Photo courtesy BC Centre for Disease Control
With World AIDS day on Dec. 1, thoughts turn to prevention and treatment of sexually transmitted infections.
Whether you use one of the old names—venereal disease, STD—or the one common now, STI (sexually transmitted infections), the numbers are on the rise throughout our province.
While all sexually-active ages are seeing a rise in incidence, one surprising group that’s seeing a rise in new infections is seniors.
Dr. Jason Wong is an epidemiologist in public health and preventative medicine at British Columbia’s Centre for Disease Control (BCCDC).
“Chlamydia, gonorrhea and syphilis are on the rise throughout British Columbia, including among seniors,” Wong says. For BCCDC’s statistics, seniors are people aged 60 and over.
“Sexual health is definitely an important part of people’s lives regardless of your age,” says Wong.
“You have a new partner, have a healthy sex life and want to maintain a healthy sex life. We recommend that they get regularly screened so you don’t have or you don’t transmit, a sexually transmitted infection.”
There are many different kinds of sexually transmitted infections, including three common bacterial types still in circulation.
While STI-caused infertility may no longer be of concern for seniors, Wong says there are still serious problems they can cause: “Chlamydia and gonorrhea, if you don’t treat them can lead to, for women, pelvic inflammatory disease which can lead to chronic pain. For men, it can also infect the testicles or structures around them, the epididymis, which can lead to infertility or chronic pain. These STIs can reduce quality of life because of pain and discomfort.”
Initially, chlamydia and gonorrhea can cause no symptoms. Sometimes they cause a discharge or painful urination, a burning sensation. Often that can be a simple bacterial or fungal infection not related to sexual activity. Whatever the cause, it is treatable.
Then there’s the third-most common bacterial STI. “Syphilis is a little different bug,” says Wong. Untreated, it causes perplexing symptoms and
remissions that can lead to life-altering damage, even death. It can be 10 days to 3 months after you get infected with syphilis before the initial signs show up. On average, it’s usually three weeks after the bacteria enters your system before you notice anything. The bacteria can survive in body fluids so can be spread by more than traditional intercourse.
“Syphilis typically causes a local presentation, a painless open sore, an ulceration. So, some people notice it and wait to see if does get better. It goes away.” At that point, many think that whatever they had is gone. Not true, says Wong.
“The syphilis can then present elsewhere in the body, in a systemic infection, as rash or hair loss. There is a whole host of things syphilis can cause—it’s called the great imitator because it can cause so many different types of problems.”
This is where older adults have an additional challenge to getting diagnosed. These perplexing symptoms can be attributed to a host of other problems common in seniors. If you have had a new partner within the last year, tell your doctor.
Then, with syphilis, whatever caused those problems seems to go away.
“In the next stage, for the first 12 months, there are absolutely no symptoms, no rashes, no hair loss. They feel totally fine so people are distinctly not unwell but they are still infectious.”
That means, they can unknowingly pass along syphilis to their sexual partners.
In the final phase, Wong says, “People are not infectious but syphilis has caused organ damage to their heart, brain, liver. It can cause permanent damage to people that can be very debilitating. Typically, it takes years to reach this stage.” There is some thought that Winston Churchill’s father’s early-onset dementia was a result of late-stage syphilis.
Because of what these bacterial infections can do to a developing baby, that’s why all pregnant moms are tested early for a host of STIs, when they are still treatable, before they can damage the growing child.
And child-bearing brings up one of the reasons Wong thinks STIs are on the rise because seniors think, “I don’t need to worry about pregnancy. That doesn’t prevent sexually-transmitted infections.”
Another reason may be that seniors often lose their long-time partner. The need for love and intimacy does not end at any certain age or with the loss of a spouse.
So, given the STIs out there, what should people do, at any age?
“If you have a new partner, have a healthy sex life and want to maintain a healthy sex life, we recommend that you get regularly screened so you don’t have, or you don’t transmit, a sexually transmitted infection.”
And if the test turns up positive? “All of these bacterial sexually transmitted infections are curable. All curable with the right antibiotics,” says Wong. “Once treated, they are gone.”
Some doctors will want to do additional tests after the fact to make sure the infection has been thoroughly treated. And, it is important to remember that these infections don’t leave you immune to them. Anyone can catch them again.
Outside the three main bacterial STIs is HIV. It is not bacterial. It is a retrovirus. It can be prevented; it can be treated life-long so it is no longer a death sentence but, as yet, it cannot be cured.
The great news is that everything one does to prevent the main three bacterial STIs also works on the viral sexually transmitted infections like HIV and Hepatitis.
If you do test positive for HIV, there is medicine you can take that can keep it under control. This year’s World AIDS Day sees a much more optimistic outlook that it did even a decade ago.
If your partner has tested positive for HIV, Wong says, “There are many different strategies. Pre-exposure prophylaxis (PREP) for HIV has a very high efficacy, very high effectiveness. In the real world examples, people taking the medication regularly have close to zero risk of acquiring HIV.”
For Hepatitis, some kinds have effective treatments and one has a cure. But Wong is clear, prevention is best and if you do test positive for an STI, early treatment is very effective in most cases.
But how can you broach the subject with a doctor? Wong suggests “saying ‘I have a new partner and I’m wanting to make sure they are healthy and that I can have a healthy sexual life with my partner.’ That’s the type of conversation to have.”
Wong says, many hospitals and doctors now make STI screening part of regular medical tests so it is standard, that way neither patients nor doctors have to bring it up.
“Talk to your doctor about sexual activity or any concerns you have around sex. Those are the key messages that I would recommend,” says Wong.
“Certainly we would recommend that people have safer sex whether with it’s with a condom, there are many types of strategies that people can use to have safer sex. Really, it is about empowering people. Regular testing is a strategy to ensure that you are healthy and you are not infected with HIV or an STI and you are not going to pass it along to your partners,” says Wong.