STDs in Older Adults

Age is not an amulet against STDs. STDs are not just a young person’s problem. STDs can affect anyone regardless of age, gender, and socioeconomic background.

According to the epidemiology data from the Centers for Disease Control (CDC), STDs such as chlamydia affect 0.03% of young adults between ages 20-24 and affect 0.0002% of adults 55 and above. Even though the numbers are lesser in comparison to the younger generation, the incidence of STDs in older people is not completely negligible. Just like the younger population, the elderly can be infected with STDs.

This article strives to increase sexual health awareness in mature adults and highlight the importance of taking proactive measures by considering screening and early treatment in those who may have contracted STDs.

What are the local epidemiological studies of STDs in older adults?

According to a retrospective epidemiological study between 1996 and 2000, it is noted that 7.6% of the notified STD cases in Singapore involve patients aged 50 and older. The common STD infections that affect the elderly group include STDs such as gonorrhoea, syphilis, non-gonococcal urethritis, genital warts, and genital herpes.

Why are STDs rising in older adults?

Older adults may be becoming more sexually active with other partners following divorce and widowhood. They may resume sexual relationships after decades of sexual inactivity without being equipped with safe sex information. This group will be ready to mingle and forge new relationships via friends, social outings, social media platforms, and various dating apps.

With medical advancements, life expectancy has improved, and people tend to live longer. Furthermore, effective treatment for erectile dysfunction and beneficial hormonal replacement for both men and women allow the older generation to continue enjoying sexual experience into their ripe years.

Unfortunately, there remains a poor understanding of sexually transmitted diseases (STDs) as STDs topics are usually taboo back in those days. Furthermore, sexual education was incomplete or an embarrassing topic in society back then. Older adults may also no longer be in that stage of life where they need to be worried about unwanted pregnancy in a sexual relationship; hence, they may engage more frequently in unprotected sex, underestimating the risk of STDs that may be involved.

Why is it important to treat STDs in older adults?

Although STD complications such as infertility are not a concern in older adults, chronic untreated STDs can be associated with persistent inflammation and scarring, leading to chronic pelvic pain in females or chronic testicular pain/urinary discomfort in males. STDs such as HIV, syphilis, or hepatitis B or C can have severe implications for various vital organs of the body – one can even succumb to the complications of STDs. 

Not to forget, being responsible for ourselves, screening and treating STDs is another way of ensuring our loved ones are safe from the spread of STDs.

If I am an elderly adult, am I at risk of getting STDs?

You can be at risk if you:

• Have had sex with a new partner without a condom
• Have multiple sex partners
• Have had sex with a person(s) who has STD

If you are unsure of your risk of exposure to STDs, you are encouraged to reach out to your physician for further discussion and evaluation of your risk.

When should I consider seeing a doctor if I am an elderly adult and concerned about STDs?

If you have had a recent unprotected sexual encounter or you are experiencing abnormal symptoms such as:

• Painful urination
• Painful urination
• Increase urine frequency
• Urinary discharge (in men)
• Abnormal vaginal discharge (different colour, consistency, volume, or smell) (in females)
• Anal discharge
• Lower pelvic pain
• Painful testicles (in men)
• Painful intercourse
• Rashes over the genital region
• Itching over the genital region
• Swellings, bumps, or ulcers over the genital region

You are encouraged to see your trusted doctor for further evaluation and consider STD screening. It is important to note that STD infection will require the correct medication and the correct dose of medication for treatment. Delay in seeking treatment of STDs may result in further health complications and spreading of the disease to your loved ones.

What are the STD tests that I should consider?

STD tests should include screening for infections such as HIV, syphilis, chlamydia, gonorrhoea, herpes, hepatitis infection, HPV warts, trichomonas, etc.

STD screening tests usually begin with your doctor obtaining a concise and relevant medical and sexual history, followed closely by a physical examination of your genital/pelvic region. Depending on individual risk of exposure, your doctor may offer screening tests such as finger prick tests, blood tests, genital swabs, oral swabs, and urine tests to evaluate for any STD infections.

How can older adults protect and protect themselves against STDs?

• Practise safe sex. Use barrier contraception such as condoms the correct way when engaging in oral, vaginal, and anal sex.
• Use a water-based lubricant, not an oil-based lubricant, which can weaken latex condoms and cause condoms to break more easily.
• Get to know your partner well before being sexually involved.
• Limit your number of sex partners.
• Be open in communication with your partner(s). Share your past and present medical history.
• Consider regular sexual health checkups.
• Ensure your immunisation vaccines for hepatitis or HPV are up to date.
• Get yourself checked with your doctor if you have concerning genital symptoms suggestive of STDs.

What have I learnt today?

• Just like the younger generation, senior adults who are sexually active can catch STDs.
• The elderly are generally not well equipped for safe sex and unaware of the risk of STDs involved when engaging in sex.
• Increasing awareness in the elderly group of STDs and the symptoms associated with STDs are imperative.
• One should seek medical assistance if they develop unusual genital symptoms, even if they are in the elderly age group.
• STD screening should be offered to the elderly group who have no symptoms but may be exposed to STDs.
• Treating STDs in elderly adults is important to reduce long-term health implications and prevent the further spread of the disease(s) to others.

References

1.     Tan HH, Chan RK, Goh CL. Sexually transmitted diseases in the older population in Singapore. Ann Acad Med Singap. 2002 Jul;31(4):493-6

2.     Smith ML, Bergeron CD, Goltz HH, Coffey T, Boolani A. Sexually Transmitted Infection Knowledge among Older Adults: Psychometrics and Test-Retest Reliability. Int J Environ Res Public Health. 2020 Apr 3;17(7):2462.

3.     Relhan V, Bansal A, Hegde P, Sahoo B. Sexually transmitted infections in the elderly: A 6-year retrospective study in a tertiary care hospital in New Delhi. Indian J Sex Transm Dis AIDS. 2021 Jul-Dec;42(2):144-149.

4.     Bourchier L, Malta S, Temple-Smith M, Hocking J. Do we need to worry about sexually transmissible infections (STIs) in older women in Australia? An investigation of STI trends between 2000 and 2018. Sex Health. 2020 Dec;17(6):517-524.

5.     Camacho C, Camacho EM, Lee DM. Trends and projections in sexually transmitted infections in people aged 45 years and older in England: analysis of national surveillance data. Perspect Public Health. 2023 Sep;143(5):263-271.