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People over the age of 60 might be getting grey hairs and counting the days to their retirement, with grown-up children and even grandchildren, but that does not make them exempt from the risk of contracting an STI (sexually transmitted infection). With many individuals having lost a partner, whether to death or divorce, the elderly have started to enjoy a more active sex life, compared to those of the same age group in the previous century.
In Malaga, between 2022 and 2024, there has been a significant increase in the incidence of genital herpes (from 51 to 146), syphilis (from 268 to 610) and lymphogranuloma venereum or LGV (from 19 to 62), and there has been a "notable increase" in chlamydia infections (64% more) and gonorrhoea (69% increase), as Javier de la Torre, coordinator of the Andalusian plan for STIs, HIV and AIDS 2023-2030 (PAITSIDA), says. But this age group is only a reflection of the generalised escalation of STIs in the entire population, with an overall increase of 130-135% since the pandemic.
With the emergence of HIV in 1981, STIs declined due to fear of infection. But once treatment for the disease was found (late 1990s), there was once again a rise in STIs again. Initially, it was a slow but gradual rise, which accelerated in 2016. With the arrival of Covid-19, the records plummeted, due to the strain on surveillance systems and because no tests were being carried out, but once the health crisis was overcome, the incidence shot up as physical relations resumed and more cases were reported. The rise in reporting has been, to a great extent, favoured by the implementation of tracing and diagnosing at the primary care level.
Why have STIs become so widespread among the over-60s section of the population? Firstly, people have started to feel better at that stage of life and they "live longer, have a more active and healthier life, which prolongs their sexual activity", says De la Torre. Added to that is the use of drugs for erectile dysfunction and the tendency to seek new relationships after divorce or the death of a partner. "The famous Viagra and many other medicines that have come out allow the population to have continuous intimate relationships, even at an advanced age." In addition, dating apps have made access to sexual relations easier than ever. The act has been further facilitated by the concerning phenomenon known as 'chemsex', which involves the consumption of drugs to facilitate or intensify sexual activity.
This, together with the perception of low risk and the low use of condoms, either because there is no longer fear of an unwanted pregnancy or because of a lack of habit, contribute to the increase in infections. "The problem is that older people don't talk about it and health professionals don't ask them about it either. There is a lack of education in this respect. Moreover, this older generation did not receive any sex education and are often unaware of the risks involved in having other partners if they do not take the right precautions".
Most of these sexually transmitted infections are usually asymptomatic and, if they do show up, they do so mildly and can be misinterpreted or confused with other ailments. People might "feel some discomfort, such as itching or stinging, but they barely notice it". "Specifically, chlamydia stands out for its high incidence due to being asymptomatic in 50-80% of cases, which makes it difficult to detect, especially in older people who tend to have fewer tests. In the medium and long term, chlamydia can cause infertility and miscarriages in young people and pelvic inflammatory disease with abdominal pain or discomfort due to secretions in older people."
All such diseases are transmitted through contact with fluids. However, with genital herpes even mere contact, without penetration, can transmit the disease. "If infected skin outside the condom is touched, there will be contagion," warns De la Torre. There is no cure for both herpes and HIV, only control treatments. HIV cases have dropped by 10% in Andalucía in the last year.
The other three major STIs - chlamydia, gonococcus (the bacterium that causes gonorrhoea) and syphilis - can be cured with either a 7-14 day course of pills or an injection (sometimes three), although they do not leave the immune system and can be reacquired.
De la Torre insists on the importance of prevention, not only because of the damage caused to those affected, but also because they can transmit the infection to other people. That is why prevention campaigns are important, especially aimed at older people, as well as training for health workers. In addition, other helpful measures are the promotion of the use of tests in new relationships to avoid contagion (in sexually active people it is advisable to have a screening every year and in those who have had a new relationship and have not taken precautions it is advisable to have a test every three months); raising awareness that any symptoms should be reported to your GP, as they are equipped with "the means to carry out microbiological studies to detect any STI and know the result within two to five days". "Thanks to these screenings, we discover many asymptomatic cases and with treatment we cut the chain of transmission, because all STIs can cause multiple problems if not caught in time. HIV affects the defences, syphilis can evolve and cause blindness, gonococcus can trigger pelvic disease and chlamydia, infertility and miscarriages."
All sexually transmitted diseases are more prevalent in men than in women, except for chlamydia, which is split 50/50. However, syphilis and gonococcus mostly affect men, especially men who have sex with men (two thirds of cases). As for the areas with the highest incidence, De la Torre says that the metropolitan and more cosmopolitan areas such as Seville and Malaga, as well as the west of Almeria and the coast of Huelva due to emigration, are the areas with the highest incidence of syphilis and gonococcus.
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