Written by Aishwarya Nagar, research assistant and Anne Trolard, manager of the Public Health Data and Training Center, with support from the Harvey A. Friedman Center for Aging staff at the Institute for Public Health
Missouri and the St. Louis region consistently observe rates of gonorrhea and chlamydia that are higher than the national average. Many contemporary interventions targeting rates of these sexually transmitted infections (STIs) address adolescents and young adults. However, rates of STIs have seen a steady increase in a particularly understudied and underserved population: adults over 45 years.
Sexual health interventions tend to focus on early youth and the reproductive years of a person’s life, often excluding others. There is a stereotype that older people are not sexual, which is not supported by scholarly or anecdotal evidence. In fact, rates of gonorrhea and chlamydia have increased among adults ages 45 and older from 2012-2016 (see Figure 1).1 The implications of these infections are more serious among youth (including infertility), but they also increase the chances of transmitting and acquiring HIV.
An ongoing study at Washington University led by Dr. Hilary Reno, characterizing visits made to local St. Louis city emergency departments for STI care, shows that 10% of all visits were made by adults 45 years and older (range 45-100, mean 56 years) over the past 4.5 years. The prevalence of gonorrhea among this age group has increased from 1.8% in 2012 to 4.9% for the first half of 2016; and has remained roughly the same for chlamydia. Additionally, data from the Missouri Department of Health and Human Services shows of all newly diagnosed cases of HIV infections in Missouri in 2016 (n=293), 25.9% were among those ages 45-64; and of all those living with HIV in 2016, 52.6% were ages 45-64.2
Seventy-two percent of the adults (45+) visiting emergency rooms for STI care have either Medicare, Medicaid, or private insurance, compared with 49% of those ages 15-44 having these insurances. This means the older group can more often be referred to the primary care setting which is better equipped than an emergency department to follow up with patients regarding their treatment and additional testing, and has more resources to take sexual health histories and provide resources.
It is hypothesized that increasing rates of STI prevalence in older adults could be associated with risky sexual behaviors, including resistance to using preventative methods (e.g., condoms), the availability of medications that help adults continue to have sex when physiological changes pose challenges (e.g., Viagra, hormone replacements), and the limited focus on STI risk for people outside of their teens and 20s.3 Providers need to routinely talk about sex as it relates to health and risky behaviors, including STIs, with adults of all ages, and provide information and resources.