Seniors' sex lives are up — and so are STD rates

Dr. Connie Micklavzina talks with an older female patient recently. The rate of STDs among seniors is up. (George Skene, Orlando Sentinel)

Across the nation, and especially in the Sunshine State, the free-love generation is continuing to enjoy an active — if not always healthy — sex life.

At a stage in life when many would expect sexually transmitted diseases to be waning, seniors are noticeably ahead of the national curve.

In the five years from 2005 to 2009, the number of reported cases of syphilis and chlamydia among those 55 and older increased 43 percent, according to the Centers for Disease Control.

In Central Florida, the rise is even more dramatic. Among those 55 and older, the reported cases of syphilis and chlamydia increased 71 percent in that same five-year period. That puts Central Florida ahead of the state, which saw a 62 percent rise in those two sexually transmitted infections among the same age group.

The rates at which syphilis and chlamydia increased among older adults outpaced the nation's average. Among all age groups nationwide, reported cases of syphilis increased 60 percent between 2005 and 2009; among those in the 55 to 64 age group, it went up 70 percent. Meanwhile, the incidence of chlamydia rose 27 percent among all ages, and double that among the older group.

As a result of the national trend among seniors, Medicare is considering providing coverage for STD screenings for seniors. Last month, the Centers for Medicare and Medicaid office announced that it was looking into adding STD exams to the national health insurance program, which already pays for HIV screenings. Medicare also is weighing the benefits of paying for behavioral counseling for sexually active seniors.

The factors driving the rise of STDs in the older set include Americans living longer, healthier lives and a new class of medications, which include Viagra, that's making more sex possible. Many older adults didn't get the safe-sex messages that younger generations received, say experts, so their condom use is lower. In addition, more seniors are living in group retirement communities where there's more socializing.

"These seniors may lose a spouse, then get lonely," said Dr. Jason Salagubang, a geriatrician on staff at Florida Hospital Apopka. "They're living in retirement communities with others in the same boat, and sparks fly."

Julia Gill, director of the division of disease control for the Florida Department of Health, says the heavy marketing for sex-enhancing pharmaceuticals aimed at seniors and Florida's lure as a retirement destination are likely causing the state's seniors — particularly those in Central Florida — to lead the trend.

"Certainly we've noted the change and will adjust our outreach, testing and marketing efforts to reflect that," Gill said.

Besides Viagra, other medications such as hormone replacements are helping seniors remain sexually active longer. Progesterone and estrogen creams help make sex more comfortable for women, while testosterone replacement drugs give libido a boost in both men and women.

Finally, a more open sexual attitude has contributed to the rising infection rate. "The flower children who were in their 20s back in the 1960s are now in their 70s," said Salagubang. "They're the make-love-not-war generation, and old habits die hard."

Not just for kids

Just because seniors are older and wiser, doesn't mean they're not susceptible to the same diseases as everyone else, Salagubang said. In fact, they're more susceptible.

As people age, their immune systems tend to weaken, and other health problems make them more prone to infection. Medications for heart disease, hypertension and diabetes also cause seniors to be more likely to pick up what's going around.

Because STDs often have no symptoms, they frequently go untreated and make seniors more prone to other infections, said Salagubang. And these infections will make other conditions, such as diabetes or heart disease, worse.

"If I think a patient may be sexually active, I suggest he or she gets screened," said Salagubang. "I let patients know that STDs and HIV are on the rise among seniors, and are a lot more common than many seniors think."

Although older Americans account for a relatively small proportion of new STD diagnoses overall, providing them education and services to help protect them from infection is critical, said Rachel Powell, CDC spokeswoman.

"Many older Americans face unique prevention challenges, including discomfort in discussing sexual behaviors with physicians and partners, and discomfort discussing condom use," she said.

Given the changing sexual climate for seniors, Dr. Connie Micklavzina, a gynecologist at Winnie Palmer Hospital in Orlando has started asking her older patients more questions, including whether they would like to be screened for sexually transmitted diseases.

"Often I see a huge look of relief on their faces, because they are too embarrassed to ask," said Micklavzina, who's been in practice 25 years. "The responsibility of bringing this up should be on the practitioner, not the patient, to make the conversation easier."

Practitioners should not make any assumptions based on a patient's age, or social or marital status, Micklavzina added. "It has nothing to do with it."

She also broaches the subject of condom use. "I'm surprised by the number of women in their 50s and 60s who aren't insisting that their partners use condoms."

A study conducted by sex researchers at Indiana University found that in the United States, condom use was lowest among men over age 50. Men in their 50s reported using a condom only 28 percent of the time with a casual partner. By comparison, men in the 18 to 39 age-range used a condom with casual partners at least 50 percent of the time.

"We often assume that younger people are at greater risk for sexual health challenges like HIV and STD," said Michael Reece, director of the Center for Sexual Health Promotion, at Indiana University. "However, these data suggest that younger Americans are using condoms more consistently than older Americans."

The fact that older Americans aren't worried about preventing pregnancy accounts for some of the lower condom use, but this age group clearly needs more education about the risks of unsafe sex, Reece said.

According to a 2007 study reported in the New England Journal of Medicine, 67 percent of men and 39 percent of women aged 65 to 74 surveyed reported having had sex in the previous year; 38 percent of men aged 75 to 85 reported the same.

"We should not be profiling people based on their age, and making assumptions about their sexual activity," said Dr. Stacey Landau, ob-gyn at the University of Chicago and author of the study. "Removing age-based profiling with respect to STD screenings is a good idea."

mjameson@tribune.com or 407-420-5158