Sexually transmitted diseases (STDs) are diseases transmitted from one person to another through sexual contact, including vaginal, oral, or anal intercourse, and other sexual activities involving the penis, vagina, mouth, or anus. It may come as a surprise to some, but the prevalence of STDs among older adults is increasing, highlighting the fact that anyone who engages in sexual activity can be at risk. Thus, it is crucial for both older adults and their caregivers to familiarise themselves with the risks associated with STDs. The purpose of this article is to make you aware of the escalating risks, associated challenges, and the critical importance of testing with an STD test package among older adults. 

Changing Demographics: STD Trends in Older Adults 

In a tertiary care hospital located in Western Uttar Pradesh, a study conducted in 2022 revealed that out of 310 confirmed cases of STDs, older adults (those over 40 years old) accounted for 178 cases (57.41%) compared to 132 cases (42.58%) among younger individuals. This shows that the elderly population is significantly vulnerable to STDs.  

Factors contributing to the rise in STDs in older adults are multifaceted and include societal shifts and lack of awareness: 

• Increased accessibility to medications addressing erectile dysfunction has facilitated sexual activity among more men in their older years, potentially leading to higher instances of transmission of STDs. 
• The use of online dating platforms is likely to decrease the ability to discern the sexual history and background of potential partners, increasing the likelihood of exposure to STDs. 
• Older adults are less likely to perceive themselves as vulnerable to STDs. 
• Many older adults did not receive formal safe sex education during their younger years. Consequently, they may lack the necessary knowledge to understand the importance of safe sex practices in preventing STD transmission, thereby contributing to the rising rates of STDs among this demographic. 

Common STDs in Older Adults 

Sexually active older individuals face the potential risks of contracting a variety of STDs including syphilis, gonorrhoea, chlamydia, genital herpes, hepatitis B, genital warts, and trichomoniasis. The data on HIV from the Centers for Disease Control and Prevention (CDC) supports this statement, as approximately half of the population diagnosed with human immunodeficiency viruses (HIV) in the United States comprises adults aged 50 and above. 

Common Symptoms of STDs 

STDs may not always exhibit symptoms or may only present mild ones, leading to undetected infections. However, even without symptoms, STDs can be harmful and transmitted during sexual activity. Symptoms may include: 

• Abdominal pain 
• Fever 
• Unusual genital discharge 
• Painful urination 
• Genital itching or redness 
• Genital sores or warts 

• Oral blisters 
• Abnormal vaginal odour 
• Anal discomfort 

If not treated, STDs can lead to severe complications such as organ damage, infertility, chronic pain, swollen testicles, urethral and prostate infections, and AIDS. Thus, it is crucial to detect and treat STDs early to prevent these issues. 

Risk Factors for STD Transmission in Older Adults 

The transmission of STDs among older adults is influenced by many factors, such as: 

• New/multiple sexual partnerships 
• Risky sexual behaviours such as unprotected intercourse 
• Sexual relations with commercial sex workers 
• Age-related changes in genital mucosa, vaginal secretions, and immune function 
• Not perceiving themselves as susceptible to STDs 
• Rise of online dating platforms 
• Medications addressing erectile dysfunction 
• Prevalence of divorce 

Many STDs in older adults go unnoticed, leading to delayed diagnosis and severe damage. This is especially true for HIV, where symptoms may be mistaken for ageing or other conditions. Therefore, accurate and timely diagnosis of STDs is crucial for older adults. 

Barriers to STD Testing in Older Adults 

Barriers to STD testing in older adults stem from numerous factors, such as: 

• Reduced emphasis on safer sex behaviours contributes to unhealthy sexual practices and higher STD rates among older people. 
• Some older adults may feel embarrassed or uncomfortable asking their doctor for STD testing, leading to delayed diagnosis and missed opportunities for early treatment. 

• Absence of routine screening, exclusion from prevention programs, physician oversight, limited discussion about sexual health and delayed symptom presentation. 
• The stigma surrounding sexuality in older age can adversely impact older adults, leading to personal anxieties and restricted access to sexual healthcare services for this demographic. 

Importance of STD Testing in Older Adults 

Age does not guard against STDs, underscoring the necessity for older adults to gain knowledge about the risks associated with STDs. In fact, older adults diagnosed with AIDS often experience elevated mortality rates, as reported by the CDC. This could be attributed to complicating factors such as heart disease, diabetes, or a weakened immune system due to ageing. Thus, accurate and prompt diagnosis is crucial for ensuring proper management. Further, reducing the risk of transmitting the infection to a sexual partner(s) involves having an open conversation before engaging in sexual activities. Overall, ensuring confidential and non-judgmental testing options for older adults is vital for promoting their access to STD testing and care. 

Overcoming Barriers to STD Testing 

Overcoming barriers to STD testing involves: 

• Encouraging loved ones to discuss STDs with their primary-care physicians. 
• Educating older adults about STDs for better protection for them and their partners. 
• Providing STD and HIV outreach services to underserved populations through community-based organisations. 
• Creating age-appropriate, evidence-based prevention education programs and interventions aimed at enhancing STI knowledge among older adults. 
• Religious influences play a significant role in shaping the sexual and reproductive health of individuals. Therefore, religious organisations that have the potential to serve as valuable advocates should be urged to promote help-seeking behaviours in this regard. 

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Encouraging Safer Sexual Practices in Older Adults 

Empowering older adults with knowledge and promoting proactive measures in them can foster safer sexual practices. Some of these are: 

• Promote condom use as a preventive measure against STD transmission. 
• Encourage regular STD testing to prevent spreading infections to others. 
• Prioritise addressing the sexual needs of older adults and provide comprehensive sex education. 
• Advise refraining from sexual activity if there’s suspicion of a partner having an STD. 
• Request new partners to undergo testing before engaging in sexual activity. 
• Promote open discussion and awareness regarding STDs among the elderly. 
• Encourage the inclusion of older adults in screening programs to ensure early detection. 
• Offer prompt diagnosis and treatment to effectively manage STDs. 

Conclusion  

It is crucial to recognise the risk of STDs in older adults and prioritise testing with an STD test package. A comprehensive STD test package includes screenings for hepatitis B and C, chlamydia, herpes, HIV 1 and 2, syphilis, and gonorrhoea. Thus, empowering older adults to take charge of their sexual health by seeking testing and treatment when needed is vital.