Blame Viagra, or just the fact that Americans are living longer, healthier lives. For several reasons, sexually transmitted diseases (more accurately called sexually transmitted infections, or STIs, because it’s possible to be infected without developing any symptoms or signs) are still rising among older adults, with potentially serious health consequences.
The most recent surveillance data from the CDC show significant increases in the following three STIs between 2017 and 2021 among people 65 and over:
- Chlamydia infections increased by about 28 percent, to 2,780 cases.
- Syphilis infections rose by about 139 percent, to 835 cases.
- Gonorrhea infections increased 35 percent, to 3,189 cases.
The number of STI cases in those ages 55 to 64 in 2021 were higher still: 14,249 for chlamydia, 3,483 for syphilis, and 15,295 for gonorrhea.
In sheer numbers, young adults ages 20 to 24 have the highest prevalence of STIs by far. They contracted just short of 780,000 cases of the above three STIs in 2021 (though young adults ages 25 to 29 had the highest numbers of syphilis in that year), compared with the 6,804 cases among people 65 and older.
Still, the increases in older people concern health experts because STIs were rare in this age group in the past. In addition, people 50 and older account for one in six new HIV infections, and they’re more likely than younger adults to be diagnosed with AIDS (late-stage infection) at the same time as they learn their positive HIV status. (That’s because among older adults, HIV symptoms may be mistaken for signs of other age-associated conditions, so they end up being tested and diagnosed at a later stage of HIV, with AIDS being the last stage.) Aging with HIV presents special challenges since both age and HIV infection increase the risk of heart disease, bone loss, and certain cancers.
What’s behind the increase?
Several factors are likely driving the rise in sexually transmitted infections among older adults:
- Rising STI rates overall. In what the CDC is calling an epidemic, rates of STIs have continued to rise in the U.S. population—increasing 7 percent from 2017 to 2021. (The agency says this won’t slow down without more investment in, among other things, rapid testing, vaccine development, treatment, and diagnosis.) Older people are at much lower risk than younger adults, but they aren’t immune to the trend.
- People are living longer and healthier lives. This might translate into a larger proportion of older adults who are sexually active than in the past. Plus, widely prescribed drugs such as sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra), and avanafil (Stendra) have enabled men with erection problems to continue or resume a sexually active life.
In a 2018 national poll from the University of Michigan, 40 percent of respondents ages 65 and older said they were currently sexually active, as did a quarter of those over 75. More than half of those surveyed (all between ages 65 and 80) reported that sex is important for their quality of life. (Substantially more men than women said this.)
In a more recent Swedish study published in 2021 of 1,680 people ages 60 and older, 46 percent overall said they were sexually active. For those 60 to 66, 73 percent said they were sexually active. About 10 percent of those at least 90 years old said they were, too. About three-quarters of all respondents across all age groups said they were satisfied with their sex life. Overall, more men than women said they were sexually active, but men also reported being more dissatisfied.
- More older people are divorced. According to a 2022 study, older adults (50 and older) had very low rates of divorce between 1970 and 1990, but then the rates more than doubled between 1990 and 2010 and continued to increase through 2019 in those 65 and older. So more older people are on the dating market with the potential for new sexual partners. And online dating apps and websites (including some geared to people over 45, such as Silver Singles and OurTime) make it easier to find potential partners.
- Less safe sex. Baby boomers, the oldest of whom are now in their late 70s, came of age when birth control pills were widely accepted and “protection” was mainly about avoiding pregnancy—not infection. A lack of concern about pregnancy, along with the perceptions that risk of STIs and HIV is low, may largely explain why sexually active older adults have the lowest rate of condom use of all age groups.
- Lack of communication with doctors. Another contributing factor to the STI problem among older adults may be that the topic of sex—and safe sex in particular—doesn’t often come up in their visits with healthcare providers. This may be a relic of past societal assumptions that older people don’t have, or want to talk about, sex. In a survey of older adults 65 to 80 published in 2021, only 17 percent said they had talked about their sexual health with a healthcare provider in the past couple of years, and, in most cases (60 percent), they—not the providers—initiated the conversation. That lack of communication may be especially harmful for women, since changes in the vaginal lining after menopause can make older women even more vulnerable to infections than younger women.
Words to the wise: Sexually transmitted infections have reached an all-time high among Americans, and older adults are not exempt. Men who have sex with men and people who have more than one sexual partner (or whose partner does) are among those at highest risk. Unless you are in a mutually monogamous relationship, keep condoms on hand and use them. If you develop symptoms of an STI, such as a blister, sore, discharge, or rash in the genital or anal area, get medical attention. If you’re at risk for STIs, persistent unexplained flu-like symptoms and abdominal pain are other signals to see your doctor.
Note that Medicare covers free yearly STI screening, including HIV testing, along with counseling sessions, for people considered to be at increased risk (and if ordered by their primary care doctor).
