New research to be presented at the European Congress of Clinical Microbiology and Infectious Diseases (Barcelona, 27-30 April) shows a rise in sexually transmitted infections (STIs) in older people, including gonorrhoea, syphilis, and genital warts. Professor Justyna Kowalska from the Medical University of Warsaw in Poland will give the presentation, highlighting the need for conversations around older people and sexual health to be normalised.
Data from the US Centers for Disease Control and Prevention (CDC) showed that rates of chlamydia, gonorrhoea, and syphilis among adults older than 55 have doubled over the past ten years. In England, over 30,000 new STIs were diagnosed in patients older than 45 in 2015, and this value rose by almost 10,000 in 2019. This was an increase of 18%, affecting mainly men. In addition, high STI cases have also been reported in older adults around the world, including China, Korea, Kenya, and Botswana.
“Rising divorce rates, forgoing condoms as there is no risk of pregnancy, the availability of drugs for sexual dysfunction, the large number of older adults living together in retirement communities, and the increased use of dating apps are likely to have contributed to the growing incidence of STIs in the over 50s”, explained Professor Kowalska. “These data likely underestimate the true extent of the problem as limited access to sexual health services for the over 50s and trying to avoid the stigma and embarrassment both on the part of older people and healthcare professionals, is leading to this age group not seeking help for STIs.”
Prof Kowalska believes that part of the problem comes from misconceptions about sexual activity in older adults. “People do not become asexual with age. In fact, with preventive medicine and improved lifestyles, people are enjoying a healthy life and sex life for longer. Older people often find greater satisfaction in their sex lives due to experience and known expectations. We need more role models like Samantha Jones in the TV show Sex and the City to challenge stereotypes around older sexuality,” said the researcher.
Research shows higher levels of sexual desire, greater sexual frequency, and more sexual partners among older men than women. And the effects in men became even larger after sildenafil (Viagra), the first phosphodiesterase type 5 inhibitor (PDE5 inhibitor), hit the market. “These findings indicate that sexual risk-taking is common among older adults, particularly men. Given that the number of people aged 60 years and older is set to double worldwide by 2050 and the widespread availability of drugs to enhance sexual activity, health professionals must be proactive in discussing sexual concerns and making sexual health a routine part of general health care for older adults,” said Prof Kowalska.
Despite the increase, the number of STIs is still lower than in younger people. However, Prof Kowalska still advocates a need to greater awareness about sexual health in older adults, explaining that they did not have sex education at school. “Sexual health campaigns are focused on young people and overlook the needs and experiences of those aged 50 and older”, said the researcher. “Health promotion messages give the impression that condoms and concerns about STIs only apply to young people. But the dangers of undiagnosed and untreated STIs such as HPV-related cancers and onward transmission are very real, particularly in this age group who are more likely to have underlying conditions such as heart disease and stroke.”
During her presentation, Prof Kowalska will also highlight that simply promoting positive behaviors doesn’t work. Instead, these patients need better education about how STIs spread and what can be done to avoid them. “Increasing older adults’ knowledge of the risk of STIs and how to engage in safer sex is crucial to tackling record levels of STIs,” says Professor Kowalska. “Tailoring education programmes to the over 50s and including peer support and ensuring they are located within existing community settings is vital to their success,” concluded the researcher. “Older people have a right to good sexual health, so let’s normalise conversations around sex and older people, and change the narrative on ageing.”