Sexually transmitted diseases have been steadily increasing in the United States in recent years, but the elderly population is particularly affected.
According to data from the Centers for Disease Control and Prevention, among people age 65 and older, chlamydia diagnoses increased more than three-fold between 2010 and 2023. Gonorrhea cases increased about six-fold, and syphilis cases increased almost ten-fold.
To address this worrying trend, clinicians, health officials, and the general public need to understand the underlying factors that are causing it. Here are six:
1. Lack of knowledge about STIs. In a 2020 study, researchers asked people ages 65 to 94 basic questions about STIs, and many gave incorrect answers. For example, only half knew there was a treatment for chlamydia, and almost two-thirds said a woman could tell if she had gonorrhea by looking at her body.
Matthew Lee Smith, the study's lead author and an associate professor at the Texas A&M University School of Public Health, told me that many older adults received little to no sexual health education in schools when they came of age, and as a result, they may not be aware of their risks for contracting STIs or the need to prevent them.
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2. Low condom use. Smith explained that condom use in this age group is “very limited.” This may be the result of the misconception that condoms are primarily used to prevent pregnancy. Because pregnancy is no longer a concern in this age group, many people have stopped using condoms.
One AARP survey found that only 8% of older adults who had sex in the past month always used condoms, and another found that only 3% of people over 60 had used condoms in the past year.
3. Older adults are healthier and stay sexually active longer. Advances in medicine, such as erectile dysfunction medications and hormone therapies to ease vaginal dryness, allow today's older adults to maintain longer, healthier sex lives than ever before.
One survey found that more than half of men and 31 percent of women ages 65 to 80 reported being sexually active. Another survey by the AARP concluded that 26 percent of people ages 60 to 69 have sex once a week, and 17 percent of people ages 70 and older have sex once a week.
4. More opportunities to find new sex partners: Smith noted that widows and divorcees are increasingly choosing co-living communities. “They're living together and they're looking for intimacy,” he said. Plus, there are a number of dating apps that specifically target older adults, including OurTime, SeniorMatch and SilverSingles.
5. Gender imbalance. Women's life expectancy is about six years longer than men's. A disproportionate number of women outlive their partners, creating what Smith calls a “partner gap,” where older men have sex with multiple women. This non-monogamous behavior, combined with low or no condom use, increases the risk of sexually transmitted diseases.
This phenomenon is supported by CDC data showing large gender disparities in STD rates among people over 65. In that age group, men are about seven times more likely to develop gonorrhea and about 10 times more likely to develop syphilis than women. Some of this disparity may be due to men having sex with other men, but it is more likely that some men are having unprotected sex with multiple women and unknowingly spreading the infections.
6. Reluctance to discuss sex. Many older people are hesitant to discuss their sexual preferences and needs with a new partner, Smith said. They may not ask about each other's sexual history or whether they've been tested for STIs recently.
Unfortunately, this discomfort extends to medical professionals as well: Despite the prevalence of sexual activity among older adults, one survey found that only 17% of people between the ages of 65 and 80 had talked to their doctor about their sexual health in the past two years. Most of these conversations were initiated by the patient, not the doctor.
It's possible that clinicians are focusing on more urgent aspects of a patient's medical history, such as heart disease, diabetes or other chronic conditions. But ageism is undoubtedly at play, as health care providers succumb to the misconception that older people just don't have sex anymore.
Ample data shows the opposite, and health systems must change their practices. Doctors routinely ask young people about their sexual histories and test them for STIs, and they should do the same for older people. Public health officials should launch awareness campaigns about condom use for older people, just as they do for adolescents, and enlist the help of community living facilities and dating apps.
“Society should not discourage or shame older people for their desires and desires for intimacy, affection and sex,” Smith said. Indeed, an active sex life among older adults is a sign of vitality and good mental and physical health. The health care system and society at large should support everyone to live their best life, regardless of age.
