Just because a patient is older is no reason not to consider a sexually transmitted infection (STI) as the reason for their presentation, according to Justyna Kowalska, PhD, from the Medical University of Warsaw, Hospital for Infectious Diseases, in Poland.
It is important to normalize conversations around older people and sexual health, she said at the 2024 ESCMID Global Congress (formerly ECCMID), in Barcelona, Spain.
Data from the CDC indicate that rates of chlamydia, gonorrhea and syphilis among U.S. adults 55 years of age and older have more than doubled over the past 10 years. For example, rates of gonorrhea among those 55 to 64 years rose from around 15 cases per 100,000 people in 2015 to 57 per 100,000 in 2019.
In England, 31,902 new STIs were recorded in those older than 45 in 2015, which rose to 37,692 in 2019—an increase of 18%, with most new diagnoses in men who have sex with men (Perspect Public Health 2023;143[5]:263-271).
High STI prevalence estimates have also been reported more broadly in older adults around the world, including China, Korea, Kenya and Botswana.
“Rising divorce rates, forgoing condoms as there is no risk of pregnancy, the availability of drugs for sexual dysfunction, the large number of older adults living together in retirement communities and the increased use of dating apps are likely to have contributed to the growing incidence of STIs in the over 50s,” Dr. Kowalska explained. “These data likely underestimate the true extent of the problem, as limited access to sexual health services for the over 50s, and trying to avoid the stigma and embarrassment both on the part of older people and healthcare professionals, is leading to this age group not seeking help for STIs.”
Compounding the problem are the many misconceptions around sexuality and sexual activity in older adults, and the importance of sex and intimacy to older people’s happiness and well-being. “People do not become asexual with age. In fact, with preventive medicine and improved lifestyles people are enjoying a healthy life and sex life for longer. Older people often find greater satisfaction in their sex lives due to experience and known expectations,” she said.
In a study in England, one-half of men and almost one-third of women ages 70 and older reported being sexually active. Similarly, in a Swedish study, 46% of individuals 60 and older reported being sexually active, as did 10% of those 90 and older (Arch Sex Behav 2016;45:133-144 https://doi.org/10.1007/s10508-014-0465-1).
Studies show higher levels of sexual desire, greater sexual frequency and more sexual partners among older men than women. A retrospective study from the United States involving 420,790 couples aged 67 to 99 years found that widowhood was associated with an increased risk for STIs in older men, but not women. And the effects in men were larger after sildenafil, the first phosphodiesterase type 5 inhibitor, hit the market.
“These findings indicate that sexual risk taking is common among older adults, particularly men. Given that the number of people aged 60 years and older is set to double worldwide by 2050 and the widespread availability of drugs to enhance sexual activity, health professionals must be proactive in discussing sexual concerns and making sexual health a routine part of general healthcare for older adults,” Dr. Kowalska said.
Although the incidence of STIs among the over 50s is small compared with younger age groups, it is rising, and she called for raising awareness about sexual health in older adults, explaining that they came of age at a time when sex education in school did not exist.
“Health promotion messages give the impression that condoms and concerns about STIs only apply to young people. But the dangers of undiagnosed and untreated STIs such as HPV-related cancers and onward transmission are very real, particularly in this age group who are more likely to have underlying conditions such as heart disease and stroke,” she said.
Discussions about preventing HIV and STIs are important to have with older patients.
“Increasing older adults’ knowledge of the risk of STIs and how to engage in safer sex is crucial to tackling record levels of STIs,” Dr. Kowalska said. “Tailoring education programs to the over 50s and including peer support and ensuring they are located within existing community settings is vital to their success.” Ultimately, she said, “older people have a right to good sexual health, so let’s normalize conversations around sex and older people and change the narrative on aging.”
Source: IDSE