Sexually transmitted infections double in older population
Sexually active adults aged 45 and over are being encouraged to pay more thought to safe sex in line with recent figures showing that STIs in 50-90 year olds have doubled in the past ten years.
In an editorial published in the Student BMJ, Rachel von Simson, medical student at King’s College London and Ranjababu Kulasegaram, consultant genitourinary physician at St Thomas’ Hospital London, discuss research showing that 80% of 50-90 years olds are sexually active.
Statistics show an increase in cases of syphilis, chlamydia and gonorrhoea in the UK, USA and Canada in 45-64 year olds.
There has also been an increase in cases of HIV with those aged 50 and over accounting for 20% of adults accessing HIV care, an 82% increase on figures from 2001. This may however, be down to HIV patients living longer, but new diagnoses of HIV in the over 50s have doubled between 2000 and 2009.
This is in part because of prolonged survival; however, new diagnoses in over 50s doubled between 2000-9 to account for 13% of the total. Although this is low in proportion to the population percentage aged over 50, this is not a group traditionally considered at risk. The result of this low index of suspicion is worrying—62% of new diagnoses in over 50s were “late”, and late diagnoses in older adults are associated with poor outcomes; older adults presenting late are twice as likely to die than younger adults diagnosed late.
There has been little research on the reason behind the increase but it is thought that due to physical changes, older, post-menopausal women are more vulnerable to STIs.
Furthermore, men on erectile dysfunction drugs are significantly more likely to be diagnosed with an STI within the first year of usage and in the year before starting the drug.
The authors suggest that GPs should take the opportunity to discuss safe sex with men seeking erectile dysfunction drugs as they have a high risk of contracting an STI. Telephone motivational interviewing has also been found to discourage involvement in unprotected sex.
The authors report that the UK is currently lacking in STI research in older adults and more needs to be done, but conclude that “doctors should maintain a low threshold for investigating sexually transmitted infections in older adults” and should encourage discussions regardless of the patient’s age.
2 February 2012.