Purported 'epidemic' of senior STD's misleading

By Ginger Manley | Posted: Sunday October 5, 2014

April 2014

Dear Ginger:
I am in my 70's and single since my husband passed away four years ago. I think I'm ready to start dating again, but now I am scared. I have been reading how venereal diseases are on the rise in people my age and I certainly don't want that to happen to me. What should I do?
Mary


Dear Mary:
I wonder if what you have read is the story that first appeared Jan. 18 in the New York TImes Re View ("Sex and the Single Senior") written by a University of Pennsylvania physician, Dr. Ezekiel Emanuel. That story got picked up by news services worldwide and has frightened a lot of folks.


The writer begins by saying people in retirement communities, assisted living facilities, and nursing homes are not so much engaging in "quiet reading, crossword puzzles, bingo, maybe shuffleboard" as they are in unsafe sex. He follows this by describing "startling" statistics from Medicare that show seniors are receiving free sexually transmitted disease screenings and counseling sessions at a rate of 2.2 million beneficiaries a year.


Further, he says "more than 66,000 received free H.I.V.tests." Then, most startling of all, he says rates of two sexually transmitted diseases--chlamydia and syphilis--have increased 31% and 52% respectively since 2007 for Americans over age 65. He says, "(t)hose numbers are similar to S.T.D. trends in the 20-24-year-old age group." He ends the story by labeling this an "epidemic among the Social Security generation that rivals what we imagine is happening in those 'Animal House' fraternities." Finally, in the last paragraph after readers eyes are rolling and tongues wagging, he recommends "a big public health campaign on safe sex aimed not just at college students but at older people who are living independently."


Wow--not a pretty picture! But as with many such "startling" stories we see regularly in tabloid-type publications, this one is only partly true.


The true part is that while rates of chlamydia and syphilis (both are sexually transmitted diseases) did increase from 2007 to 2011, the increase was only a total of 255 cases for chlamydia (809 in 2007 to 1064 in 2011=31% ) and 47 cases for syphilis (91 in 2007 to 138 in 2011=51%). Technically-speaking these are the percentage increases Dr. Emanuel  described but hardly an epidemic in a total population of more than 35 million people.

It is also true that 2.2 million Medicare beneficiaries used the sexual health preventive services that became available for the first time as part of the Affordable Care Act in November of 2011, a rate that was about the same as for screening colonoscopies and mammograms. This is not something that ought to startle us. Rather, as the Consortium of Sexuality and Aging said in response to the NY Times story, “the …Consortium encourages more older adults to attend to their sexual health needs in this manner.”   


Knowing one's HIV status is important for many older people, especially since nearly one in four persons in the United States living with HIV, AIDS is older than fifty. With one exception, this does not necessarily mean more older people are contracting the disease as much as it shows that people who acquired the virus twenty or more years ago are living into older age, something no one thought would happen before the discovery of effective medications.


The exception is the disproportionate rate of new cases of HIV/AIDs in one group of older women. According to the National Institute on Aging, a division of the U.S. National Institute of Health, there is a steep increase in new HIV diagnoses for women over fifty and of color. This is because of a number of factors, including contracting the disease during intravenous drug use from sharing needles with an infected person; becoming infected from sexual activity with an infected partner; ignorance about barrier protection, and because women outlive men and become sexually active again after their regular partner has died.

In addition, the natural processes of aging cause thinning of vaginal tissues and increased dryness, predisposing  all older women to tiny tears in the vagina which can serve as entry points for diseases. In the rural south the disproportion is even greater because some African American men, oftentimes married and who staunchly consider themselves heterosexual, engage in sex with other males "on the downlow," then fail to disclose their behavior and risk to their female partners. Without services and providers for this group of people, as may be true in many southern rural communities, the disease rate soars.


As I look at this information, Mary, I see lots of reasons to be positive, some reasons to be cautious, and very little reasons to indicate that older adults ought remain celibate if indeed they wish to find new relationships. First of all, it is a good thing health care providers are now encouraged to intervene in the sexual health of their older patients, just as they ought to be inquiring in these same areas for all ages. The Affordable Care Act allows payment for such patient care visits and does not cause an out of pocket expense for the patient, so it seems to be a win/win situation.

Second, prevention and protection of sexually transmitted diseases is relatively simple. While using barrier protection--condoms--is not something many older people may think about since preventing pregnancy is rarely a worry at this age, nevertheless, condoms are still the most reliable protection against transmitting or receiving a disease. Additionally, many older women, whether sexually active or not, need help with re-hydrating their vaginal tissue. For some women that may mean a prescription from their provider or it may mean using an over-the-counter vaginal moisturizer, in addition to using external oils such as grapeseed or coconut oil.


Mary, from what you have written it seems you have appropriately grieved the loss of your spouse and are ready now to look forward. Women in their 70's who are relatively healthy can expect to live another 15 or 20 or more years. While some women may wish never to be paired again, many do want to date and maybe to mate again. If you practice safer sex (carry a three-pack of condoms) and if you nourish your vagina and use common sense in who you invite into your intimate life, I think there's little to be concerned about.

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