Sexually transmitted infections are a major public health issue, and the complacency surrounding their prevalence and impact is as infectious as the diseases themselves, especially in our aging population. The prevalence of STIs has significantly risen in recent years among older adults who are widowed or divorced.
Currently, one in five adults in the U.S. have an STI. That’s nearly 68 million people, with new infections totaling about $16 billion in direct medical costs. From the rampant spread of chlamydia to the dangerous nature of HIV, these infections know no bounds when it comes to wreaking havoc on our bodies, sometimes leading to expensive long-term health issues. With rising STI rates globally, understanding the reasons behind the increase, the importance of prevention and the cost – both monetary and personal – associated with these infections is more crucial than ever.
Scope Of The Problem
Around the world more than 1 million STIs are acquired every day. In fact, WHO estimated in 2020 that 374 million new infections of just the top four STIs occurred: chlamydia (129 million), gonorrhea (82 million), syphilis (7.1 million) and trichomoniasis (156 million).
Of the existing sexually transmitted infections, chlamydia, trichomoniasis, genital herpes and HPV account for 98% of all existing STIs and 93% of all new STIs. Yet, based on the CDC’s findings, the rates of primary and secondary syphilis have more than tripled in people aged 65 and older. Additionally, the rates of chlamydia and gonorrhea have more than doubled in older adults in recent years.
Of the more than 30 different bacteria, viruses and parasites that we know can be transmitted through sexual contact, many if not most infections go undetected due to lack of symptoms. But STIs have serious health consequences ranging from infertility to cancer. These infections can also fuel antimicrobial resistance, reducing the efficacy of treatment options available for those that can currently be treated.
And while many point the finger at younger, sexually active individuals the truth is that demographics for STIs are quickly and dramatically shifting. New patterns of infections were even observed during the pandemic, when STI cases decreased in the first months of the pandemic, but saw a resurgence by the close of 2021.
Slowing The Spread Has Many Hurdles
Younger people aged 15-24 account for almost half of new sexually transmitted infections each year. But the proportion has been consistent for some time, as young people are consistently less aware of and educated about the spread of disease, have increased risky behavior and often lack access to protection options.
What has caught researchers off guard is the growing body of data showing that the rates of STIs, including HIV, is rising at a faster pace among individuals aged 55 and older compared to other age groups–with no signs of slowing. While seniors still have a lower STI rate than other groups, the number of infections in that age range, adjusted for population, has more than doubled from 11.8 per 100,000 to 24.5 over a span of just five years. This increase can be attributed in part to the larger population of Baby Boomers transitioning into the senior age bracket.
People over the age of 55 are far less likely to take precautions such as using condoms. Not only because of less concern over getting pregnant, but because peers and health providers are less likely to talk to them about the concerns of unprotected sex. Further, as individuals live longer and face higher rates of divorce the opportunity to engage in sexual activity with more partners naturally increases. That said, there are significant differences in STI rates among older Americans.
For example, the District of Columbia’s average STI rate is more than eight times the overall national rate for those 55 and older. On the opposite end of the spectrum, North Dakota (14.9) and Wyoming (17.8) have the lowest rates of STIs in the aging population. Researchers believe these great differences can be traced back to sexually active individuals who underestimate their risk.
Fortunately, there are effective treatment options available for several STIs including three bacterial (chlamydia, gonorrhea and syphilis) and one parasitic (trichomoniasis). The only require a single dose of antibiotics. For herpes and HIV, the most effective medications available are antivirals that can control the course of the disease, though they cannot cure the disease. For hepatitis B, antivirals can help fight the virus as well as slow damage to the liver.
But slowing the spread of STIs is where we need more focus and action. This will require older people to make informed choices like using condoms correctly every single time they have sex, engaging in regular testing and having open conversations with partners about sexual health. It also means getting vaccinated against infections.
Through swabs, urine tests and bloodwork, health providers can identify the culprit behind symptoms, or in many cases, confirm their silent presence. But again, this requires older individuals and their doctors to have open, honest conversations about sexual health and activity. Regular testing should also become a routine part of medical visits so patients can make informed decisions and take appropriate measures to protect themselves and their partner(s) if an infection is detected.
STIs are a public health concern with implications that stretch far beyond individual bedrooms. But lack of education and awareness have resulted in infection rates moving in the wrong direction. This is truer for our aging population than anyone else. Increasing knowledge about condom use, questions to ask partners and doctors and how often to get tested need to become a standard part of health care for those 55 and older. Taking a stand on STIs means being informed, being vigilant and being unapologetically proactive about your sexual health, no matter your age.
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