Older Adults and STIs: What the Data Actually Says

Here's something the healthcare system doesn't do a great job of communicating: sexually transmitted infections are rising fastest among adults over 50.

This isn't a moral statement. It's an epidemiological one.

The Numbers

Between 2007 and 2017, STI diagnoses among adults aged 55 and older increased substantially across North America. In the United States, chlamydia rates in this age group increased by more than 180% and syphilis rates by over 160% during that period (Centers for Disease Control and Prevention, 2018). Canadian surveillance data show a similar pattern, with rates of chlamydia, gonorrhea, and infectious syphilis all trending upward in older adults (Public Health Agency of Canada, 2019).

There are several reasons for this. Older adults dating after divorce or widowhood are often re-entering sexual activity after decades in monogamous relationships, without updated information about risk. Condom use among this age group is significantly lower than among younger adults, partly because pregnancy is no longer a concern and partly because STI education was never particularly well-targeted at people over 50 (Bodley-Tickell et al., 2008). The physical changes of aging, including vaginal atrophy and reduced mucosal integrity, can also increase susceptibility to STI transmission (Poynten et al., 2013).

The Screening Gap

Clinicians are less likely to screen older patients for STIs, and older patients are less likely to initiate the conversation. Research consistently shows that healthcare providers underestimate sexual activity in this population and therefore under-screen (Nusbaum et al., 2004). This creates a quiet epidemic of undiagnosed infection.

If you are sexually active, at any age, you deserve accurate information and access to regular STI screening. That means asking your physician for a full panel if you have new or multiple partners, and not assuming that your doctor will bring it up unprompted — because they probably won't.

What This Means Practically

Condoms remain the most effective behavioural tool for reducing transmission risk, including for HPV, herpes, chlamydia, gonorrhea, and syphilis. They are not foolproof for skin-to-skin transmitted infections like herpes and HPV, but they substantially reduce risk. Knowing your status, communicating with partners, and asking questions of your healthcare provider are not awkward extras. They are informed consent in action.

Sex at any age carries responsibility. That's not a reason to avoid it. It's a reason to approach it with the same care you'd bring to any other aspect of your health.

References

Bodley-Tickell, A. T., Olowokure, B., Bhaduri, S., White, D. J., Ward, D., Ross, J. D., Smith, G., Duggal, H. V., & Goold, P. (2008). Trends in sexually transmitted infections (other than HIV) in older people: Analysis of data from an enhanced surveillance system. Sexually Transmitted Infections, 84(4), 312–317. https://doi.org/10.1136/sti.2007.027250

Centers for Disease Control and Prevention. (2018). Sexually transmitted disease surveillance 2017. U.S. Department of Health and Human Services.

Nusbaum, M. R. H., Lenahan, P., & Sadovsky, R. (2004). Sexual health in aging men and women: Addressing the physiologic and psychological sexual changes that occur with age. Geriatrics, 60(9), 18–23.

Poynten, I. M., Grulich, A. E., & Templeton, D. J. (2013). Sexually transmitted infections in older populations. Current Opinion in Infectious Diseases, 26(1), 80–85. https://doi.org/10.1097/QCO.0b013e32835c2173

Public Health Agency of Canada. (2019). Report on sexually transmitted infections in Canada, 2017. Government of Canada.