STI rates are increasing among midlife and older adults. We need to talk about it

Globally, the rates of common sexually transmissible infections^[1] (STIs) are increasing among people aged over 50. In some cases, rates are rising faster than among younger people.

Recent data^[2] from the United States Centers for Disease Control and Prevention^[3] shows that, among people aged 55 and older, rates of gonorrhoea and chlamydia, two of the most common STIs, more than doubled between 2012 and 2022.

Australian STI surveillance data^[4] has reflected similar trends. Between 2013 and 2022, there was a steady increase in diagnoses of chlamydia, gonorrhoea and syphilis among people aged 40 and older. For example, there were 5,883 notifications of chlamydia in Australians 40 plus in 2013, compared with 10,263 in 2022.

A 2020 study of Australian women^[5] also showed that, between 2000 and 2018, there was a sharper increase in STI diagnoses among women aged 55–74 than among younger women.

While the overall rate of common STIs is highest among young adults^[6], the significant increase in STI diagnoses among midlife and older adults suggests we need to pay more attention to sexual health across the life course.

Why are STI rates rising among older adults?

STI rates are increasing globally for all age groups^[7], and an increase among midlife and older people is in line with this trend.

However, increases of STIs among older people are likely due to a combination of changing sex and relationship practices^[8] and hidden sexual health needs among this group.

The “boomer” generation came of age in the 60s and 70s. They are the generation of free love and their attitude to sex^[9], even as they age, is quite different to that of generations before them.

Given the median age of divorce^[10] in Australia is now over 43, and the internet has ushered in new opportunities for post-separation dating^[11], it’s not surprising that midlife and older adults are exploring new sexual practices or finding multiple sexual partners.

It’s also possible midlife and older people have not had exposure to sexual health education in school or do not relate to current safe sex messages^[13], which tend to be directed toward young people. Condoms may therefore seem unnecessary for people who aren’t trying to avoid pregnancy. Older people may also lack confidence negotiating safe sex^[14] or accessing STI screening.

Hidden sexual health needs

In contemporary life, the sex lives of older adults are largely invisible. Ageing and older bodies are often associated with loss of power and desirability^[15], reflected in the stereotype of older people as asexual and in derogatory jokes^[16] about older people having sex.

With some exceptions^[17], we see few positive representations of older sexual bodies in film or television.

Older people’s sexuality is also largely invisible in public policy. In a review of Australian policy^[18] relating to sexual and reproductive health, researchers found midlife and older adults were rarely mentioned.

Sexual health policy generally targets groups with the highest STI rates, which excludes most older people. As midlife and older adults are beyond childbearing years, they also do not feature in reproductive health policy. This means there is a general absence of any policy related to sex or sexual health among midlife or older adults.

Added to this, sexual health policy tends to be focused on risk rather than sexual wellbeing. Sexual wellbeing^[19], including freedom and capacity to pursue pleasurable sexual experiences^[20], is strongly associated with overall health and quality of life for adults of all ages. Including sexual wellbeing as a policy priority would enable a focus on safe and respectful sex and relationships across the adult life course.

Without this priority, we have limited knowledge about what supports sexual wellbeing as people age and limited funding for initiatives to engage with midlife or older adults on these issues.

How can we support sexual health and wellbeing for older adults?

Most STIs are easily treatable. Serious complications^[22] can occur, however, when STIs are undiagnosed and untreated over a long period. Untreated STIs can also be passed on to others.

Late diagnosis is not uncommon as some STIs can have no symptoms and many people don’t routinely screen for STIs. Older, heterosexual adults are, in general, less likely than other groups to seek regular STI screening^[23].

For midlife or older adults, STIs may also be diagnosed late because some doctors do not initiate testing^[24] due to concerns they will cause offence or because they assume STI risk among older people is negligible.

Many doctors are reluctant to discuss sexual health^[25] with their older patients unless the patient explicitly raises the topic. However, older people can be embarrassed or feel awkward raising matters of sex.

Resources for health-care providers and patients to facilitate conversations about sexual health and STI screening with older patients would be a good first step.

To address rising rates of STIs among midlife and older adults, we also need to ensure sexual health promotion^[26] is targeted toward these age groups and improve accessibility of clinical services.

More broadly, it’s important to consider ways to ensure sexual wellbeing is prioritised in policy and practice related to midlife and older adulthood.

A comprehensive approach to older people’s sexual health, that explicitly places value on the significance of sex and intimacy in people’s lives, will enhance our ability to more effectively respond to sexual health and STI prevention across the life course.

References

1. ^{^} sexually transmissible infections (www.healthdirect.gov.au)
2. ^{^} data (gis.cdc.gov)
3. ^{^} Centers for Disease Control and Prevention (www.nbcnews.com)
4. ^{^} STI surveillance data (www.kirby.unsw.edu.au)
5. ^{^} 2020 study of Australian women (www.publish.csiro.au)
6. ^{^} highest among young adults (www.kirby.unsw.edu.au)
7. ^{^} increasing globally for all age groups (abcnews.go.com)
8. ^{^} changing sex and relationship practices (www.jeanhailes.org.au)
9. ^{^} attitude to sex (www.sciencedirect.com)
10. ^{^} median age of divorce (aifs.gov.au)
11. ^{^} post-separation dating (journals.sagepub.com)
12. ^{^} Tint Media/Shutterstock (www.shutterstock.com)
13. ^{^} do not relate to current safe sex messages (sti.bmj.com)
14. ^{^} lack confidence negotiating safe sex (www.tandfonline.com)
15. ^{^} loss of power and desirability (www.sciencedirect.com)
16. ^{^} and in derogatory jokes (theconversation.com)
17. ^{^} some exceptions (www.sciencedirect.com)
18. ^{^} review of Australian policy (link.springer.com)
19. ^{^} Sexual wellbeing (www.thelancet.com)
20. ^{^} capacity to pursue pleasurable sexual experiences (www.tandfonline.com)
21. ^{^} Southworks/Shutterstock (www.shutterstock.com)
22. ^{^} Serious complications (my.clevelandclinic.org)
23. ^{^} seek regular STI screening (www.publish.csiro.au)
24. ^{^} doctors do not initiate testing (www.thelancet.com)
25. ^{^} reluctant to discuss sexual health (www1.racgp.org.au)
26. ^{^} sexual health promotion (www.sciencedirect.com)