STDs Rise Sharply Among Older Americans

If you think young people are the only ones getting sexually transmitted infections — often called STDs or STIs — think again. According to statistics released by the Centers for Disease Control and Prevention (CDC) on October 8, 2019, the number of cases of gonorrhea rose 164 percent among Americans age 55 and older between 2014 and 2018, while cases of syphilis rose 120 percent in this population, and chlamydia rose 86 percent.

Actual numbers of STDs are much higher among older teenagers and adults in their twenties than in adults in their fifties and sixties. For example, 1,420,838 cases of chlamydia were reported among people between the ages of 15 and 29 in 2018, compared with 14,867 cases among adults 55 and older.

But the steep increases in STDs among older adults in the space of five years shows that baby boomers and the generation older than boomers, sometimes called the silent generation, have as much need to practice safe sex as their younger counterparts.

Pssst, Pass It On: Sexuality Continues Throughout the Lifespan

Wait, what? Aren’t older folks supposed to be ramping down all the sex stuff?

“Absolutely not,” says Beverly K. Johnson, PhD, RN, a lecturer at the Seattle University College of Nursing in Washington, who is the author of an earlier paper on sexually transmitted infections in older adults published in The Journal of Gerontological Nursing.

“It’s a myth that as we age we become less sexual. Studies show that we continue a range of sexual activities into older age,” Dr. Johnson says.

What’s Behind the Drastic Rise in Infections?

If older people have always been sexually active, what is driving the relatively new rise in STDs? Part of it is simply that reporting has become more accurate. But there are other factors that are pushing the numbers upward, says Stacy Tessler Lindau, MD, professor of obstetrics and gynecology and medicine-geriatrics at University of Chicago Medicine in Illinois and director of WomanLab, an educational website on women and sex.

Those factors include:

Men are able to remain sexually active longer due to drugs for erectile dysfunction, such Viagra (sildenafil).
For women, vaginal estrogen, lubricants, or moisturizers can make postmenopausal sex more comfortable, so they too may remain sexually active for longer. New drugs, such as Vyleesi (bremelanotide) and Addyi (flibanserin), are also coming out to treat women with low libido, but these drugs have not been approved for women after menopause.
There is a general lack of understanding in the older population about how STDs can spread. People may not know that they can get infected through oral and anal sex, as well as vaginal intercourse. And since there is no longer fear of pregnancy in this age group, condom use may seem less important.
Older adults who live in or who can retire to communities in warmer places may be less isolated — and more likely to date and have sex. “We do see clustering of STDs and higher rates in some warmer climates such as Florida, where there are higher concentrations of older people,” says Dr. Lindau.
While divorce marks the end of sexual activity for some older adults, for others it may be the beginning of dating again after a long period of monogamy. However, those who haven’t dated in many years may feel uncomfortable talking to their partners and their healthcare professional about safe sex.

In addition to these social trends, there are some physical reasons older adults are more susceptible to sexually transmitted infections, including:

The longer we live, the more chance that we may have a health condition that weakens the immune system (such as cancer and the treatment to deal with it) and increases the risk of contracting an infection.
When women lose estrogen due to menopause, it can cause thinning of the vaginal tissues, leaving them vulnerable to microabrasions. This can increase susceptibility to STDs, especially HIV and other bloodborne infections.

Don’t Get Complacent About STDs

While some STDs are easily treated, some are not. And even the infections that are curable often cause no symptoms that would prompt you to go to the doctor, which is why screening is so important for individuals with new or multiple partners.

If not diagnosed and treated, some STDs — notably chlamydia — can cause pelvic inflammatory disease in women, and open sores in the genital tract from any cause increase the risk of HIV transmission.

And even though HIV and Hepatitis C can be controlled today with drug therapies, they are still not easy diseases to manage.

With the rise of antibiotic resistance, some of the diseases that are curable today might not be so simple to treat in the future. That’s why prevention is the best approach for any sexually transmitted infection.

Symptoms to Watch Out For

See a doctor right away if you develop any of the following symptoms, which could be related to STDs, says the Urology Care Foundation:

Burning or itching in the penis or vagina
A foul vaginal odor or unexplained bleeding from the vagina
Yellowish or watery discharge from the penis or vagina
Pelvic pain
Pain in the vagina during sexual penetration
Sores, bumps, or blisters in the vagina, penis, anus, or mouth
Burning and pain in penis or vagina with urination or in the rectum with bowel movements
Frequent urination and bowel movements

Protection, Prevention, and Communication

It can be scary enough to reenter the dating pool when you are older without having to also worry about sexually transmitted infections. You can, however, reduce your personal risk of STDs — and the anxiety you may be feeling about them — by making sure you are informed and are acting on that information.

Condoms Using condoms during sexual activity is extremely important in preventing the spread of infection. However, older men may not get firm enough erections to use condoms effectively, in which case the condom might slip off. If that’s the case, you might want to give erectile dysfunction drugs or vacuum pumps, per the Mayo Clinic, a try. There is also a female (internal) condom, notes Planned Parenthood, that a woman can insert in her vagina prior to sexual activity.

Screening Lindau recommends getting screened for STDs if you are initiating a new sexual relationship where you or your partner have more than one partner; if you have symptoms suggestive of a STD; if you have risk factors for HIV and have not been tested in the previous six months; if you have had sex without a condom with a person whose history you don’t know; or if you have been the victim of sexual assault or rape and have not been tested since the assault.

Vaginal Lubricant Women can decrease vaginal friction with the goal of increasing comfort and reducing the risk of tears with use of an over-the-counter moisturizer or lubricant, such as a hyaluronic acid or polycarbophil product, per an article published in March 2016 in the journal Climacteric.

“Vaginal thinness can be improved with use of a prescription vaginal estrogen product, like a cream, ring, tablet, or suppository, or a DHEA suppository,” Lindau says.

Communication Talk frankly with your doctor and partner about risks and histories. “It’s really important for older sexual partners to communicate as openly as they can, and healthcare providers should always assess the risk for STIs among older adults,” says Johnson.

Lindau adds, “We have very good evidence from repeated studies looking at doctor-patient communication about sex in late to middle-age life. Doctors are usually better a talking about it with men, but overall the rates are repeatedly low. People of all ages value their sexual function, and we don’t treat it like an essential aspect of health. If we could change the way doctors think about sexual function in later life, we could eliminate a lot of unnecessary suffering.”

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