Treating ADHD With Medication Found to Reduce Risk of Sexually Transmitted Infections

Adolescent and young adults with attention-deficit/hyperactivity disorder (ADHD) are at a higher risk for subsequent sexually transmitted infections (STIs), but taking medicine for ADHD can help cut the risk, according to a study from Taiwan. Based on the findings, the authors made recommendations for clinicians, who may be reluctant to prescribe ADHD medicine for some patients.

The study was published in the January 2018 issue of the Journal of the American Academy of Child and Adolescent Psychiatry. The findings are based on the Taiwan National Health Insurance Research Database, which is a nationally representative database of medical claims and healthcare data.

The study included 17,898 adolescents and young adults diagnosed with ADHD and 71,592 age and sex-matched non-ADHD controls who did not have STIs prior to enrollment. Adolescents aged 12 to 17 years and young adults aged 18 to 29 years were followed from January 1, 2001, through the end of 2009.

The researchers tracked data related to risk of STIs, including HIV, syphilis, genital warts, gonorrhea, chlamydial infection, and trichomoniasis, as well as the presence of other psychiatric conditions. They also measured whether subjects were taking methylphenidate or atomoxetine for ADHD. Short-term use of medicine was defined as taking medicine between 30 and 364 days, and long-term use was defined as more than 365 days.

Findings included:

• ADHD increased the risk of subsequent STIs by about 3 times, but the short- and long-term use of ADHD medication reduced the risk of subsequent STIs among men by 30% and 41%, respectively.
• Adolescents and young adults with ADHD had greater incidence of any STI (1.2% versus 0.4%), and developed STIs at a younger age (20.51 ± 4.48 versus 21.90 ± 4.49) as compared to age- and sex-matched peers.
• Adolescents and young adults with ADHD had a higher prevalence of psychiatric comorbidity, including disruptive behavior disorder (13.5% versus 0.3%), alcohol use disorders (1.1% versus 0.5%), and substance use disorders (2.5% versus 0.8%).
• Male short-term and long-term ADHD medication users had a significantly lower risk of developing any STI during follow-up—an effect seen only in males.
• Only women had an association between substance use disorders and STIs, after adjusting for demographics, comorbidities, and ADHD medications.

The researchers wrote that the differences in the risk of STIs between male and female patients with ADHD require additional study.

While previous studies have suggested that ADHD is related to risky sexual behaviors—a major STI risk factor—the link between ADHD and subsequent STIs has been unknown. The authors said there were several possible explanations for the findings, as previous studies have discussed how the main symptoms of ADHD, as well as certain comorbidities, relate to risky sexual behavior.

• Substance use disorders increase the susceptibility to unprotected sex and intravenous substance use, which are known STI risk factors.
• Impulsivity, the core symptom of ADHD, is also associated with increased susceptibility to risky sexual behaviors and STI.
• ADHD medications, such as methylphenidate, are beneficial in regulating impulsivity, which could possibly decrease impulsivity-related risky sexual behaviors and, in turn, the risk of subsequent STIs.
• Medicine could also help with another symptom of ADHD, executive function, which can also play a role in risky sexual behavior.

While the authors noted that some clinicians could have concerns about prescribing ADHD medications, especially psychostimulants, to patients with ADHD who also have a substance use disorder, they pointed to accumulating evidence indicating those concerns may be unfounded. Receiving ADHD medication is unlikely to be associated with a greater risk of substance-related problems in adolescence or adulthood, and the medicine is associated with lower concurrent risk of substance-related events.

The researchers suggested that healthcare providers focus on the increased risk of STIs for patients with ADHD and substance use disorders, and be “exceptionally diligent” in seeking treatment compliance with this high-risk group.

Several limitations were noted with this study.

• The prevalence of both STIs and ADHD could have been underrepresented in the database, although the authors wrote the chance of diagnostic validity was improved since diagnoses were made by board-certified physicians.
• The database did not contain information on the severity of ADHD symptoms, so an association between ADHD severity and risk of subsequent STIs could not be determined.
• The definitions of short-term and long-term use of ADHD medications is based on the number of cumulative defined daily dose, which could be arbitrary.
• ADHD medication use could be a proxy measure for treatment compliance or the severity of ADHD. ADHD severity was not measured in this study.
• Timing of an ADHD diagnosis might be arbitrary; another study involving a birth cohort could be used to confirm these findings.
• Factors specific to Taiwan, where the study took place, may have had an effect. Although the prevalence of ADHD was 3.3% to 7.5% in Taiwanese youths, up to 40% of Taiwanese patients with ADHD did not receive medication because parents tend to be concerned about overuse of ADHD medication, the authors wrote.

Reference

Chen M, Hsu J, Huang K, et al. Sexually transmitted infection among adolescents and young adults with attention-deficit/hyperactivity disorder: a nationwide longitudinal study. J Am Acad Child Adolesc Psychiatry 2018;57(1):48—53.