Sexually transmitted infections (STIs) for adults 65 or older have more than doubled in the U.S. in the last decade, a product of multiple factors including heightened sexual activity in senior-living facilities, low condom use and lack of knowledge about STIs.
Sandra Adamson Fryhofer, MD, an AMA trustee who serves as the AMA’s liaison to the Advisory Committee on Immunization Practices (ACIP). During an AMA Senior Physicians Section presentation at the 2024 AMA Interim Meeting, Dr. Fryhofer explained why STIs have gone up in this age group and how physicians can bring down the numbers.
Chlamydia, gonorrhea, syphilis on rise
About 40% of people 65–80 are sexually active, and nearly two-thirds of older adults are interested in sex, according to a 2018 AARP survey. More recent AARP data found that 26% of 60- to 69-year-olds had sex weekly, as did 17% of those 70 or older. “Hormone-replacement therapy, vaginal lubricants and the approval of sildenafil (Viagra) and its relatives have extended people’s sex lives,” Dr. Fryhofer noted.
Rates of syphilis, gonorrhea, and chlamydia more than doubled among those 55 or older over the past 10 years. “But for those aged 65 and older, chlamydia cases more than tripled between 2010 and 2023, gonorrhea cases increased sixfold, and syphilis cases soared in numbers nearly tenfold,” Dr. Fryhofer explained.
Dr. Fryhofer also cited a study of health insurance claims finding that STIs rose nearly 24% in the 65-or-older group during the COVID-19 public health emergency, with human papillomavirus (HPV) seeing the largest increase. HPV causes 44,000 cancers in the U.S. each year.
Lack of knowledge, low condom use driving statistics
Several factors are driving up STI rates. Older people are healthier and staying sexually active for longer, but condom use is low. Only 3% of people 60 or older had used condoms in the past year, said Dr. Fryhofer, citing a 2015 publication.
Another study flagged a lack of knowledge about STIs in this age group. There are also more opportunities to make new friends in nursing homes and senior-living centers, leading to new sexual partners. A U.S. survey of nursing-home directors found sexual activity was common in these settings.
Life expectancy also plays a role. Women live longer than men, creating a gender imbalance and a partner gap. “This can also lead to multiple partners, sharing of partners and more STIs,” said Dr. Fryhofer.
What physicians should ask
People 60 or older are having sex. “But are they telling their doctors about it? These findings show they need to, and we need to ask. It's clear we need to pay more attention to STI prevention in older patients,” advised Dr. Fryhofer.
The Centers for Disease Control and Prevention (CDC) recommends the five P’s approach to taking a sexual history: ask about partners, practices, protection from STIs, history of STIs, and pregnancy intention.
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“Condoms are an important part of STI prevention, but pregnancy in someone 65 and older doesn't usually happen,” said Dr. Fryhofer. This can lead to a false sense of security and less condom use.
The House of Delegates also took action at the Interim Meeting, directing the AMA to:
- Advocate and promote the U.S. Preventive Services Task Force’s recommendations for STI screening through interested older-adult advocates, specifically targeting chlamydia, gonorrhea, HIV, HPV and syphilis, for the older-adult population who are not regularly screened.
- Continue to promote discussion, collaboration and consensus among expert groups and medical specialty societies involved in the development of practice guidelines for sexually transmitted diseases in the older-adult population.
- Offer CME regarding best practices for reducing sexually transmitted disease (including oral cancer risks) in the older-adult population through the AMA Ed Hub™ as a resource to guide the delivery of clinical preventive services.
Learn more with an AMA toolkit that can help physicians and other health professionals increase routine screenings for HIV, STIs, viral hepatitis and latent tuberculosis infections.
Tools for protection
Vaccination is another important tool physicians have in their arsenal. The hepatitis B vaccine is recommended for any adult at any age who wants it, including those with multiple sex partners. Both the hepatitis B and HPV vaccines prevent STIs as well as cancer. The CDC recommends HPV vaccination for everyone through age 26 if not adequately vaccinated when they were younger. The HPV vaccine is not recommended for everyone older than 26, though some adults 27–45 years old might decide to get the vaccine based on shared clinical decision-making with their physician. The hepatitis A and Mpox vaccines are recommended for people at increased risk, including men who have sex with men.
For HIV prevention, there's PrEP and PEP for pre- and post-exposure prophylaxis. And while there are no vaccines to prevent bacterial causes of STIs, DoxyPEP (doxycycline 200 milligrams) taken within 72 hours after sex can help prevent gonorrhea, syphilis, and chlamydia.
“You can think of this as a morning-after pill for STIs,” said Dr. Fryhofer.
Read about the other highlights from the 2024 AMA Interim Meeting.
