With Valentines Day just around the corner, many of our patients may be celebrating with a bouquet of flowers, a box of chocolates or a candlelit dinner? However many may not be considering the gift that keeps on giving – a sexually transmitted infection. Sexually transmitted infections (STIs) are infections that result from the transmission of certain bacteria or viruses during physically intimate acts.
STIs affect people of all ages and backgrounds. Although recent years have seen increases in STIs in younger age groups, there have also been increases among older age groups in Australia, the UK, the US and other countries. This indicates that prevention and testing for older adults may need more attention. The Kirby Institute Annual Surveillance Report provides insight into the occurrence of STIs by collating data from multiple sources into one report.
Although STI’s are still more prevalent among younger people and can potentially have greater health consequences such as infertility and ectopic pregnancy, infection at any age can cause complications, discomfort or distress. Postmenopausal women may in fact be at a greater risk of acquiring infections due to thinning of the vaginal wall, reduced lubrication, changes in vaginal pH and greater risk of abrasions. Having a STI can also increase the chance of acquiring other STI’s including HIV.
An Australian study showed that many older adults continue to engage in sexual activity, and that older adults see sex as an important part of their lives contributing to their wellbeing. Although sexual frequency commonly reduces over time, complete abstention from sexual activity is more often due to health problems or the lack of an available partner, rather than because of aging.
Louise Bourchier, a PhD researcher in sexual health at the University of Melbourne, has looked at STI trends in older women (women aged 55 to 74) in Australia. Her 2020 study revealed that in the five years from 2014 to 2018, the largest increases in the rates of chlamydia, gonorrhoea and infectious syphilis were in the older age groups.
More concerning is the fact that the figures may under-estimate the extent of the problem as the study only looked at those who had been tested. Mathematical modelling suggests that as many as 77% of chlamydia cases remain undiagnosed. The chlamydia testing and positivity analysis relied on Medicare rebate information and therefore excluded testing from settings where Medicare was not utilised (including some hospitals and sexual health clinics).
General practitioners (GPs) are often less likely to test older people due to the current recommended screening guidelines which target younger people. Along with this, most available sexual health promotion messages also target younger adults, in contrast to the sexual health needs of older women which are largely unacknowledged. Considering sexual risk in older people may be increasingly necessary, as well as STI testing for those at an increased risk.
Research suggests that further training for healthcare providers is necessary so that they are better equipped to address the sexual health concerns of their older patients. The low uptake of testing among older adults, may be attributable to limited knowledge of safer sex and STIs and not regarding themselves as at risk of infection. Researchers have also advocated for greater access to sexual health promotion materials that are relevant to older adults to improve knowledge of STIs among this age group.
Community pharmacies who offer sexual health services and counselling – with a focus on prevention – can be a major factor in raising awareness of the issue and helping to reduce it.