The San Francisco Department of Health petitioned the Food and Drug Administration (FDA) on August 5 to change the label on Viagra (and other similar drugs) to warn users about an increased risk for sexually transmitted diseases (STDs), including HIV.

Since the approval of Viagra in March of 1998, the drug has been made widely available, and is one of the most popular prescription medications in the United States, according to the petition. The drug has also been very popular among gay and bisexual men, and the increase in use has corresponded with an increase in certain STDs reported by the Centres for Disease Control and Prevention (CDC) in 2002.

"Multiple studies have found the use of Viagra outside of medical supervision to be common, with rates as high as 31 percent among men who have sex with men (MSM)," the petition states. There have also been studies connecting the use of Viagra and other club drugs with unsafe sexual behaviour. If you take certain club drugs, you may have a difficult time getting an erection, and Viagra can combat that problem, however the combination may be extremely dangerous.

In addition to amending the label, the petition also called for the FDA to promote educational campaigns about the risks of Viagra, to change the marketing of Viagra, and to classify the drug as a controlled substance.

"We are requesting that the FDA take action to reduce the problem of Viagra abuse and the subsequent risks for STDs, including HIV infection," says Jeffrey D. Klausner, MD, MPH, the director of the San Francisco STD Prevention Section, who submitted the petition on the behalf of the department of public health.

According to a GayHealth.com online survey of more than 1550 people in April 2002, more than 54 percent of people who reported taking Viagra, took it for purely recreational reasons. While the recreational use of Viagra is a major concern, even when people do get the drug legitimately from their doctor, they aren't necessarily going to receive counselling about risk taking and sexual behaviour.

"It is mind boggling that a patient could request Viagra, a doctor prescribe it and there be silence about sexual activity or sexual risk behaviour. This is irresponsible and must change," says Klausner. "The FDA should encourage doctors and patients to talk about risk reduction, including condom use with new or multiple partners," he says.

The petition says the risk factors of Viagra include a longer erection, the increased blood flow and increased mucosal susceptibility - not to mention the increase in sexual risk taking - that increases your risk for these infections.

A San Francisco study cited in the petition found that Viagra users had a higher average number of sex partners, and were more likely to have unprotected anal sex. In addition, Viagra users were more than twice as likely to get diagnosed with HIV.

"The FDA must take immediate steps to target the ongoing public health problem of Viagra use and STD transmission, including HIV infection," the petition urges. "The FDA has a responsibility to abate risk-associated abuse, which has been clearly shown in the case of Viagra."