of Preventive Medicine, experts look at the emerging evidence that HPV screening may be a better way than Pap tests for doctors to screen for cervical cancer. They also address the difficulty of implementing such a change in different parts of the world based on available resources or public health priorities.

"Whether in conventional or automated forms, Pap cytology has been a core technology in medicine and public health; that is until it was firmly established that cervical cancer was the long-term consequence of persistent infection with a specific sexually transmitted infection. It has since become clear that testing for the causal agent, HPV, can bring substantial improvements and efficiency to cervical cancer screening," remarked Preventive Medicine Deputy Editor Gayle A. Shinder, PhD, Department of Oncology at McGill University. "The above transition in technologies serves at the backdrop for this special series of articles and commentaries."

The issue presents in-depth coverage of the scientific evidence supporting the transition from cytology to HPV testing, along with reasons why policy around cervical cancer screening is so context specific. The contributors to this issue endorse that HPV testing offers a better way to screen for cervical cancer, but also acknowledge that changes to screening paradigms cannot be made in a vacuum, based only on scientific findings.

As Guest Editor for the special issue, Mark Schiffman, MD, MPH, Senior Investigator in the Clinical Genetics Branch of the National Cancer Institute, NIH, Bethesda, MD, wrote, "HPV testing is coming and the role of cytology will be reduced; however, this collection of evidence summaries, guidelines, and editorials aims to illustrate the variety of ways the changeover will occur globally. More broadly, this special issue illustrates the importance and limits of epidemiology as the 'basic science of public health.' The conclusion is that given an established epidemiologic set of scientific facts and validated prevention tools, real-life concerns that vary by region will determine which public health strategies are used."

Dr. Schiffman's straightforward editorial touches on the potentially controversial elements of HPV testing as a primary screening method for cervical cancer. "It turns out that detailed implementation of HPV primary screening to replace cytology reveals many choices reliant on value judgments and not risk assessment, particularly when resources are limited," said Dr. Schiffman. "Controversial areas include acceptable costs and effort, choices of safety and action thresholds, and the role of the clinician in the integration of test data vs apps and guidelines."

This special issue highlights the evidence for supporting the switch from cytology to HPV testing, contrasted with regional responses. Two reviews address the efficacy and specificity of HPV testing, along with providing possible triage methods to help clinicians identify the highest risk patients. Another study uses HPV vaccine data to make the case for phasing out first-line cytology and replacing it with HPV testing.

In addition to the studies, the special issue also features five commentaries focusing on how different approaches to health care and levels of available resources around the world are set to influence this change in screening protocols. They address how these changes would affect various parts of the world based on their existing health care systems, the values of those systems, and the available medical resources in different areas.

The special issue is designed to help facilitate a meaningful conversation about evidence-based best practices for cervical cancer screening in many different parts of the world and to begin to look at the challenges associated with implementing such a shift. "I believe that, among experts, there is an emerging consensus that HPV testing is theoretically the optimal available primary screening testing, but that optimal implementation is far from settled," concluded Dr. Schiffman. "As different strategies are applied worldwide, the hope is that they will be translatable and represent different societal conclusions sharing a jointly-understood scientific base."

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Male contraceptive proves effective as alternative to vasectomy
http://www.medicalnewstoday.com/articles/315682.php

From birth control pills to non-hormonal injections, researchers have recently been investigating more and more options for male contraception. New research tests a contraceptive gel in monkeys as an alternative to vasectomy.

Almost half of all pregnancies are unintended, according to the latest statistics from the Centers for Disease Control and Prevention (CDC).

While women have traditionally had a wide range of contraceptives available to them, the medical research community has only recently taken an interest in developing male contraceptives.

In 2016, the male non-hormonal contraceptive gel Vasalgel was successfully tested in rabbits, showing promise as a long-term contraceptive for males.

Vasalgel is a high molecular weight polymer that could work as a potentially reversible alternative to vasectomies.

In the new trial, researchers - led by Dr. Catherine VandeVoort, from the California National Primate Research Centre (CNPRC) - tested the drug in primates. The findings were published in the journal Basic and Clinical Andrology.

How Vasalgel works in monkeys

Vasalgel is injected into the so-called vas deferens - the thick-walled tube that transports sperm from the testicles to the urethra.

Inside the cavity of the vas deferens, the gel forms a barrier that puts a stop to the movement of the sperm.

In this study, Dr. VandeVoort selected a test group of 16 adult male rhesus monkeys housed at the CNPRC, and a control group of 16 age-matched monkeys that had been previously vasectomized.

The animals were sedated with Ketamine for the duration of the surgery and administered approximately 100 microliters of Vasalgel with the help of a syringe through a small incision.

This dose of Vasalgel formed a barrier of approximately 2 centimeters in length inside the vas deferens. The animals were administered analgesics postoperatively to help with the pain, and were monitored daily for 7 days after the surgery.

After that, researchers returned the monkeys to their normal group housing, where they cohabitated with females for a minimum of one breeding season of around 6 months. Seven males lived almost continuously with females for 2 years.

The paternity of all the offspring was tested via blood samples and genetic testing. The researchers report that the treated males had no conceptions after the Vasalgel injections.

In similar housing conditions, sexually mature females are expected to have a pregnancy rate of 80 percent per breeding season.

Vasalgel is 'safe' and produces 'fewer complications' than vasectomies

The authors report a few minor complications, similar to those commonly associated with traditional vasectomies. One monkey in the group developed sperm granuloma after the injection. This complication - consisting of a lumpy buildup of sperm in the vas deferens - occurs in around 60 percent of human vasectomy cases, according to the authors. As they explain, there are typically no serious side effects resulting from sperm granuloma.

The rate of sperm granuloma in vasectomized male rhesus monkeys is typically around 15 percent, whereas 1 in 32 - as was the case in this study - amounts to little over 3 percent.

In the age-matched control group, 5 out of 16 (or over 32 percent) of the vasectomized male rhesus monkeys developed a form of sperm granuloma.

"Our research shows that Vasalgel placement into the vas deferens produces reliable contraception in mature male rhesus monkeys as shown by the lack of pregnancies in reproductively viable females with which the males were housed. Importantly, we show that the method of Vasalgel placement is safe and produced fewer complications than usually occur with a vasectomy."

Dr. Catherine VandeVoort

Dr. VandeVoort and her colleagues recommend that future research investigates the reversibility of Vasalgel in monkeys before the gel can become a valid alternative to vasectomy in human males.

"Vasalgel shows real promise as an alternative to vasectomy because research in rabbits has previously shown the product to be reversible," she adds. "Although it is possible to reverse a vasectomy, it is a technically challenging procedure and patients often have very low rates of fertility following reversal."

[Big Sexy]

New drug screening system could help speed development of a cure for HPV
http://www.medicalnewstoday.com/releases/315751.php

Scientists have used genetic engineering techniques to develop a new system that could aid identification of potential drug targets and treatments for human papillomavirus (HPV) infection, according to a PLOS Pathogens study.

HPVs include more than 200 subtypes and cause illnesses ranging from genital warts to throat and cervical cancer. Every year, six million people are diagnosed with new HPV infections in the U.S. alone. Doctors administer a wide variety of treatments for illnesses caused by HPVs, with varying success, but no specific cure for HPV infection yet exists.

To aid development of a cure, Mart Toots and colleagues of the Icosagen Cell Factory Ltd. and University of Tartu, Estonia have created a new method that enables identification of potentially effective drugs and drug targets. Unlike previously developed systems, their method takes into account the full HPV genome, as well as all three stages of the viral life cycle that occur during HPV infection.

To develop the new system, the researchers genetically engineered HPV genomes by adding "reporter genes" that code for bioluminescent proteins and allow for easy monitoring of viral growth at any life cycle stage. This enables the use of a method called high-throughput screening to quickly test the effects of many different chemicals on viral growth and identify potential drug candidates or drug targets.

The scientists demonstrated the new system by using it to screen more than 1000 chemical compounds in HPVs grown in cells derived from human tissue. They identified several compounds that blocked the growth of some HPV subtypes. Some of these compounds inhibit specific human cellular proteins that HPVs hijack to replicate inside the body, suggesting that these proteins could serve as targets in the development of new anti-HPV drugs.

"We are confident that the developed HPV drug screening assay system will allow to identify several different novel drug targets and small molecule drugs," the authors further explain. "These could be used effectively for elimination of cutaneous and mucosal low risk and high risk Human Papillomavirus infections, therefore addressing serious unmet medical need in society, like benign and malignant HPV positive epithelial tumours."

This work was supported by project EU42266 from the Enterprise Estonia (EAS) as well as by the IUT 20-27 from Estonian Research Council, research grants 9385 and 9467 from the Estonian Science Foundation and Center of Excellence in Chemical Biology (3.2.0101.08-0017). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

[Big Sexy]

Weight-loss surgery can get the blood flowing
http://www.medicalnewstoday.com/releases/315870.php

Research reveals patients regain urinary and erectile function within a month.

Men with severe obesity who undergo lifesaving bariatric surgery start to regain urinary and erectile function within a month, according to a new study published in the Journal of Sexual Medicine.

Research carried out by Dr Maha Aleid of King Faisal Specialist Hospital Research Centre, in collaboration with Anglia Ruskin University and University College London Hospitals NHS Foundation Trust, surveyed 30 men with obesity over the age of 30 who were undergoing bariatric surgery - used to treat people who are severely obese when other treatments, such as lifestyle changes, haven't worked. Of these, 18 reported erectile dysfunction before the operation.

The patients were then surveyed a month, three months and six months after surgery, as their Body Mass Index (BMI) decreased and each reported rapid improvement in urogenital function, unexpectedly starting as quickly as a month afterwards.

Urogenital function was also tested before and after the surgery and the same rapid improvements were found.

Selim Cellek, Professor of Health and Biomedicine at Anglia Ruskin University, said: "Previous studies found that patients who have undergone bariatric surgery show improvement in erectile and urinary function within 19 months, but this study shows that these functions can in fact start to improve far quicker than we expected."

"Obesity is a complex disorder that has a negative effect on urinary and erectile function, which can be extremely tough to live with. For people with severe obesity, bariatric surgery leads to marked sustained weight reduction, decreases mortality and improves many of the co-morbidities that are associated with obesity.

"This study shows that bariatric surgery also leads to rapid improvement in urogenital function and these findings warrant further investigation."

[Big Sexy]

Erectile dysfunction: Causes and treatment in young men
http://www.medicalnewstoday.com/articles/316215.php

Most men will experience problems getting or keeping an erection at some point during adulthood, but this is not always caused by a medical problem. However, some men do develop a medical condition called erectile dysfunction.

Erectile dysfunction (ED) is a condition that occurs when the penis does not receive enough blood to produce an erection that is capable of having sexual intercourse. For men with ED, this happens repeatedly and affects a man's ability to sustain an active sex life.

While erectile problems are widely thought to be an older man's issue, ED can affect younger men as well. It can be both frustrating and embarrassing for a man to admit to having ED. Few young men, especially those under the age of 40, want to acknowledge that they may have it.

Although ED is not as common in young men, it can affect about 25 percent of men under the age of 40. However, only about 5 percent of all men under 40 have complete ED.

Causes

The causes of ED widely vary and can be caused by psychological, neurological, or lifestyle issues. ER can also be the result of side effects of particular medications.

All men who experience symptoms of ED should talk to their doctor to identify the probable cause and to determine the best course of action in terms of treatment.

Some of the causes for ED in young men include:

performance anxiety when the man is too nervous to sustain an erection
depression, schizophrenia, and other psychological disorders
penile abnormalities, such as foreskin problems or curvature
spinal cord injuries
microvascular disease from diabetes
nerve injuries
hypogonadism, a condition where the body does not produce enough sexual hormones
certain medications including some antidepressants
multiple sclerosis

Additionally, some young men might experience ED as result of factors that they have more control over.

For example, young men can suffer from ED due to:

obesity
diabetes
poor diet
lack of exercise
smoking
excessive drinking
relationship stress

If ED is caused by any of these lifestyle factors, it may be possible for men to reduce or eliminate the symptoms through changes to their lifestyle and diet.

However, even if a man thinks he knows the reason for his ED, he should see a doctor for a formal diagnosis and treatment. A doctor can also rule out any potentially harmful conditions that may cause ED.

Symptoms

There are three main symptoms of ED, which are relatively easy to identify. These symptoms are:

inability to get an erection
inability to maintain an erection long enough to have sexual intercourse
trouble having an erection that is firm enough for sexual intercourse

These symptoms may lead to a lack of sexual desire or a loss of interest in sex.

Complications

Physical complications of ED are generally mild. Men who experience ED do not typically experience any long-term health problems. However, ED may be a symptom of a more serious problem, such as heart disease.

The most common complications include:

an unsatisfactory sex life
inability to get a partner pregnant

While the physical complications may be mild, the emotional effects on a young man's quality of life may be more severe. Whether a man experiences all the potential complications or not depends largely on the individual and his own life experiences.

Additional lifestyle complications that some men might experience include:

stress or anxiety around sexual performance
embarrassment or low self-esteem due to inability to perform
relationship problems that possibly stem from stress or embarrassment

Treatment

Treatment for ED varies from person to person. Some men may find that improving their overall health may be enough to help the ED. Other people may require more treatment, such as relationship counseling, before they see any improvements.

If lifestyle and relationship improvements are not sufficient to improve ED, doctors may recommend medications. There are also some natural treatments available that may be considered.

When treating ED, a doctor or medical professional may suggest the following:

Lifestyle changes: One of the first things a young man can do to potentially improve or eliminate ED is make positive choices that will also have an impact on the rest of his life. Some changes a man can consider include increasing exercise, eating a heart-healthy diet, quitting smoking, and drinking alcohol only in moderation. Where a man has relationship problems, seeking counseling may also be helpful.
Natural treatments: Although natural remedies are increasingly available for sale over the counter, there is little scientific evidence to support their claims of improving ED. These remedies may produce adverse side effects or react negatively with other medications a man is taking. Before trying any over-the-counter treatments, it is essential to consult a doctor.
Medication: A doctor may prescribe a medication that stimulates blood flow to the penis, helping a man achieve an erection. There are many drugs available to choose from and each has its own set of side effects. Speaking to a doctor about the types of medication available is strongly recommended.
Changes to current medications: If a doctor determines that ED is caused as a result of a man taking a certain medication, they may change or stop the problematic medication. No one should stop or alter their medication without talking to a doctor first, however.

Outlook

Young men typically have a good chance of reversing ED. This can be achieved through lifestyle changes that generally improve overall health and by taking medication, or both. It is not uncommon for young men with ED to go back to experiencing a normal sex life if they follow the treatment and advice provided by their doctors.

[Big Sexy]

Parental concerns about sexual activity declining as reason not vaccinating children against HPV: Physicians need to discuss benefits of vaccine
http://www.medicalnewstoday.com/releases/316340.php

Concern about sexual activity is declining as a reason parents do not get their daughters the human papillomavirus (HPV) vaccine, according to a research study presented at the Society of Gynecologic Oncology's 2017 Annual Meeting on Women's Cancer.

Instead, according to a study presented by lead researcher Anna Beavis, MD, MPH, an SGO member and gynecologic oncologist fellow at Johns Hopkins University, parents continue to not see the vaccine as a necessity and are concerned about side effects and safety. The HPV vaccine, introduced in 2006, is used to prevent adolescents from contracting the HPV virus, which causes almost all cases of cervical cancer in women, as well as several other cancers.

"With the new nine-valent vaccine, almost 90 percent of all cervical cancer could be prevented if all adolescents were vaccinated," Beavis said. "Yet unfortunately, vaccination rates in the U.S have lagged considerably behind those of other Westernized nations."

The data presented compared the National Immunization Survey, or NIS-Teen, data, from 2010-2014, which reported on U.S. parents' responses to a question about why they did not vaccinate their daughters against HPV and did not intend to in the next 12 months.

From 2010-2014, the top two reasons were the concerns regarding safety and side effects and the belief the vaccine is not necessary. Yet, the third most common reason, adolescents' lack of sexual activity, dropped as a reason for parents not vaccinating. According to the data, in 2010, 18 percent of parents reported adolescents lack of sexual activity a reason, but in 2014 it dropped to 9 percent.

Prior literature has shown that physicians often delay or do not discuss HPV vaccination with parents because they feel they would also have to address sexual activity, Beavis said. Yet, the data shows that parents need to understand the necessity and safety as well as the benefits of cancer prevention.

Additionally, the vaccine produces a stronger immune response in younger children, and thus only two shots instead of three are recommended if the vaccine is given to children under the age of 15.

"Physicians should not be afraid to discuss the HPV vaccine with parents," Beavis said. "Our focus should be on cancer prevention."

[Big Sexy]

Choosing between Viagra, Cialis, and Levitra: What to consider
http://www.medicalnewstoday.com/articles/316355.php

Viagra, Cialis, and Levitra are the three most popular drugs used to help treat the symptoms of erectile dysfunction.

They are used for the same function, yet have distinct differences. It is important to understand these differences in order to make the best choice about which to choose.

How Viagra, Cialis, and Levitra work

Viagra is the brand name for the drug sildenafil, Cialis is the brand name for tadalafil, and Levitra is the brand name for vardenafil. Each of these drugs works in much the same way.

The drugs are considered PDE5 inhibitors. This class of drugs helps to relax the muscles and increases blood flow to the body. This makes it easier for blood to get into the penis, and allows people with erectile dysfunction (ED) to experience a lasting erection during sexual activity.

The action of the drugs is relatively fast. Manufacturers of PDE5 inhibitors recommend that users take the pill at least 30 minutes to 1 hour before sexual stimulation.

How long these drugs last is one of the key differences between them:

Viagra is a drug that is used only when needed. The drug is taken 30 minutes to 1 hour prior to sexual activity, and the effects typically last for 3-5 hours.
Levitra may start working faster than Viagra, but lasts for about the same amount of time.
A similar dose of Cialis may be felt for up to 36 hours. For this reason, people looking for a long-lasting drug may choose Cialis.

Side effects and interactions

Viagra, Cialis, and Levitra drugs all come from the same class of chemicals and so have many similar side effects and interactions.

For instance, manufacturers recommend not taking PDE5 inhibitors with grapefruit or grapefruit juice, because the fruit may affect how the drugs work. Nitrates will also interact with these drugs and should be avoided.

There are some drug specific side effects to be aware of, however.

Viagra

Side effects

headaches
stomach pain
facial flushing
congestion
nausea or diarrhea
color blindness
blurred vision

Interactions and warnings

Interactions with Viagra do occur, and it is important for people to be aware of them before choosing a medication for ED. Any drugs for pulmonary hypertension may also interact with Viagra, causing blood pressure to drop to unsafe levels.

A recent study in JAMA Internal Medicine has suggested that Viagra could increase the risk of skin cancer. The study found that 3.7 percent of skin cancer cases in men who used the drug sildenafil might have been prevented by not taking it.

Cialis

Side effects

headaches
facial flushing
low blood pressure
congestion
dizziness
chest pain

Interactions and warnings

Cialis is also associated with some more serious side effects. Cialis should not be taken with guanylate cyclase stimulators or blood pressure medications, as this can cause an unsafe dip in blood pressure.

A person who is taking Cialis and has prostate problems should avoid prescription alpha-blockers, as Cialis serves the same function. Certain antifungal medications and antibiotics should also be avoided by people taking Cialis.

Anybody considering taking medications, such as Cialis, for ED should always involve their doctor in the decision. The doctor may ask if the patient has a history of any of the following:

heart problems
stroke
liver or kidney problems
stomach ulcers
abnormal penis shape
blood cell problems like sickle cell anemia

All of these conditions may affect the doctor's decision to prescribe Cialis.

Levitra

Side effects

headache
congestion
facial flushing
indigestion
upset stomach
dizziness
back pain
color blindness

Interactions and warnings

If a person has been told by their doctor to avoid sexual activity due to health problems, they should avoid Levitra. Sexual activity can put extra strain on the heart, especially if it is already weak from heart disease.

Like Cialis, people taking guanylate cyclase stimulators or blood pressure medications should not take Levitra as it can cause an unsafe dip in blood pressure that can lead to fainting. People with prostate problems should avoid alpha-blockers if they are taking Levitra. They should also avoid certain antifungal medications and antibiotics.

A doctor may ask a person if they have a history of any of the following:

heart problems
stroke
hearing problems
retinitis pigmentosa, an inherited eye condition
liver or kidney problems
stomach ulcers
abnormal penis shape
blood cell problems, such as sickle cell anemia

All of these conditions may affect a doctor's decision to prescribe Levitra. People who are taking drugs to treat abnormal heartbeat should also avoid taking Levitra.

All three medications may sometimes cause priapism, an erection that will not go away. If a person experiences an erection lasts for more than 4 hours, they should seek medical attention to avoid lasting damage.

In rare cases, these drugs can cause serious side effects, including sudden loss of vision in one or both eyes or sudden hearing loss. If a person experiences these symptoms, they should stop taking the drug immediately and call their doctor.

Cost and availability

The other thing a person might consider is the cost and availability of each of these drugs. Some drugs have been around longer and may be more widespread than others.

All three of these drugs are set to go generic by 2018, which could also have an impact on prescription prices.

Viagra

Viagra has been used since 1998, and is possibly the best-known drug for ED in the world. Its use in the United States is widespread and it is available in most pharmacies. There are currently no approved generics for Viagra on the market in the U.S.

Cialis

Cialis has been on the market since 2003. It is very widespread and also a cheaper option than Viagra. There are also no approved generics for Cialis on the market in the U.S.

Levitra

Levitra was approved in 2003, and is available in most pharmacies in the U.S.

A generic version of Levitra has also been approved by the U.S. Food and Drug Administration (FDA), which could possibly mean lower prescription costs. The generic version is not widely available, however.

Who are the drugs best suited for?

Every person is different and what drug suits one person may not suit another.

Cialis is the only drug of the three that is approved for use by people with benign prostatic hyperplasia (BPH) or enlarged prostate. So people with both ED and BPH should consider Cialis as their treatment option. Cialis also helps to improve urine flow.

Cialis can be taken on a daily basis to keep the body ready for sexual stimulation at any time. This allows for some sexual freedom that may be missing with the other options.

Viagra or Levitra may be better for people who don't engage in sexual activity at very regular intervals and would rather just take one pill each time they plan on having sex.

There are also personal reasons that may guide a choice. Each body reacts to medications differently. Side effects vary from person to person and the potential side effects may help an individual to decide which drug suits them best. For instance, if the nausea or dizziness caused by one drug makes someone unable to have sexual intercourse, they should consider another drug.

Outlook

Viagra, Levitra, and Cialis may provide many people with relief from symptoms of ED. There are many side effects and interactions to consider, but when used correctly these drugs show good results.

The only way to know which drug is best is often through trial and error. People should work directly with a doctor to track side effects and decide which drug is their best treatment option.