STDs Have No Age Limit

Discussions about sexually transmitted diseases (STDs) largely revolve around condom use among the target demographic of young, healthy people. The underlying assumption is this hormonally charged age group has a lot of sex—unprotected sex. Indeed, young adults between 15 and 24 years old account for about half of all new STD infections in the United States, states the Centers for Disease Control and Prevention (CDC).

However, there is another subset of the population having unprotected sex and contracting STDs: seniors. According to statistics released by the CDC in October 2019, the number of gonorrhea cases increased by 164 percent among Americans age 55 and older between 2014 and 2018, while cases of syphilis increased by 120 percent and chlamydia by 86 percent.

Yes, seniors are still having sex

Many factors contribute to the dramatic rise in STDs among seniors over the past few years.

Historically, sexual activity has been known to drop as people get older, in part due to erectile dysfunction (ED) in men and decreased vaginal lubrication in women. However, with the prevalence of ED medications such as sildenafil (Viagra) and tadalafil (Cialis), as well as effective vaginal lubricants available over the counter and via doctor's prescription, people are able to continue enjoying an active sex life well into their senior years.

Another contributing factor is the baby boomer generation did not receive as robust a sex education as younger generations—and given the flaws of modern sex ed, that's saying something. It's been shown people older than 60 have the lowest rates of using barrier contraception, or condoms. Considering senior women have gone through menopause and are not at risk for pregnancy anymore, they may not see the necessity for contraceptive forms that would also help stop the spread of sexually transmitted diseases.

"Physician bias also plays into this rise, as well," said Oladmeji Oki, M.D., a family physician in the Bronx in New York City. "As we continue to incorrectly assume our patients either: a) have one stable sexual partner, b) aren't having regular sexual intercourse or c) would know the risks of contracting an STD and would get in contact for regular screening if needed, we miss out on potential opportunities to test and treat."

The stigma around sexual activity among seniors is a problem. Patients are often embarrassed to discuss their sex lives with their doctors, and many doctors are embarrassed to ask older patients to discuss their sexual history.

Special considerations for seniors

"STDs present similarly physiologically in seniors as they do in other age groups," said Odelia Lewis, M.D., a family physician in Brooklyn in New York City. "Symptoms can include burning with urination, pelvic pain, penile or vaginal discharge, vaginal pain with sexual activity, frequent urination or sores/bumps on the vagina, penis, anus or mouth."

Generally, as people age, their bodies are less resistant to inflammation caused by STDs, increasing the risk of negative outcomes such as heart disease and cancer.

It's also been noted that people older than 55 are less likely to get tested for sexually transmitted diseases. This means when they are diagnosed, they are more likely to be in an advanced stage where they are symptomatic and possibly more disseminated. For example, untreated gonorrhea and chlamydia can progress to pelvic inflammatory disease (PID) or even abdominal abscesses, both of which are very serious and potentially life-threatening infections.

For the most part, sexually transmitted diseases are treated the same way in seniors as in younger patients, although some consideration is required for other medical problems that people develop as they get older. For example, there are HIV medications that can decrease bone density; anyone with osteopenia or osteoporosis would be advised to avoid them. Many medications used for STD treatment are cleared from the body by the kidney and, as older people are more likely to have kidney disease, lower doses may be needed.

It is also important to talk about partner notifications. STD transmission requires at least two people, and a plan should be in place to notify or treat any sexual partners to prevent reinfection.

Medical complications of STDs

Long-term cases of diseases such as HIV and syphilis can have cognitive effects causing or worsening dementia. As dementia is present in some seniors, an STD diagnosis may be missed if clinical suspicion is not already in place. Neurosyphilis, a devastating long-term effect of untreated syphilis, is treated with up to two weeks of regular intravenous (IV) infusions of medications versus the one intramuscular injection often used for early primary syphilis.

As mentioned, untreated gonorrhea and chlamydia can progress to pelvic inflammatory disease and even abscesses within the body if untreated, which would necessitate longer durations of antibiotic treatment, potential hospitalization and other procedures. Persistent infections have been shown to increase inflammatory markers in the body and can worsen cardiovascular risk, including heart attack and stroke.

Sexual activity is an important part of most healthy lifestyles regardless of age. With that in mind, it's crucial to stop pretending seniors are not sexually active and acknowledge that we can help educate them with information about contraception and regular STD testing.