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Sexually Transmitted Diseases in Elderly

Introduction

While sexually transmitted infections and diseases (STIs and STDs) are mostly seen in adolescents and young adults, the elderly (>50 years) may be catching up. Advances in modern medicine mean that people are living longer and healthier lives. In many developed countries, the average life expectancy is close to 80 years. This also means that older people are increasingly sexually active and therefore increasingly susceptible to STIs. In the US and the UK, cases of STIs such as chlamydia and syphilis are increasing at a much faster rate among senior citizens compared to the rest of the population. Many factors could be driving this rise, and an increase in awareness, prevention and better screening may be key to stemming the tide.

Cause

As a result of older people living longer and healthier lives, many of them are sexually active. Reports state that among senior citizens, more than half the men and a little less than half of the women are sexually active.

The increased availability of erectile dysfunction (ED) drugs such as Viagra (sildenafil citrate), Levitra (vardenafil) and Cialis (tadalafil) have made sexual activity possible for the elderly. ED is far more common in men over the age of 60, compared to those in their 40s. The advent of these drugs has made it possible for many elderly men to overcome this condition and be able to have sex.

Many of the elderly live in retirement homes, nursing centers and assisted living homes where it is not uncommon for them to have multiple sexual partners. Evolving societal norms, increase in divorces and a high number of widowed elderly can also contribute to sex with multiple partners.

All this sexual activity is however not being accompanied by the use of condoms. Condom usage is far less in sexually active elderly compared to that in younger people. There could be multiple reasons for this:                                                                                                                                                                               Since they no longer have to worry about pregnancy, they are far less likely to use condoms.            Senior citizens grew up in the 50s and the 60s when condom usage was scarce. In fact, studies have shown that older men who use erectile dysfunction drugs are far less likely to use condoms compared to younger men.

Physiological changes in the elderly may also make them more susceptible to contracting STIs. Medications for arthritis, heart disease, hypertension and diabetes which are commonly used by senior citizens may weaken the immune system, making them more prone to STIs.

Risk Factors:

When the elderly do not use condoms and have unprotected sex they increase their risk of STIs. Indulging in other high-risk sexual practices, such as having multiple sexual partners and the presence of health conditions that weaken their immune system further increase the risk for contracting STIs.

Clinical Presentation

STIs commonly seen in the elderly are:

Chlamydia: It is caused by the bacterium Chlamydis trachomatis and is transmitted during vaginal, oral and anal sex. It can cause a variety of infections such as cervicitis, urethritis, proctitis, epididymitis, and pelvic inflammatory disease (PID).

Gonorrhea: is caused by the bacterium Neisseria gonorrhoeae. Its clinical symptoms are similar to that of chlamydia with cervicitis, urethritis, proctitis, PID and epididymitis most common. It can also be accompanied by arthritis and rashes.

Syphilis: is caused by the bacterium Treponema pallidum and is characterized by lesions on the penis, cervix, anus and rectum in its primary form.

Human papilloma virus (HPV): An HPV infection in the elderly can cause genital warts, dysplasia or carcinoma such as cervical cancer.

Herpes simplex virus (HSV-2): Genital HSV-2 infection can cause genital symptoms such as itching, burning and irritation but is not always symptomatic.

Diagnosis

STIs are diagnosed taking into account symptoms seen and confirmation is done via further testing of body fluids. For example, chlamydia infection is tested with a urine specimen test, gonorrhea may be tested using urethral discharge, blood tests are used to detect antibodies towards the syphilis bacterium and pap smears are used to detect infection by the HPV virus. In the case of HSV-2 infection, routine screening/testing is not recommended unless the patient is symptomatic.

Treatment

Treatment depends on the STI contracted. Most bacterial STIs are treated with a course of antibiotics. Genital herpes is treated using anti-viral medications such as famciclovir and aciclovir. There is no cure for HPV infection and treatment focuses on the symptoms of the infection.

Prevention

Clinicians must be aware of the increasing trend of STIs in the elderly and prescribe STI screenings when treating older patients.

While the potential benefit of the HPV vaccine among older women is thought to be low, regular pap smears can help detect HPV infection early.

Safe sex counselors at retirement homes and assisted living facilities can help increase awareness about STI risks and promote the use of condoms.

Public health campaigns on safe sex aimed not just at young people but also at the elderly can have a positive impact.