Adolescents and young adults with ADHD were at higher risk for STIs later in life compared with those without the disorder; however, ADHD medications may reduce this risk, by as much as 41% in men, according to researchers in Taiwan.
“Increasing evidence supports the association between ADHD and various health-risk behaviors, such as risky driving, substance abuse and risky sexual behaviors, which have been associated with the core symptoms of ADHD, including executive dysfunction, problematic decision making and impulsivity,” Mu-Hong Chen, MD, from the department of psychiatry at Taipei Veterans General Hospital, and the College of Medicine at National Yang-Ming University in Taiwan, and colleagues wrote. “However, the association between ADHD and STI has rarely been investigated, and findings have been conflicting.”
Researchers used data from a nationally representative database of medical claims and health care data in Taiwan to examine the risk for STIs among teens and adolescents. They compared risk between 17,898 patients with ADHD and 71,592 age- and sex-matched controls without ADHD, who did not have STIs prior to study enrollment. Participants were enrolled from 2001 to 2009, with follow-up until the end of 2011. Researchers tracked related data, such as risk for HIV, syphilis, genital warts, gonorrhea, chlamydial infection and trichomoniasis, as well as data on psychiatric comorbidity and medication use for ADHD (methylphenidate or atomoxetine).
Analysis showed a significant association between ADHD and subsequent risk for any STI (P < .001). During follow-up, adolescents and young adults with ADHD had a higher incidence of any STI compared with patients without ADHD (1.2% vs. 0.4%; P < .001). After adjusting for demographic data, psychiatric comorbidities and ADHD medications, adolescents (HR = 3.27; 95% CI, 2.51-4.25), young adults (HR = 3.57; 95% CI, 2.3-5.54), men (HR = 3.81; 95% CI, 2.88-5.04) and women (HR = 2.71; 95% CI, 1.85-3.96) with ADHD were likely to develop an STI later in life. The association between ADHD and risk for HIV, syphilis, genital warts, gonorrhea, chlamydial infection, and trichomoniasis was significant for all comparisons (P < .001).
Among teens and young adults with ADHD, short-term users (HR = 0.7; 95% CI, 0.53-0.94) and long-term users (HR = 0.59; 95% CI, 0.37-0.93) of ADHD medications had a 30% and 41% lower risk for any STI during follow-up; however, these effects were only observed in men.
Patients in the ADHD group had a higher prevalence of psychiatric comorbidities, such as disruptive behavior disorder (13.5% vs. 0.3%, P < .001), alcohol use disorders (1.1% vs. 0.5%, P < .001) and substance use disorders (2.5% vs. 0.8%, P < .001). However, after adjustment, there was an association between substance use disorders and STI only among women (HR = 3.87; 95% CI, 1.98-7.55).
According to the researchers, an underlying reason for this relationship between ADHD and the risk for STIs later in life is that ADHD comorbidities (like substance use disorders) can heighten the susceptibility to unprotected sex which raises the risk of subsequent STIs. In addition, when examining the relationship between medication use and lower risk of subsequent infection, prior study has indicated that because impulsivity, a symptom of ADHD, may increase susceptibility to risky sexual behaviors and STI, treatment with ADHD medications that modulate impulse control can also decrease impulsively-risky sexual behaviors thus cutting the risk for subsequent infections.
“We recommend that clinical psychiatrists focus on the occurrence of risky sexual behaviors and the risk of STIs in patients with ADHD and emphasize that treatment with ADHD medication could be a protective factor for prevention of STIs,” Chen and colleagues wrote. “Future studies would be necessary to further investigate whether other ADHD treatments, such as family therapy or psychotherapy, are effective in preventing STIs.” – by Savannah Demko
Disclosures: The authors report no relevant financial disclosures.