Cocaine excretion in the semen of drug users.

The belief that cocaine has aphrodisiac properties has prevailed among drug users for decades. Cocaine use is frequently linked with stimulated sexual behavior; addicts often rate cocaine as the most effective drug for increasing libido and sexual responsiveness. Animal studies with radiolabeled cocaine indicate that the drug is deposited in genital and extragenital organs, including the epididymis and seminal vesicles (1). Specific binding sites have been characterized on human spermatozoa (2), but in vivo studies have not been performed on the kinetics of excretion of cocaine in human semen. We report results of a controlled dosing study of cocaine with five experienced, drug-free cocaine users who provided informed consent. Cocaine hydrochloride was administered by the intravenous and intranasal routes, and cocaine base ("crack") was administered by the smoking route. Semen samples collected prior to cocaine use were negative for cocaine and metabolites, whereas semen samples collected 1 h after cocaine use contained parent drug and metabolite in concentrations ranging from 60 to 80% of plasma concentrations (Table I). At 24 h, semen concentrations of cocaine had declined to trace or nondetectable levels, but small amounts of benzoylecgonine were still present. No discernible effects were noted on semen/plasma ratios by changing the route of cocaine administration. Although mean semen/plasma cocaine ratios were less than unity, occasional ratios were obtained that were greater than unity (range, 0.08-1.88 at I h). Generally, prostatic fluid is more acidic than plasma, causing ion trapping of the weak base, cocaine, to occur in the prostate. This would lead to semen/plasma ratios greater than unity. However, semen also contains vesicular fluid that is alkaline (3). The wide fluctuations in semen/plasma ratios were likely due to variations in prostatic and vesicular fluid pH and corresponding differential contributions to ejaculate volume. The presence of cocaine and benzoylecgonine in semen raises concern regarding the effects of cocaine intake by the male partner engaged in sexual activity. Drug effects could potentially be expressed in the drug taker, in the sexual partner (as a result of exchange of body fluids), and in offspring. Studies of male offspring of alcoholics have provided evidence of specific cognitive impairment as a result of chronic alcohol consumption (4,5). Sons of early onset alcoholics were impaired on tests measuring attention and verbal intellectual capacity compared with control subjects. Cicero (6) offered