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What is the most common STD in elderly people?

4 min read

According to a July 2024 study, between 2020 and 2023, sexually transmitted disease (STD) diagnoses in the US surged by 23.8% among people aged 65 and older. Given these rising rates, it is crucial to understand what is the most common STD in elderly people and how to address this growing public health issue.

Quick Summary

STDs in older adults are rising, with Human Papillomavirus (HPV) diagnoses seeing the largest percentage increase in those 65 and over between 2020 and 2023. Other common STDs in seniors include syphilis, chlamydia, and gonorrhea, fueled by factors like less condom use and a lack of awareness.

Key Points

  • HPV Diagnoses are Rising Fastest: While not definitively the most prevalent, HPV diagnoses saw the largest percentage increase among adults 65 and older between 2020 and 2023.

  • Immune Decline Allows Dormant Infections to Reactivate: Older adults may experience a reactivation of HPV infections acquired decades ago, as their aging immune systems become less able to suppress the virus.

  • Many Seniors Don't Use Condoms: The decreased concern about pregnancy in older age leads to lower rates of condom use, increasing the risk of contracting and transmitting STDs.

  • Physiological Changes Increase Vulnerability: Postmenopausal women experience thinning of vaginal tissue, which can lead to micro-abrasions and higher susceptibility to STDs.

  • Provider Education and Patient Advocacy Are Critical: Both healthcare providers and older adults must overcome social stigma to openly discuss sexual health, perform routine screenings, and ensure timely diagnosis and treatment.

  • STDs Can Mimic Age-Related Symptoms: Misdiagnosis is common, as early STD symptoms like fatigue or genital itching can be mistaken for normal signs of aging or other conditions.

  • Risk for Long-Term Complications is Higher: Delayed diagnosis and weakened immune systems in older adults can lead to more serious and long-term health consequences from STDs like syphilis, HPV, and HIV.

In This Article

Common STDs and Rising Rates in Older Adults

While definitive data on the single most common STD in elderly people is complex due to under-reporting, a recent study analyzing health insurance claims found that Human Papillomavirus (HPV) diagnoses saw the largest percentage increase (32.2%) among people aged 65 and older between 2020 and 2023. This does not necessarily mean HPV is the most prevalent, but its rapid increase is a significant concern. Other common and fast-rising infections include chlamydia, gonorrhea, syphilis, and genital herpes.

Many older adults who are sexually active may not feel the need to use condoms, as they are no longer concerned with pregnancy. This, combined with a lack of up-to-date sexual health education and healthcare providers who may not discuss sexual health with their senior patients, creates a perfect storm for rising STD rates.

The Resurgence of Syphilis

Syphilis, a bacterial infection, has seen a dramatic resurgence across all age groups, including older adults. For those aged 55 and older, syphilis cases soared nearly tenfold between 2010 and 2023. The infection can lead to serious health complications if left untreated, affecting the heart and nervous system. While primary chancres may be less common in older patients, late latent or tertiary syphilis is more likely.

HPV and its Implications in Seniors

While HPV is often associated with younger populations, a significant number of older adults are affected, often due to a reactivation of a long-dormant infection. The aging immune system can be less effective at suppressing the virus, allowing it to become active again. In older adults, a persistent HPV infection poses an increased risk for cancers of the cervix, anus, and oropharynx (throat). For women over 65, one in five new cervical cancer cases occurs in this age group, and many are diagnosed at a late stage. Regular screening, even after 65, is crucial.

Chlamydia and Gonorrhea on the Rise

Statistics show that chlamydia and gonorrhea rates have more than doubled among those aged 55 and older over the past decade. These bacterial infections often present with mild or no symptoms, making them easy to miss or misdiagnose. Without treatment, they can cause serious long-term complications, such as pelvic inflammatory disease in women and epididymitis in men.

Genital Herpes (HSV-2) in Older Age

Genital herpes, caused by the Herpes Simplex Virus type 2 (HSV-2), is also common among older adults. For postmenopausal women, genital herpes symptoms like vulvar ulcerations may be mistaken for atrophic vaginitis. Recurrent episodes of genital herpes can occur, and some studies even suggest a link between HSV infections and an increased risk of developing dementia later in life.

Factors Contributing to Increased STD Rates

Several factors contribute to the escalating rates of STDs among the elderly population:

  • Increased Longevity and Sexual Activity: People are living longer and staying sexually active well into their later years. The availability of erectile dysfunction medications and hormone replacement therapies has further extended people's sex lives.
  • Lack of Condom Use: For older adults not concerned with pregnancy, condom use drops significantly. This greatly increases the risk of transmission for infections like chlamydia, gonorrhea, and HIV.
  • Insufficient Sexual Health Education: Many older adults received their last sexual health education decades ago and are unaware of the ongoing risks or the full spectrum of STDs.
  • Misconceptions and Stigma: There is a strong social stigma surrounding older adults and sexuality, leading many, along with their healthcare providers, to overlook or feel embarrassed to discuss sexual health.
  • Under-screening by Healthcare Providers: Doctors may not routinely screen older patients for STDs, attributing symptoms to other age-related issues. This can lead to delayed diagnosis and treatment, causing more severe complications.

Comparison of Common STDs in Older Adults

Feature Human Papillomavirus (HPV) Syphilis Chlamydia Genital Herpes HIV/AIDS
Most Common Cause Reactivation of dormant virus or new infection Bacterial infection Bacterial infection Viral infection (HSV-2) Viral infection
Symptom Presentation Often asymptomatic, but can cause genital warts or lead to cancer Can have primary (sore), secondary (rash), or latent/tertiary stages Often asymptomatic; can cause discharge, pain Recurrent painful sores or blisters Flu-like symptoms initially, progresses over time
Transmission in Seniors New partners or reactivation due to immune decline New partners; rise driven by changing sexual behaviors Same as younger populations; less condom use Reactivation or new infection Unprotected sex with infected partner
Long-Term Risk Cancers of the cervix, anus, or oropharynx Cardiac and neurological damage Infertility, pelvic inflammatory disease Potential link to dementia AIDS, opportunistic infections

Conclusion: Addressing the Gap in Senior Sexual Health

The question of what is the most common STD in elderly people highlights a significant gap in public health awareness and clinical practice. While a single pathogen cannot be definitively identified as most common, infections like HPV, syphilis, and chlamydia are demonstrably on the rise and pose serious threats to older adults. The factors driving this trend are clear: reduced condom use, decreased immune function, and a pervasive silence around geriatric sexuality. Healthcare providers must initiate candid conversations with older patients about sexual health, risk factors, and the importance of continued screening and safe sex practices. Older adults, in turn, need to be their own advocates, seeking testing with new partners and understanding that their age does not preclude them from STD risk. Addressing this issue requires a multi-pronged approach, from targeted public health campaigns to age-inclusive clinical practices, to ensure the sexual health and well-being of the growing senior population.

For more information on HPV and its risks, consult authoritative sources like the Centers for Disease Control and Prevention.

Frequently Asked Questions

Yes, older adults are at a growing risk for STDs due to increased longevity, changing sexual behaviors, less condom use, and a lack of awareness and screening.

Many older adults do not use condoms because they are not concerned about pregnancy. This leaves them unprotected from sexually transmitted infections.

Yes, HPV can lie dormant for years and reactivate later in life due to a weakened immune system. This can increase the risk of HPV-related cancers.

Many STDs, like chlamydia and syphilis, are often asymptomatic, meaning they show no symptoms. The only way to know for sure is for both partners to get tested. It is important to have an open conversation with your partner about sexual health and testing.

Healthcare providers may not routinely screen older patients for STDs due to misconceptions and discomfort around discussing sexual health in this age group, sometimes mistaking STD symptoms for other age-related conditions.

According to a Fair Health study, Human Papillomavirus (HPV) diagnoses saw the largest percentage increase (32.2%) among people aged 65 and older between 2020 and 2023.

Yes, physiological changes in older adults, such as thinning vaginal tissue in postmenopausal women, can affect symptom presentation. Genital herpes, for instance, might be mistaken for atrophic vaginitis.

References

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Medical Disclaimer

This content is for informational purposes only and should not replace professional medical advice. Always consult a qualified healthcare provider regarding personal health decisions.