As recently reported in a thorough analysis (1) by U.S. News and World Report’s contributing reporter Elaine K. Howley, the Centers for Disease Control and Prevention (CDC), which tracks sexually transmitted infections in the United States, reports an increase in the rates of Syphilis, Chlamydia and Gonorrhea among people ages 45 and older during the period 2012-2016 (2). We should be concerned about safe sex in later life and it is recommended that older adults be tested for hepatitis C (3,4) and for HIV (5,6). Still, rates of most STIs are low among older adults and there is no compelling evidence for a widespread or growing epidemic of STIs after menopause.

To put older adult STI rates in context, most STIs in the 2018 CDC report are more common among 10-14 year old children than they are among older adults in the U.S. (7). Let’s agree that rates of STIs among 10-14 year olds should be zero – anything higher than that should be cause for serious concern and intervention.

The National Social Life, Health and Aging Project, the most comprehensive study of sexuality and aging in the U.S., shows that partnered sexual activity occurs throughout the life course, including well past menopause. If your only sexual activity is on your own by masturbating, you are not at risk of a sexually transmitted infection. If you are sexually active with any partner, your risk of a sexually transmitted infection is bigger than zero. This fact applies before and after menopause, and for men too. If you and your partner only have sex with each other, and you have both tested negative for HIV and other STIs, then your risk is exceedingly low. Rather than worry about STIs, your health-related energy would be better spent on keeping your heart healthy and optimizing your balance, flexibility and hearing. Or helping to eliminate STIs among children, starting with evidence-based sex education.

If you or your partner are having sex with other partners, then you are at increased risk for sexually transmitted infections. Most sexually transmitted infections, including HIV and hepatitis C, are not a death sentence – they are treatable with medicine. Here are some questions to bring to your doctor or other healthcare professional about sexually transmitted infection after menopause.

1. What are common symptoms and signs of STIs after menopause? We like this resource on STIs from the Office on Women’s Health at the U.S. Department of Health and Human Services. One important addition: new onset of pain with intercourse, especially pain deep inside the vagina or rectum (if you have anal sex), may be a symptom of an STI that causes inflammation in your pelvis. While this symptom is missing, this is a comprehensive and evidence-based resource to learn more about STIs.
2. Would it be ok to include my partner in this discussion?
3. I no longer have vaginal intercourse. Am I still at risk for an STI?
4. I am post-menopausal. Do we need to use a condom every time we have sex? Are male condoms the only form of protection against STIs?
5. I’ve had a total hysterectomy. Am I still at risk for STIs?
6. If I have an STI, do you have resources to help me communicate with my partner(s) about it?
7. Do vaginal dryness, or treatments for dryness like lubricants or estrogen, affect my risk for STIs?
8. I have a male partner who is using medicine to help with his erectile dysfunction. Does use of this medication affect transmission of STIs?
9. How often do I need to get screened for STIs? Which STIs? How are the tests done? Should my partner be screened too?
10. I’d like to have a new partner, but I’m avoiding sex because I’m really afraid of getting on STI. What can I do to get over this fear?

Citations:

1. What to Know About Rising STD Rates Among Seniors. U.S. News and World Report. https://health.usnews.com/health-care/patient-advice/articles/2018-12-10/what-to-know-about-rising-std-rates-among-seniors
2. 2017 STD Surveillance Report | 2018 | Newsroom | NCHHSTP | CDC. https://www.cdc.gov/nchhstp/newsroom/2018/2017-STD-surveillance-report.html. Published September 25, 2018. Accessed January 4, 2019.
3. Recommendations for the Identification of Chronic Hepatitis C Virus Infection Among Persons Born During 1945–1965. https://www.cdc.gov/mmwr/preview/mmwrhtml/rr6104a1.htm. Accessed January 4, 2019.
4. Final Update Summary: Hepatitis C: Screening – US Preventive Services Task Force. https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/hepatitis-c-screening. Accessed January 4, 2019.
5. Final Update Summary: Human Immunodeficiency Virus (HIV) Infection: Screening – US Preventive Services Task Force. https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/human-immunodeficiency-virus-hiv-infection-screening. Accessed January 4, 2019.
6. HIV and Older Adults Understanding HIV/AIDS. AIDSinfo. https://aidsinfo.nih.gov/understanding-hiv-aids/fact-sheets/25/80/hiv-and-older-adults. Accessed January 4, 2019.
7. Sexually Transmitted Disease Surveillance 2017. 2017:168.

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Edited by Kelsey Paradise and Megan DePumpo