Sexually Transmitted Infections in Older Adults

According to research recently published by athenahealth, older adults (aged ≥60 years) represent the largest increase in in-office treatment of sexually transmitted infections. Between 2014 and 2017 the percent change in treatment rate per 100,000 people among the 60+ group was nearly 25%. For perspective, during the same 4-year period, the entire population aged ≥13 years saw an increase in treatment of STIs of 11%.

The trend among older adults is of concern given the natural waning of immunity and other age-related changes. What can primary care providers do? Focus a bit more attention on your older patients. And, find out how much you know with a short quiz.

1.  Approximately what percentage of older adults aged 75-85 years are sexually active?

A. 10%

B. 15%

C. 20%

D. 25%

Please click here for answer and next question.

Answer: D. Approximately 25%. According to a survey of >3000 people conducted by the National Social Life, Health and Aging Project, about 26% of people aged 75-85 are sexually active. Among those aged 57-64 yrs, 73% report being sexually active and among those aged 65-74 yrs, 53% are sexually active.¹

2. According to research, roughly what percentage of men aged 70-79 years report using a condom during their last sexual encounter?

A. 0%

B. 5%

C. 10%

D. 15%

Please click here for answer and next question.

Answer: A. 0%. According to a 2010 study, 0% of men aged 70-79 years report using a condom during their last sexual encounter. Among men in other age groups, the percentages were²:

• 24% for ages 50-59

• 17% for ages 60-69

• 14% for ages 80+

For women, reported use of a condom was:

• 24% for ages 50-59

• 28% for ages 60-69

• 0% for ages 70-79

• 0% for ages 80+

Research is sparse on this issue, and more studies are needed to understand whether these percentages have changed in recent years. Various factors may explain lack of condom use among older adults:

• Older adults no longer need to worry about pregnancy with unprotected intercourse.

• Some baby boomers who are now widowed or divorced may return to the sexual freedom of their youth without adequate education about the need for condoms to prevent STDs like HIV.

• Women have a longer life expectancy than men and may have fewer male sexual partners from which to choose. They may fear losing a partner if they ask to use condoms.³

3. Which of the following has most likely contributed to increasing rates of STIs among older adults in recentl years?

A. Viagra

B. Online dating

C. High rates of mid-life divorces

D. All of the above

Please click here for answer and next question.

Answer: D. All of the above. In recent years, rates of STDs have been steadily increasing among older adults. A recent analysis by athenahealth found that, among adults aged ≥60 years, rates of diagnosed herpes, gonorrhea, syphilis, hepatitis B, trichomoniasis and chlamydia rose by 23% between 2014 and 2017.³

Authors note several factors that may have contributed to the increase including availability of drugs like Viagra that have enabled older individuals to stay sexually active. Other factors include high-rates of mid-life divorce and increasing rates of online dating among older individuals. Waning immunity with age and inadequate safe sex education may also contribute.⁴

4. Approximately what percent of Americans living with diagnosed HIV are over age 50 years?

A. 20%

B. 30%

C. 40%

D. 50%

Please click here for answer and next question.

Answer: D. Approximately 50%. More than 50% of Americans living with diagnosed HIV are aged >50 years, according to 2016 data from the Centers for Disease Control.⁵ Aging of infected persons contribute to this high percentage, but new diagnoses are also common among older adults. In 2017, about 1 in 6 new HIV diagnoses were among people aged 50 and older. The CDC also reports that approximately half of persons aged >55 years who received an HIV diagnosis in 2015 had been living with HIV for 4.5 years before the diagnosis; this is the longest delay for any age group.⁵

5. For women, the risk of contracting an STD decreases with age.

A. True

B. False

Please click here for answer.

Answer: B. False. For women, the risk of contracting an STD increases with age, and is related to biological factors. Decreasing estrogen levels after menopause can cause vaginal dryness and thinning, which can lead to microabrasions or tearing during intercourse that in turn increase the risk for STD transmission.  Older women are at increased risk for breast cancer, and treatment with aromatase inhibitors for breast cancer can further thin the vaginal endothelium.^6,7

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References:

1. Waite LJ, Laumann EO, Das A, et al. Sexuality: measures of partnerships, practices, attitudes, and problems in the National Social Life, Health, and Aging Study. J Gerontol B Psychol Sci Soc Sci. 2009;64 Suppl 1:i56-66. doi: 10.1093/geronb/gbp038.

2. Schick V, Herbenick D, Reece M, et al.  Sexual behaviors, condom use, and sexual health of Americans over 50: implications for sexual health promotion for older adults. J Sex Med. 2010;7 Suppl 5:315-29. doi: 10.1111/j.1743-6109.2010.02013.x

3. Alison Pereto. Patients over 60? Screen for STIs. Accessed December 10 2019 at: https://www.athenahealth.com/insight/over-60-stis-may-not-be-done-you

4. Benjamin Rose Institute on Aging. Sexually transmitted diseases in older adults. Accessed December 6 2019 at: https://www.benrose.org/-/sexually-transmitted-diseases-in-older-adults

5. CDC. HIV: People aged 50 and older. Accessed Dec 6 2019 at: https://www.cdc.gov/hiv/group/age/olderamericans/index.html

6. Mac Bride MB, Rhodes DJ, Shuster LT. Vulvovaginal atrophy. Mayo Clin Proc. 2010;85:87-94. doi: 10.4065/mcp.2009.0413.

7. Kallak TK, Baumgart J, Göransson E, et al. Aromatase inhibitors affect vaginal proliferation and steroid hormone receptors. Menopause. 2014;21:383-90. doi: 10.1097/GME.0b013e31829e41df.