Surging Rates Of Sexually Transmitted Infections Among Seniors

photo Kelly Sikkema Unsplash

Syphilis is not a thing of the past

Over the last decade, there has been an alarming surge in the number of reported cases of sexually transmitted infections among people over sixty. It’s not the volume of cases among older adults that is concerning, it’s the rate of increase that is raising the alarm bells. 

Sexually transmitted diseases have been prevalent in society for centuries (have you seen The Great on prime TV) and remain a global public health issue even in higher-income countries. 

You might remember teachers using the term STD (sexually transmitted disease) when we were learning about sex back in grade 8. STDs, of which there are dozens recognized, are also referred to as sexually transmitted infections (STI). 

The three most commonly transmitted STIs are chlamydia, gonorrhea and syphilis. Information about reportable common STIs can be found on CDC 

It’s happening where you live

Countries across the globe have seen increases in these reportable infections possibly related to a greater number of single seniors, social stigma, the use of dating sites, or a knowledge gap.

Healthcare providers are required to advise the public health department when a diagnosis of an STI has been confirmed since they are classified as reportable infections. The purpose of reporting is to ensure appropriate care and follow-up actions are undertaken and to limit transmission. 

In Canada, reportable sexually transmitted bacterial diseases include chlamydia, gonorrhea and syphilis. Chlamydia is the most reported STI followed by gonorrhea and syphilis.

A 2019 report from the public health agency of Canada (PHAC) showed overall rates of STIs increasing over the previous decade. Subsequently, a five-year action plan was launched to address sexually transmitted and blood-borne infections (STBBI).

The priorities in this Action Plan are driven by evidence. STBBI are curable or manageable, and transmission can be prevented. Yet rates of sexually transmitted infections have risen dramatically over the last decade – chlamydia increased by 49 percent, gonorrhea by 81 percent, and syphilis by an alarming 178 percent 

In the US syphilis was nearly eradicated in 2000 presumably in part due to precautions being taken against acquiring HIV. In 2020 not only were historically high rates of STIs including syphilis reported among seniors in the US, but HIV has also risen substantially.  

In China, there has been a dramatic rise in syphilis in all age groups in the past several decades. As economic and social changes continue in China it is expected that STI cases will continue to rise for at least the next twenty years and presumably older adults will be among those numbers.

Are you at Risk

Part of healthy aging as we live longer is maintaining a healthy sex life. 

Men and women in the over-60 age group may no longer be hampered in their sexual activity by erectile dysfunction and vaginal dryness since these age-related limitations are more easily treated. 

If you are sexually active you are at risk. There are more and more single seniors and many of them are using dating sitesfor a variety of reasons.

A decades-long monogamous relationship poses a significantly lower risk of infection to an individual. Being single either with multiple sex partners, bisexual or a gay man increases your risk of infection. 

In communities where the male/female ratio is heavily skewed multiple sex partners is not uncommon. Men like Al (see above) living in retirement communities can have multiple partners.

It’s important to know what the symptoms of infection are. You also need to be aware that a person can be infected and not show any symptoms (asymptomatic). 

STIs can go undetected and can be unknowingly transmitted to your sex partner. 

Older adults are less likely to be tested for HIV so there is an overlapping concern with HIV infection and other STIs.

You are never too old to be infected with a sexually transmitted disease, and you can be infected more than once. 

“Hello, Dad” Peter reads the call display. 
Peter’s father Al is 85 years old, widowed and lives at a care home for the past 2 years.
 "I wanted to tell you that I've met a woman.” Al says in the same way he might announce the purchase of a new toothbrush.
“Dad, that’s so nice to hear.”  
“I want to share a bed with her.” Al declares with slightly more enthusiasm than the new toothbrush.
Okay, not what I was expecting Peter thinks then asks Al  “What’s her name?”
“I don’t remember ” 
What the heck!! “Dad, I have to call you back.”

Feeling like he is tattling on his father Peter calls the nursing station to report the rather disconcerting conversation. 
June has been a nurse at the care home since before Al arrived. She knows who ‘the woman’ is and tells Peter  “It’s really quite sweet, they lie together on top of the bed and hold hands.”
Peter feels relieved but somewhat perturbed that he is just now learning about his father’s new friend. Role reversal is a strange feeling.
“Peter” June’s tone has become less lively, “you should know that sexual activity is quite common in residential care. Since Al is seen by most of the women here as an eligible bachelor he could be at risk of sexually transmitted infections.”

What to do

Prevention is key and will come from knowledge. There needs to be increased knowledge about prevention among seniors and their healthcare providers should provide education and resources to help their elderly patients stay safe.

During the covid pandemic STD testing and reporting were impacted in North America as public health agencies focused efforts elsewhere. Case numbers are expected to continue to rise as people who deferred care are now starting to seek help.

A US study in 2020 demonstrated a need for improved STI knowledge among adults 65-94 years Although I do believe knowledge is key, this study may be misleading since none of the participants in the study lived in their own residences.  

Independent active seniors may be more knowledgeable about the subject but we still need to talk openly about sexual health. 

A healthy sex life can be such a wonderful thing but you need to know when there are risks for you and your partner. When entering into a relationship you need to know your partners’ sexual history both past and present. 

Both men and women can get STIs from oral sex. Be confident in your partner’s health disclosure before engaging in oral sex.

Condoms are not foolproof and do not protect against HPV or genital herpes.

STIs can have serious consequences for seniors. Although most STIs are treatable or curable, they can be lifelong conditions that complicate other existing health conditions.

Some of the common STIs are at risk of developing antibiotic resistance. If you have received treatment for STI you should be retested after a few months. 

There are also newer STIs like Mycoplasma genitalium (Mgen) that are more concerning because of drug resistance. Mgen is most often seen in young adults but monitoring is ongoing in all age groups.

And So….

Did you ever think you would need a sex education refresher in your senior years? Surprise!

Public health departments worldwide are concerned about the rapid rise in STI cases in the over-sixty age group.

Strategies and government action plans are being implemented in many countries in an attempt to curb the spread of infections. Your current circumstances may not be high-risk at this time, but if your relationship changes then being well-informed will be essential to maintaining your health in the future. 

As if being single and over sixty isn’t already hard enough!