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STIs & Older Americans: Where Does Your State Stand?

It may seem surprising, but sexually transmitted infections (STIs) are on the rise in older adults. Over the past five years, the CDC estimates that the rates of infection for chlamydia, gonorrhea, and syphilis have more than doubled in Americans over the age of 65. In fact, older adults now have higher rates of infection than any other age group.

STIs can have dramatic and deadly health consequences for people of all ages, but the rising prevalence of these types of infections and diseases among the oldest Americans is of particular concern, as this age group is much more likely to experience other comorbid conditions such as heart disease, cancer, and stroke. Additionally, older adults’ immune systems are not as robust as they used to be, thus allowing infections to spread more quickly.

As a group, older Americans tend to underestimate their risk for diseases like HIV and other STIs, and they are far less likely than younger people to use condoms or take other precautions when having sex because of no concern for pregnancy. As a result, every state has seen major increases over the past several years in the prevalence of common STIs among adults 55 and older.

Nationally, adults 55 and over saw the highest increase in rates of chlamydia, gonorrhea, and syphilis among any age group in the past five years. While they tend not to have the highest current prevalence of any of these infections, the increases seen among adults nearing retirement age are a major cause for concern.

We wanted to look at where older Americans are facing the most serious crises over sexually transmitted diseases and infections. Consequently, we examined the most recent available data from the CDC to identify the states with the highest current rates and the most worrying trends.

Where Is the STD Crisis Worst?

Nationally, those 55 and older have an average population-adjusted rate of chlamydia, gonorrhea, and primary and secondary syphilis of 24.5 per 100,000 people, which is the lowest rate among all adults. But that age group has also seen the average rate of those diseases rise by more than 100 percent in just the past five years, climbing from an average rate of 11.8 per 100,000 in 2014.

The increase in the average rate of chlamydia, gonorrhea, and syphilis among adults 55 and older is the highest among all age groups, and, interestingly, the five-year increases rise along with age.

Including rates of HIV, the average STD infection rate today for those 55 and older is 103.2 per 100,000, but a handful of states have rates that are higher — far higher, in some cases. In fact, the District of Columbia’s average STD rate (including chlamydia, gonorrhea, primary and secondary syphilis, and HIV) is 881.8, or more than eight times the overall national rate for those 55 and older. Other states are quite close to this number.

Half of the ten states with the highest average rates are in the South, and four others are in the Northeast. However, Midwestern states have the lowest overall average STD rate for adults 55 and over of just 42.1 per 100,000, followed by the West with 64.6 per 100,000, the Northeast at 97.8 per 100,000, and the South at 136.6 per 100,000. Without the District of Columbia, the South would fall to second place with a rate of 90 per 100,000.

While most states still have a lower average STD rate for those 55 and older than the nation as a whole, every state has seen this figure rise considerably over the past decade. In fact, many of the states with the lowest rates today have seen the largest increase in these diseases over the past 10 years.

Why the Increase in Older Adults?

There are several reasons why STIs are on the rise in older adults including:

  • They tend to get tested less due to the stigma surrounding STIs.
  • They tend to think they are at less risk due to their age.
  • Erectile dysfunction medications such as Viagra and Cialis allow men to sustain erections.
  • They may have several sexual partners after the death or divorce of their spouse with whom they were monogamous.
  • They may not think of other types of sexual activity such as oral or anal sex as a way of transmitting or contracting STIs.
  • Those with early dementia or memory loss may simply not consider this an issue.

FYI: Contrary to what you might expect, assisted living communities and nursing homes are frequently places of STI transmission.

Signs and Symptoms

While pregnancy is not a concern, other issues are. Left untreated, chlamydia or gonorrhea in women can cause pelvic inflammatory disease, a painful condition that requires admission to a hospital and IV antibiotics. In men, the diseases can cause painful urination or inflammation of the urethra called urethritis. It can also spread to the testicles and cause extreme pain and swelling of the scrotum and testicles.

Any vaginal or penile discharge should be examined for the presence of sexually transmitted bacteria. Syphilis usually starts with a painful sore on the penis in men or around the mouth. It then advances to a rash on the palms of your hands and the soles of your feet. In advanced cases, it can lead to heart damage and dementia.

Herpes starts out as painful, burning blisters on the vaginal, penile, and pubic areas of women and men. They often rupture and weep clear fluid and are highly infectious.

If you have any of these symptoms, consult your doctor and get tested immediately. Even if you have no symptoms, if you are sexually active, it is a good idea to get screened for STIs on a regular basis.

HIV

The prevalence of HIV, or human immunodeficiency virus, has remained roughly steady in the U.S. over the past several years, but the rate of HIV among older Americans may be surprising. Nearly 39,000 people were newly diagnosed with the virus that causes AIDS in 2017, but about 17 percent of them were 50 or older.

Because it is now considered a chronic manageable disease, about half of all those living with HIV in the U.S. are 50 and older. However, those who aren’t diagnosed until they are older are far more likely than younger people to have a late-stage HIV infection, which means they could have already experienced major damage to their immune systems.

Looking specifically at those 55 and older, they are infected with HIV at a population-adjusted rate of 339.4 per 100,000, which is the second-lowest rate among all adults. Outside of the District of Columbia, which skews the scale based on its population density, New York has the highest rate of HIV infections among older adults, while North Dakota’s is the lowest.

Importantly, no state has seen its infection rate for HIV among adults 55 and older fall over the past several years, and the average increase between 2010 and 2016 (the oldest and most recent years for which data is available by state for this age group) is more than 120 percent.

Chlamydia

Chlamydia, a bacterial infection, is the most common STD in the U.S., with about 2.9 million infections occurring every year. But the disease often shows no physical symptoms for years, if at all, so only about half of the true cases are actually diagnosed. Like other STDs, chlamydia is much more common in younger people than older ones, but those 55 and older have seen the biggest increase of any age group over the past decade.

The good news is that chlamydia is very easily treated, and many people can be cured of their infections by a single dose of antibiotics.

Nationally, those 55 and older have a chlamydia prevalence of 34.5 per 100,000 people, which is the lowest rate among all adults. A handful of states have much higher rates, while most of the states have lower rates than the overall national rate for the age group.

In every state, the rate of chlamydia infections among older adults has climbed, and several states have seen their rates explode. Wyoming, for instance, had a chlamydia rate that was so low it was reported as zero in 2008. The state’s rate today is the second-lowest in the country, but to understand how significantly chlamydia has increased in Wyoming, we assumed there were at least some chlamydia infections in the state in 2008. This was enough to create a rate of  0.5 per 100,000, which gives the state an increase of 1100 percent between 2008 and 2017, and that’s a conservative estimate.

Gonorrhea

Gonorrhea, colloquially referred to as “the clap,” is a bacterial infection that strikes an estimated 820,000 people in the U.S. every year. About half of those who have it are diagnosed, and infection rates are by far the highest in adults between 25 and 29.

Like chlamydia, gonorrhea can often be treated very easily, but the disease has developed resistance to antibiotics over time, and the CDC estimates that about 30 percent of new infections are resistant to at least one drug, which has dangerously narrowed the options for treatment.

On the national level, adults 55 and older have a population-adjusted gonorrhea rate of 33.4 per 100,000, the lowest rate among all adults. Ten states, including the District of Columbia, have higher rates than the overall national gonorrhea rate for older adults.

In every state, the prevalence of gonorrhea among older adults has climbed over the past decade, with several states’ rates climbing from statistically insignificant to low-but-still-concerning — Montana, North Dakota, South Dakota, and Vermont.

Of note, gonorrhea and chlamydia are often transmitted together, but fortunately, a single dose of two different antibiotics given at the same time effectively treat both!

FYI: A prescription discount card can help you save money on common antibiotics such as those prescribed to treat gonorrhea.


Syphilis

Among the three common reportable STDs (syphilis, chlamydia, and gonorrhea), syphilis is the most dangerous despite being the least common of those three. This is because untreated syphilis can lead to major health problems, including organ failure and even blindness, dementia, and death. In fact, several prominent historical figures are said to have died from late-stage syphilis, including gangster Al Capone and writer Oscar Wilde.

There are three stages of syphilis, but the two earliest stages (primary and secondary) are the most helpful to examine because that is when it is most transmissible. About 115,000 cases of syphilis were reported in 2018 at all stages, with nearly one in three in the primary and secondary stages. While syphilis can be incredibly dangerous if it goes undetected and therefore untreated, it can be cured in most people with a single shot of penicillin.

Nationally, primary and secondary syphilis occurs in adults 55 and older at a rate of 5.5 per 100,000, the lowest rate for any age group. Only a handful of states have higher rates for the age group, with the District of Columbia having by far the highest rate, followed by California and Nevada.

A decade ago, syphilis was far rarer than it is today for adults 55 and older, with ten states reporting rates of primary and secondary syphilis for older adults that were almost zero. For those states, Alaska, Delaware, Iowa, Montana, New Hampshire, North Dakota, Oregon, South Dakota, West Virginia, and Wyoming, we assumed they had rates equal to the lowest reported rate in 2008, so we assume the growth rates reported below are conservative estimates.

Importantly, syphilis is the only common reportable STD where some states have managed to make progress, and eight states have seen their primary and secondary syphilis rate among older adults fall between 2008 and 2017.

Prevention

Prevention of STDs is the best way to decrease their incidence. The best way is with condoms. Communication is key; you should also have a frank discussion with your sexual partner(s) before engaging in any sexual activity. Remember, many STDs, including the ones mentioned here, may remain indolent and asymptomatic in your system for years or even decades, and you can unknowingly transmit them to others.

Get tested regularly for STDs if you are sexually active. Ask your partner about their sexual history. Talk to your doctor about your risk and how to prevent and treat any STDs. Never be afraid to communicate with your partner about your sexual concerns and health.

Conclusion

Older adults have among the lowest prevalence of most STDs, but those diseases and infections have had a huge resurgence in many states, and those 55 and older have largely seen the most dramatic increases in prevalence rates of any age group. Shockingly, all STDs have more than doubled in number in persons over the age of 55 in the last ten years.

HIV, chlamydia, gonorrhea, and syphilis are the only common STDs that state health departments are legally required to report, so they are the ones for which the most robust data is available, which is why our analysis is limited to those. But it is important to note that many other STDs are common, even among older Americans, so everyone who is sexually active should do as much to manage their sexual health as they do other aspects of their health, and the use of condoms has no maximum age limit.

Methodology & Sources

As mentioned, all of our data came directly from the Centers for Disease Control and Prevention, and we used the most recent available data that the CDC has published. All of our state-level data came from the CDC’s AtlasPlus tool, which allows users to create custom tables for a range of sexual health issues, including HIV and STDs. Current rates of primary and secondary syphilis, chlamydia, and gonorrhea among those 55 and older by state were from 2017, which is the most recent year for which the state-level data is available by age group, and the corresponding data for HIV was from 2016. To create rates of growth, we used HIV rates from 2010 (the oldest year available for HIV) and other STD rates from 2008 (to give us a 10-year period for those STDs).

You can read more about HIV among older adults here, and detailed tables on STD rates among all Americans can be found here.

Fair Use Statement

Health issues among older Americans extend far beyond heart disease and arthritis. If you share our concern over the growing rates of STDs and STIs among those 55 and older and wish to share our findings with your audience, you are free to do so. All we ask is that you provide a link back to the URL of this page.