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.
Feb-15-2019