Long COVID linked to higher risk of erectile dysfunction, new study finds

In a recent study published in the IJIR: Your journal of sexual medicinea group of researchers used a large United States (US) claims database to assess the risk of developing erectile dysfunction (ED) following an diagnosis of long-term coronavirus disease (COVID) compared to acute COVID, taking into account hospitalization status and vasopressor administration.

Study: Comparison of risk of post-infectious erectile dysfunction following SARS coronavirus 2 stratified by acute and long COVID, hospitalization status and vasopressor administration: an analysis of a large US claims database. Image credit: Prostock-studio/Shutterstock.com

Background

Since the outbreak of COVID-19, more than 750 million cases have been confirmed and nearly 7 million deaths have occurred. Post-COVID-19 sequelae impact many organ systems, including the cardiovascular, pulmonary, immunological, endocrine, vascular, reproductive and neurological systems.

These effects raise concerns among professionals who now face acute and chronic infections. From a urological perspective, patients face a higher risk of erectile dysfunction following COVID-19. Up to 50.3% of men developed erectile dysfunction within three months of infection.

Additional research is needed to better understand the differential impact of long and acute COVID on erectile dysfunction and to guide more effective prevention and treatment strategies.

About the study

The present study conducted a retrospective cohort analysis using electronic health records (EHRs) and insurance claims from the TriNetX COVID-19 Research Network, covering more than 109 million patients from 81 healthcare settings .

Data, collected through June 2023, included demographics, diagnoses (International Classification of Diseases (ICD-10) codes), and procedures (Current Procedural Terminology (CPT) codes), validated across all specialties.

TriNetX adheres to the Health Insurance Portability and Accountability Act (HIPAA), ensuring data de-identification. Because only de-identified records were used, the study was exempt from oversight by the Johns Hopkins Institutional Review Board, providing an overall patient count and statistical summaries.

Included are men over the age of 18 who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ribonucleic acid (RNA) between December 1, 2020 and June 1, 2023, with at least least one follow-up visit two weeks later. -diagnosis.

Exclusions included men with a prior diagnosis of erectile dysfunction, a prescription for phosphodiesterase type 5 (PDE5) inhibitor, intracavernous injections, penile prosthesis, prostatectomy, pelvic radiotherapy, or pulmonary hypertension.

Three analyzes assessed risks associated with a long COVID diagnosis, vasopressor use, and inpatient hospital services within 1 month of initial diagnosis. Outcomes were new diagnoses of erectile dysfunction, new prescriptions for PDE5 inhibitors, or both within 1 to 18 months after infection.

Propensity score matching (1:1, eager nearest neighbor, width 0.1 SD) balanced covariates such as age, race, comorbidities, and health care utilization. TriNetX calculated relative risks and 95% CIs using R’s Survival package, with significance defined as a two-sided alpha less than 0.05.

Study results

A total of 184,253 men met the inclusion and exclusion criteria for this study. Before propensity score matching, 2,839 (1.5%) men had been diagnosed with long COVID at least four weeks after their initial diagnosis, while 181,414 (98.5%) had only one Acute COVID.

Of these patients, 173,411 (94.1%) did not receive vasopressors within 1 month of their initial diagnosis, compared to 10,842 (5.9%). In addition, 161,383 (87.6%) men were not treated by hospital services, while 24,726 (13.4%) were.

After propensity score matching, equal-sized cohorts were established: 2,839 men with and without long-term COVID-19, 10,842 men with and without vasopressor administration, and 19,695 men with and without inpatient hospital services. .

The mean age of men in the long and acute COVID cohorts was 54.5 ± 16.7 and 55.1 ± 17.1 years, respectively (p = 0.21). The mean age of the vasopressor administration cohorts was 57.4 ± 17.8 and 56.6 ± 17.6 years, respectively (p < 0.001).

The inpatient hospital ward cohorts had mean ages of 59.0 ± 17.4 and 58.7 ± 17.4 years, respectively (p = 0.10).

The study found a statistically significant increased risk of erectile dysfunction in men diagnosed with long COVID. Specifically, 3.63% of patients with long COVID were diagnosed with erectile dysfunction or received PDE5 inhibitors, compared to 2.61% of those with acute COVID (RR 1.39, 95% CI 1.04, 1.87).

There was no statistically significant difference in the risk of erectile dysfunction for those receiving vasopressors; 2.06% of patients who received vasopressors were diagnosed with erectile dysfunction or received PDE5 inhibitors, compared to 2.23% of those who did not (RR 0.92, 95% CI 0.77, 1.10).

Similarly, no significant differences were found for patients who received hospital services, with 2.40% of these patients having been diagnosed with erectile dysfunction or prescribed PDE5 inhibitors, compared to 2.57% of those not receiving hospital services (RR 0.93, 95% CI 0.82, 1.06). ).

Conclusions

To summarize, researchers found a significantly increased risk of erectile dysfunction after long COVID infections, but no significant change in the risk of erectile dysfunction for people who received vasopressors or required hospitalization.

This demonstrates the unique impact of long COVID on sexual health. Additionally, ED diagnosis rates after long COVID were lower than previously reported in smaller cohorts, with some studies showing rates as high as 50%.