Safety Under the Sheets: What You Need to Know About STIs

Many of us are living longer, healthier lives — and that means maintaining healthy, fulfilling sexual lives as we age. Unfortunately, according to the Centers for Disease Control and Prevention (CDC), sexually transmitted infections (STIs) have more than doubled in the past ten years among U.S. adults aged 65 years and older.

One study attributes this to a variety of factors, including a lack of knowledge of STIs among older adults and fewer opportunities to discuss sexual health with medical professionals.

"The important thing to remember here is that even if pregnancy is no longer a concern, you can still get an STI. And if you do, you're not alone," explains Sara C. Flowers, vice president of education and training at Planned Parenthood Federation of America.

"According to the CDC, more than two and a half million cases of chlamydia, gonorrhea and syphilis were reported in 2019, reaching an all-time high for the sixth consecutive year. The most recent CDC analysis shows that about one in five people in the U.S. have an STI. STIs can affect anyone who's sexually active regardless of age, gender identity, or sexual orientation," she says.

For decades, the term STD, short for sexually transmitted disease, was used instead of STI.

According to the American Sexual Health Association, "While you'll see both terms used, there has been a shift in recent years to STI. Why? The concept of 'disease,' as in STD, suggests a clear medical problem, usually some obvious signs or symptoms. But many common STDs have no signs or symptoms in most of the people who have them. Or they have mild signs and symptoms that can be easily overlooked. So the sexually transmitted virus or bacteria can be described as creating 'infection,' which may or may not result in 'disease.' This is true of chlamydia, gonorrhea, herpes and human papillomavirus (HPV), to name a few."

Today many medical professionals often use STIs and STDs interchangeably to refer to infections caused by sexual activity.

However, according to experts at Tulane University, "Sexually transmitted infections, or STIs, are infections that have not yet developed into diseases, and can include bacteria, viruses or parasites such as pubic lice. They are usually transmitted during sexual activities through an exchange of bodily fluids or skin-to-skin contact where the infection is active … Sexually transmitted diseases, or STDs, on the other hand, are diseases that result from STIs, and therefore suggest a more serious problem."

Whether they're called an STI or an STD, their prevalence, and ways to mitigate risk, remain the same.

According to the CDC, STIs such as primary and secondary syphilis, chlamydia and gonorrhea among older adults have significantly increased.

Cedric "CJ" McIntosh is the DREAMS (Delivering Resources, Encouragement and Meaningful Strength) program supervisor for Terros Health, a nonprofit health care provider in Arizona that, among many other services, provides free on-site rapid STI testing and supportive services linked to HIV medical treatment.

"Perhaps one of the biggest misconceptions is that older people don't have to worry about STIs," McIntosh says. "On the contrary, data from the CDC revealed that more than half (fifty-one percent) of those in the United States diagnosed with HIV were ages fifty and older. Although HIV diagnoses among the fifty-plus age group are declining, about one in six of these individuals are still HIV-positive. The good news is that older adults who are diagnosed with HIV are living longer, healthier lives, thanks to effective treatments."

To help older adults navigate leading healthier sexual lives, Flowers offers some pointers.

"In the same way that talking to our partner (or partners) about what we like and don't like makes sex better, so does talking to our partner about STIs, getting tested, and ways to have fun, pleasurable, safer sex," she says. "Open communication and knowing your STI status can help you and your partner feel more relaxed, which can strengthen your relationship and enhance your intimate and sexual experiences."

According to Flowers, a doctor or nurse can provide information on how to have safer sex and says Planned Parenthood "is here for people of all ages with resources and information on how to talk about safer sex and where to get tested."

Both Flowers and McIntosh recommend that sexually active adults of all ages get tested for STIs regularly, especially before sex with a new partner.

"The best way to protect yourself and your partner is for the two of you to get tested for HIV and other STIs before sex," Flowers says. "STIs don't always cause noticeable symptoms. And some symptoms of STIs or HIV, such as fatigue, can be mistaken for age-related health problems."

To get tested, talk with your health care provider or search for STI testing resources near you.

Once partners decide to move forward with sexual relations, there are a variety of sexual protection measures that can be utilized.

"Safer sex is part of a pleasurable and fun sex life," Flowers says. "Using barrier methods — like condoms and dental dams for oral, anal and vaginal sex — can make sex even better by helping folks worry less about STIs."

"It's important for anyone who tests positive for an STI to know that all STIs are treatable, and many are curable," Flowers says. "Bacterial STIs like chlamydia and gonorrhea can be cleared up with antibiotics and you can move on with your life STI-free, if you take all the medicine as directed. Viral STIs like HIV, HPV and herpes are very treatable, and you can continue to have a healthy sexual life."

Flowers notes that it's often more about the stigma of the STI than the actual diagnosis.

"Your STI status doesn't make you good or bad, 'clean' or 'dirty,'" Flowers says. "Having an STI just means you've been in close contact with another person who has an STI. STIs are stigmatized because there's so much shame and stigma associated with sex in general. No one judges you if you catch strep throat from someone else. That's because strep throat isn't spread through sex. One of the consequences of the stigma our society has around sex is stigma around STIs."

If you are diagnosed with an STI, communication with past, current and future partners is key.

"If you know you have an STI, let your partner (or partners) know before starting any sexual activity so you can work together to make an informed decision about how to prevent spreading it," Flowers adds.

She continues, "If you find out you have an STI after you've already had sex with someone, let them know about your status as soon as possible so they can get tested too. It's important to share your status with previous partners as well — even if you're not still in contact with them regularly — because it isn't always easy to know exactly when you got an STI."

"It might feel scary or awkward to start conversations about STIs at first, but the more you do it, the easier it gets," Flowers says.

Michelle Talsma Everson is a writer and editor from Phoenix, Arizona. She has written for a variety of media outlets and believes in the power of storytelling to shine a light on important topics that make an impact in people's lives. You can see her work at mteverson.com. Read More