Erectile dysfunction and HTLV-I infection: a silent problem

Abstract

The human T-lymphotropic virus type I (HTLV-I) is a retrovirus associated with a chronic myelopathy known as HTLV-I-Associated Myelopathy or Tropical Spastic Paraparesis (HAM/TSP). The main objective was to assess the frequency of erectile dysfunction (ED) in HTLV-I-infected individuals from Salvador and other cities from Bahia, Brazil, as well as to verify if sexual dysfunction correlates with urinary symptoms and overall neurological impairment. From January 2001 to April 2004, 218 HTLV-I carriers (111 male and 107 female subjects) had complete clinical, neurological, and urological evaluation. They were assessed using standardized questionnaires to determine urinary complaints (Urinary Distress Inventory) and ED (Brief Male Sexual Function Inventory). Neurological impairment was established by Expanded Disability Status Scale (EDSS) from 0 to 10. HAM/TSP was considered as EDSSZ2. A total of 17 males had clinically defined HAM/ TSP (group 1). From the 94 HTLV-I-infected males, 62 were selected (group 2) and paired by age with patients in group 1. A total of 79 individuals were selected for this study. The age ranged from 35 to 81 y (mean ¼ 47.979.65). The percentage of ED in the studied population was 40.5%. In the HAM/TSP group, ED frequency was 88.2%. The associations among sexual dissatisfaction, erectile dysfunction, urinary symptoms (frequency, nocturia, and urgency) and EDSSZ2 were statistically significant. In HAM/TSP, there is a slow and progressive degeneration of the lateral funiculus of the spinal cord. HTLV-I-infected individuals present a high frequency of ED and it is closely associated to urinary symptoms and the overall neurological picture. The HTLV-I carriers already had prominent compromise of the sexual activity.

Mielopatia associada ao HTLV-1: análise clínico-epidemiológica em uma série de casos de 10 anos

“…A tetrahiperreflexia e sinal de Hoffmann positivo são sinais frequentes, apesar do pouco acometimento da força muscular e da sensibilidade dos membros superiores, com resultado compatível com o descrito em publicações anteriores 6,14 . Nota-se a importante prevalência da disfunção erétil nos pacientes masculinos, problema grave que deve ser abordado 30 . Também, existem alterações da função sexual feminina, devido à diminuição da sensibilidade perineal e das próprias limitações físicas, da progressão da doença, entretanto, no presente estudo não foi feita uma análise destes dados por não ser uma pesquisa rotineira neste serviço de reabilitação.…”

Neurologic abnormalities in HTLV-I– and HTLV-II–infected individuals without overt myelopathy

“…At each of the 6 visits with complete data (visit 4 was not included), the mean number of work-loss days was greater for HTLV-II participants when compared with that for HTLV-I and HTLV-seronegative participants ( p Ͻ 0.0001 at all visits; figure 2). Using multivariate repeated-measures analysis to control for confounding, HTLV-II participants were shown to report 14…”

“…These symptoms and conditions may later progress to HAM or constitute isolated neurologic syndromes associated with HTLV infection. Sensory neuropathy, [6][7][8] gait abnormalities, 9,10 bladder dysfunction, 6,9-12 erectile dysfunction, 13,14 ALS, 15 mild cognitive deficits, 16 and rarely, motor neuropathies 6,8,13,[17][18][19] have all been reported among HTLV-I-infected individuals without HAM. Although less research has focused on HTLV-II, sensory neuropathy has been observed with HTLV-II alone 20 and with HIV coinfection.…”

O vírus linfotrópico de células T humanos tipo 1 (HTLV-1): Quando suspeitar da infecção?

“…During the initial phases the most common urinary symptoms are nocturia, urge urinary incontinence and dysuria, progressing to feelings of micturition effort, incomplete bladder emptying and incontinence. 44,45,46 Erectile dysfunction is reported in 88.2% of patients with HAM/TSP, in comparison with a rate of 17% in the general population. 44 Rocha et al 47 observed symptoms suggestive of urinary infection in HTLV carriers, but did not confirm infection by urine culture in the majority of cases (81%).…”