Wall Street Journal Examines San Francisco STD Director’s Fight For STD Warning, Condom Promotion Labels On Viagra

Dr. Jeffrey Klausner, the San Francisco Department of Public Health director of sexually transmitted disease prevention and control, is fighting an "uphill battle" to change the warning labels on Pfizer's male impotence drug Viagra to include a statement "explicitly warn[ing]" users about STDs and promoting the use of condoms, the Wall Street Journal reports. After seeing an empty Viagra packet on the floor of a gay sex club during a health inspection, Klausner began to wonder whether the drug was contributing to unsafe sexual behavior and a rise in HIV and other diseases, according to the Journal. He has sent letters to the FDA and Pfizer asking that the drug maker be required to send letters to doctors, pharmacists and consumers "acknowledging the risk of disease" in Viagra users. In addition, Klausner is calling for Pfizer to rework its advertisements for the drug so that they mention STD risks and subsidize an education campaign aimed at gay men, the Journal reports. Both Pfizer and the FDA say that the current Viagra label is sufficent; the label states that the drug does not prevent STDs, but Klausner said, "Neither does a hamburger."

Showing Cause and Effect
Harold Jaffe, director of CDC National Center for HIV, STD and TB Prevention, said that the agency has begun examining Viagra's role in STD transmission to help "address possible increased risk of HIV from Viagra use." Recent studies in New York have shown that one-third of gay and bisexual men with syphilis had used Viagra, compared with one in five of those who did not have syphilis. Dr. Susan Blank, assistant commissioner in the New York City Department of Health and Mental Hygiene, said, "This suggests that Viagra is in some way part of the unsafe sex that is happening." National Coalition of STD Directors Executive Director Theresa Raphael said, "We are concerned that there is a spike in STDs in certain populations, and that Viagra is one of the factors contributing to that." But Mariann Caprino, a spokesperson for Pfizer, said that there is "no connection" between the drug and a higher incidence of STDs, according to the Journal. She added, "We've said this is a product for men with erectile dysfunction and have opposed recreational use from day one." Klausner points to studies he has completed in San Francisco that show that Viagra users are two to three times more likely to be diagnosed with an STD than men who do not use the drug. Don Shames, director of the FDA's division of reproductive and urologic drugs, said that there is a "big difference between association and causation," adding that there have been no claims that Viagra causes HIV or syphilis, the Journal reports. He added, "I understand [Klausner's] arguments and I'm sympathetic. But we need to have evidence to put into the label." Klausner said, "They're suggesting public health can pick up the pieces," adding, "Hey guys, "I'm picking up the pieces on the floor of sex clubs" in the form of empty Viagra packets (Chase, Wall Street Journal, 3/7).