Why STIs Are on the Rise in Older Adults

Sexually transmitted infections (STIs) have been on the rise across the country. Young adults and teens are most at risk for STIs, but infections among adults age 65 and older more than doubled between 2007 and 2017.

“Rates are highest in the under 25 age group, which accounts for about 50 percent of STIs. But we’re definitely seeing a rise in infections in the older population, particularly in people over 65.” Angelina Gangestad, MD, University Hospitals Division Chief of Obstetrics and Gynecology, explains why STIs in older adults are more common than one might expect.

Why Older Adults Are at Risk

A recent federal report showed that cases of chlamydia, gonorrhea and syphilis increased 7 percent from 2017 to 2021, reaching 2.5 million cases. Syphilis infections surged a whopping 32 percent in just one year, from 2020 to 2021.

The data reflect reported cases, but the number is likely even higher because many cases go undiagnosed.

There are a number of reasons why older adults may be susceptible to contracting an STI, Dr. Gangestad says.

• Older people may underestimate their risk and not take precautions such as condom use and STI testing before having sex with a new partner. Lack of concern about pregnancy also likely diminishes condom use.
• Erectile dysfunction drugs help more older men remain sexually active.
• Hormone therapy helps more older women remain sexually active.
• A larger number of older adults live together in assisted living facilities.
• Older people aren’t given STI education and it’s been many decades since any sexual health education they received.

“When you put all that together, you see a population where there’s probably a little more risky behavior going on, and where people are having new partners because a spouse died or they divorced,” Dr. Gangestad says.

“Older people aren’t thinking about it. Providers aren’t thinking about it either. We’re not doing the education we should be doing with the older population.”

STI Symptoms Often Unrecognized

There are no screening guidelines for STIs in older adults. Screening for chlamydia and gonorrhea is recommended for sexually active women under age 25, and for older women with risk factors such as multiple sex partners. Regular screening is also recommended for men who have sex with men.

STIs can be easy to miss in older adults. Symptoms may be overlooked or mistaken for something else. Some STIs, particularly chlamydia, may be asymptomatic.

Detection can can be especially challenging when symptoms mimic other old-age problems. Gonorrhea, for example, can cause arthritis-like symptoms. HIV can cause weakness and fatigue.

“Syphilis is known as the great imitator, because it can look like anything,” Dr. Gangestad says. “That’s what makes it a tough diagnosis. If you don’t go looking for it, you won’t find it.”

Because symptoms can be missed in older adults, they are less likely to be diagnosed at an early stage, Dr. Gangestad says.

Her tips for prevention:

• Get screened for STIs before engaging in sex with a new partner.
• Keep your doctor informed about any new partners and don’t be afraid to talk to your doctor about risk factors for STIs.

Related Links

For women, University Hospitals offers comprehensive care in every stage of life, from well woman visits to diagnosis and treatment for the full spectrum of gynecologic and women’s health conditions. Learn more.

For men, University Hospitals Cutler Center provides seamless access to the health experts, services and resources needed for a lifetime of good physical, mental and emotional health. Learn more.