For 70-year-old Nancy Hill, of Houston, being open about having herpes is a done deal—but she knows she's probably anomaly among people her age. "Maybe many older people don't talk so much about sexually transmitted diseases (STDs) because for some, discussing anything below the waist is still a secret," she says.
But guess what, people? Adults of all ages have sex! Sure, while libido may diminish or change in some people as they get older, thanks to factors like fluctuating hormones (hello, menopause), many older adults continue to have active sex lives, according to the National Survey of Sexual Health and Behavior. The bad news? It’s adults over 40 who have the lowest rates of condom use…yikes.
"People getting divorced late in their 30s and early 40s are getting back into the dating pool," Hill says. "We're just not as conscientious as we were when we were younger, and some of us think, 'I'm too old to get an STD' and that's just not true."
STIs Are on the Rise Among Older Adults
Hill is exactly right. Rates of all STIs (except for HIV, thankfully) are up in the United States in older populations and in general, says Janet Pregler, M.D., an internist at UCLA Health and director of the Iris Cantor UCLA Women's Health Center.
In fact, the Centers for Disease Control (CDC) reported there were nearly 2.3 million cases of chlamydia, gonorrhea, and syphilis in 2017. That's 200,000 more cases than in previous year and they marked the fourth year in a row of major increases in STI rates. While it’s true that more young adults have STIs overall, the stats aren’t great for older folks, either.
For example, Athena Health analyzed data from more than 110,000 providers and found that between 2014 and 2017, diagnosis rates for the above conditions, along with hepatitis B, trichomoniasis, and the herpes-simplex viruses increased 23% in the age 60+ population.
"We're just not as conscientious as we were when we were younger, and some of us think, 'I'm too old to get an STD' and that's just not true."
But it’s not all bad: "For most STIs, older people are the lowest-risk group overall," says Beatrice "Bean" Robinson, Ph.D., and professor at the Program in Human Sexuality at the University of Minnesota Medical Center in Minneapolis.
"When looking at studies, remember that even though the percentage increase is larger, the number of people affected is probably much smaller than other age groups," she says. "Still, older people need to be prudent and do what everybody else is doing to protect themselves." That means: Use condoms and get tested to confirm your (and your partner's) status. (More this below.)
Why Is It So Hard for Us to Talk About STIs?
Rather than pretending it never happened, Hill has chosen to openly discuss her diagnosis of genital herpes (in her case, herpes simplex virus 2, or HSV-2), which she received in 1989 at age 40. When she brings it up with friends, their mouths sometimes drop open. Regardless of your age, there's still an unfair stigma and sense of shame around STIs.
"Some people still want a bag over their head," she says. "No one's ever admitted they have genital herpes, but the will speak up about cold sores—a symptom of oral HSV-1, [which can also cause genital herpes]. They say, 'I've never really thought about it being contagious.’
“They must think, 'If I don't know I have it, I don’t have to admit it,’" she says.
Even when Hill later dated a seemingly educated man, she felt the STI stigma deeply in the relationship. He didn't want to know more about her condition, "and he never really wanted to touch me," Hill says. "Hey, I don't have leprosy."
A New Name for STIs
Thankfully, Hill’s not alone as a patient in her mission to educate rather than stigmatize STIs in older adults. In fact, she’s an administrator for the HSV/Herpes Support Group at ProjectAccept.org, which is a website and community where 54-year-old Nanette Tincher, R.N., is co-founder and vice chairman and also works tirelessly to reduce stigma. The goal is "to declare 'checkmate'" on herpes and human papillomavirus (HPV).
If Tincher's partner had been honest with her when she was 42, she might not have both types of herpes-simplex viruses, she says. Now living in Melbourne, FL, Nanette has dated her fiancé, a different partner, for three years.
Armed with medical knowledge, she's always made it a point to disclose her HSV status. "Men needed to not only accept it, but to be in my life in an intimate way, they had to be tested, too," she says. "Hold others to high standards like yours, and remember 80 percent of people who have it don't even know."
Knowing that HSV is one of nine herpes viruses specific to humans, she doesn't look at it as a sexually transmitted infection (STI). She looks at the STI acronym a little bit differently: “It's more of a socially transmitted infection."
The term STI is now just as common as the older term, STD, especially in the United States, says Dr. Pregler.
"There was this idea that 'disease' has some sort of negative connotation," she says, "but in reality, these are infections that are transmitted through sex."
Don't Be Shy: A Sex-Ed Refresher
So if you are one of the many, many older adults looking to have a healthy sex life—whether you're fresh to the dating scene or (cough) just need a reminder—you need to make sure you know the basics of protection.
Number one: Have a plan in place with your partner. Maybe that means agreeing to use condoms, or to get tested and share results, or committing to a monogamous relationship—or all of the above.
You don't have to limit yourself to male condoms either. "For men who have erectile dysfunction, adding the condom can make enjoying sex even harder for them," says Dr. Robinson. In that case, opt for a female condom instead, which can be inserted into the vagina before sex.
The notion of "I'm too old" to get an STI is one Dr. Pregler has heard all too often. "True, older people don't have to worry about ramifications of infertility issues from STIs. But we have seen pockets of older people acquiring HIV and it's a life-changing, serious diagnosis that's particularly concerning in an older person. Even with the disease controlled, they're at risk for heart disease, bone loss, and certain kinds of cancers."
The main message regarding HIV, specifically, used to be to just use condoms to prevent transmission, but now there's also medication that can reduce your risk if you’re in a high-risk group.
"Women are at highest risk worldwide for acquired HIV, even though doctors don't always think of them first," she says. "Protection is very important especially if they have bisexual partners."
Remember, too, that anal sex and oral sex can also transmit STIs, so don't get complacent, sexual health experts say.
And if you have been diagnosed with an STI at an older age—or any age, for that matter—Tincher hopes you won't blame or shame yourself, but instead be proactive. "Learn about it and learn about your body," she says. "No one knows you better than you, and when you go to the doctor, take information for your discussion."
Talk to a doctor about STIs, Dr. Pregler says, even if it's logistically harder when you're older. Women may not be seeing a gynecologist as often since screenings are not always recommended as frequently in the older age group, but that doesn’t mean you can’t have a sexual-health discussion with your primary-care provider. Men, however, may see a urologist for prostate issues—a good opportunity to talk STIs, too.
And keep in mind: If you go to the doctor and ask for a standard STI panel, it doesn't include every single STI in the world. Most notably, the Centers for Disease Control and Prevention (CDC) doesn't recommend testing people for herpes if they have no symptoms, Tincher says, despite the fact that it’s so common. Again, you must be proactive—if you suspect you may have herpes, you need to ask for that test specifically and not just a general test for STIs.
Bring your sexual health up, even if your doctor doesn’t ask you about STIs, Dr. Pregler says. "Tell them you're sexually active. If you think your partner may have HIV and you're at risk, ask about preventive medication. Communication is so important."
This Is Life
Her boyfriend was "an ex-drug user, single dad, nice guy." Unfortunately for Jennifer Vaughan, 49, of Watsonville, CA, he also had HIV—and Jennifer had no idea. She couldn't understand why she was so sick, including a bout with pneumonia, until her diagnosis at age 45.
She controls her HIV with medication, which has come a long way in recent decades. Now, if you take HIV medication correctly, it’s totally possible to live an otherwise healthy life. "You can't even see HIV on my blood work," Vaughan says. She's happily married and reflects calmly about then and now, sharing her insight on her YouTube channel, Jennifer's Positive Life, which has more than 41,000 subscribers.
While even an HIV diagnosis is no longer a death sentence, Vaughan and other advocates and experts agree: The more you know about your sexual health and the sexual health of your partners, the better.
"Make sure you know someone's sexual history before you hop in the sack," she advises. "They may look great on paper, but we're human, and this is life. What happened to me is my problem, and I didn't take responsibility for my own body. I don't blame the person that had it. I could have done more, yes, but I don't regret anything and I have forgiven myself for that."