As established last week, there has been a startling increase in sexually transmitted infections (STIs) among older adults in the United States. The burning question on everyone’s mind (certainly mine!) is: Why? Engaging in some “educated speculation” yields many factors possibly driving this trend. For example:
1. Provider Reluctance. Older Americans may not get regular screenings for STIs because their health care providers are often reluctant to raise the issue. That may be fueled by lack of awareness on the clinician’s part: More than 60% of individuals older than 60 have sex at least once a month, yet this population is rarely considered to be “at risk” for STIs. 1
2. Patient Embarrassment/awkwardness. For many older Americans, admitting that they are having sex makes them feel awkward or embarrassed. Reluctance to share intimate details means they may not seek evaluation and treatment for symptoms that seem related to their sexual health or activity.
3. Effects of Aging. There are 2 sides to this coin: actual physiologic changes that occur with age and assumptions that all changes are just part of aging. As people get older, their immune systems tend to deteriorate, making them more vulnerable to contracting any disease—including STIs. After menopause, women's vaginal tissues thin and natural lubrication declines, increasing their risk for microtears that can leave them susceptible to infectious organisms. And let’s be honest: Some STI symptoms, such as fatigue, weakness, and changes in memory, are nonspecific and may be mistaken by clinicians for the regular progression of age. 2
4. Social Changes. The world has changed since most older adults last dove into the dating pool. We now have online dating services, some of which cater to a mature audience; as a result, people may be less familiar with their partner’s sexual history. Compounding that, many older adults just aren’t accustomed to thinking of themselves or a partner as being at high risk for STIs—and if you don’t even think about it, you definitely won’t ask. Widowed or divorced adults may date more than one person at a time, raising their risk for infection after a long period of monogamy. Seniors also may not be accustomed to using a condom or do not use one because they think the risk for STIs is minimal or nonexistent. Seniors may not consider oral or anal sex as a way of contracting or transmitting STIs. 3
5. Medical Advances. Compared with previous generations, today’s seniors have an easier time having sex at an older age, thanks to the availability of medications such as sildenafil (Viagra) and tadalafil (Cialis) for men with erectile dysfunction. There has also been an increase in postmenopausal women requesting and receiving bioidentical hormone replacement. With increased libido and ability to perform come more sexual encounters among the older population—and as a result, more opportunities for STIs to spread. Are there other reasons for the increase in STIs in this population? Next week we’ll consider the unique societal influences of the Baby Boom generation. In the meantime, please share your insights with me at [email protected].