Sexually Transmitted Infections in the Elderly Population

            Sexually Transmitted Infections (STIs), which spread mainly through sexual relations, can affect all ages, including elderly citizens. While underappreciated among seniors, STIs have emerged as an emerging public health issue due to an increase in infection among those 60 years and older. This issue is significant for nursing, considering its practitioners have a critical role in patient education, supporting standard STI screenings, and providing appropriate care and treatment: Sexually Transmitted Infections in the Elderly Population.

           STIs among elderly patients must be taken seriously, considering untreated infection may lead to severe outcomes, such as pain, immune system weakening, and an increase in susceptibility to other diseases. Older citizens have little awareness of STIs, traditionally due to stigmatization, myths, or minimal discussion among medical practitioners. Nurses, hence, must play an active role in making sexual well-being a norm, promoting timely diagnosis, and promoting prevention.

Literature Review

            STIs have become prevalent amongst the elderly population, a fact that counters the common belief that only the youth are vulnerable to STIs. According to Smith et al. (2020), the prevalence of STIs among elderly patients has over doubled in the last decade, with symptoms like chlamydia, gonorrhea and syphilis being more common. The CDC database shows that STI rates among adults aged 65 and older have also risen over the 2010 to 2020 mark by more than 40% (Smith et al., 2020). This is because most older adults feel they are not at risk and have low awareness levels, and therefore, they rarely use condoms.

            This is evidenced by a six-year retrospective study conducted by Bansal et al. (2021) in a tertiary care hospital in New Delhi. In the year 2013, the number of elderly persons with sexually transmitted diseases stood at 17, and in the year 2018, the number rose to 33 (Bansal et al., 2021). Some of the frequent STIs diagnosed were vaginal discharge 25%, candidal balanoposthitis 19.5%, herpes genitalis 16.2%, and genital warts 16.2% (Bansal et al., 2021).

             The common symptoms reported by many patients were genital ulcers (28.4%), and genital discharge (28.4%), and most of them delayed receiving treatment because of stigmatization and embarrassment, thus developing complications such as chronic infections and the spread of STIs in society (Bansal et al., 2021).

            Another article by Liang et al. (2024) analyzed a trend in HIV and other STIs in 50-to-69-year-olds using data for the Global Burden of Disease Study. The trend indicated a reduction in STI occurrence between 1990 and 2015, followed by a re-emergence between 2015 and 2024, particularly among 65-to-69-year-olds (Liang et al., 2024). The study predicts an increase in STI occurrence among this group due to improved longevity, altered living patterns, and an elderly group living with current infection. The authors make a call for inclusive sex education, policy adaptation, and selective screening programs to address this emerging trend.

Conclusions from the Literature Review

            The literature shows that STIs among elderly individuals have been a public health priority. While there is an emerging trend, a significant number of elderly individuals have no awareness of being at risk, hence untreated and undiagnosed infection. The literature shows that myths about STIs, coupled with shame and embarrassment, make elderly individuals shun medical care. The literature shows another major issue of reluctance on the part of medical practitioners to discuss sexual health in an open discussion with elderly patients, which leads to a missed opportunity for routine screenings (Smith et al., 2020).

           The literature shows elderly individuals engaging in risky sexual practices. Though this is accompanied by lower utilization of protective practices compared to younger individuals, this leads to an emerging trend in STIs among elderly individuals. The literature calls for the inclusion of STI education in facilities for elderly care and for establishing screening programs on a routine basis to promote early diagnosis and treatment.

Effects of the Care the Elderly Client Receives in Different Care Settings or Organizations

            The increase in STIs among elderly citizens has significant implications for care provision in different care facilities. In hospitals and inpatient care, elderly patients admitted for other purposes may have undiagnosed STIs, which may make it difficult for doctors to develop a suitable treatment plan. Many elderly patients have underlying medical conditions such as diabetes or heart disease, which can interact with untreated STIs and lead to severe complications.

             Routine STI screening among elderly in-hospital patients can lead to timely diagnosis and prevention of infection-related complications. However, the risk of STI transmission is underappreciated (Crowley et al., 2021b). Many residents continue being active in sexual relations, yet these facilities traditionally have little in place regarding sexual education programs, STI prevention, and policy. Infections can spread in shared living environments in the absence of screening and education, which poses a risk of severe complications among frail residents.

            The provision of education programs, condom provision, and STI screening policies in care facilities can address this emerging issue. Primary care and clinic facilities also play a significant role in preventing and managing STIs among elderly clients.

Local, State, and National Resources

            Several sources on local, state, and national platforms promote effective and safe care of STIs in elderly citizens. At a community level, elderly wellness programs and community clinics provide STI screenings, sexual wellness education, and counseling for elderly citizens for minimal or no cost. Many clinics in a community provide confidential screening, which enables elderly clients to receive care freely, knowing there is no possibility of public stigmatization.

           At a public health agency level, public health agencies contribute to preventing STIs through public education and screening programs. Medicaid in various states covers STI screening and treatment for elderly citizens, reducing cost barriers to care (Crowley et al., 2021a). Some states have instituted concentrated outreach programs for seniors to educate seniors about STIs and encourage screenings.

          On a national platform, entities such as the Centers for Disease Control and Prevention (CDC) issue guidance on STIs in prevention, screening, and treatment in elderly citizens. The National Institute on Aging (NIA) supplies materials for sexual wellness education to elderly citizens to dispel myths and prevent risky behaviours.

Contributing Factors

            Low levels of awareness and misconceptions about the risk of STIs are among the primary reasons for an increase in STIs in elderly individuals. Older people have a misconception of being immune due to reaching an age past which a person can give birth. The widespread usage of medications for erectile dysfunction, which is a rising trend, leads to more sexual activity among older men with a time lag in the prevention of STIs (National Academies of Sciences et al., 2021). Social stigmatization and a lack of discussion of sexual health with medical practitioners lead to untreated and undiagnosed infections.

Patient Education and Medication Adherence

            Patient education is another critical issue. A good number of older adults lack adequate knowledge of the signs and symptoms of STIs, how STIs are transmitted, and when they ought to be screened. Most caregivers do not address the sexual health care needs of the elderly because they assume that the elderly are hardly sexually active. Therefore, there is a great need for educational interventions for older adults to ensure they overcome the myths and embrace strategies that include using condoms, practicing regular STI testing, and discussing with healthcare workers (Garcia & Wray, 2024).

          Another factor that hinders adequate management of STIs is medication compliance among the elderly population. Many elderly patients have co-morbid diseases for which different drugs have been prescribed, which leads to polypharmacy, which can interfere with medications for treating STIs. Similarly, the perceived poor health of some patients increases the incidences of missed doses or improper use of the required medications due to cognitive impairment among the elderly (Comerford, 2021).

        Physical disabilities in walking and accessing medical facilities may be another reason for non-compliance. Solutions for these barriers entail support for managing medications, caregivers, and organized follow-up care for drug regimes.

Conclusion

            The occurrence of sexually transmitted diseases among elderly populations reflects a pervasive, though underrecognized, public health issue fueled by escalating infection due to increased sexual activity, unawareness, and a lack of prevention practices. The literature calls for routine STI screening, improved patient education, and demarginalization of sexual discussions among seniors. Awareness of this as a nurse will change my practice by discussing sexual well-being openly among elderly patients, advocating for STI screening in standard care for seniors, and providing prevention and treatment-specific education.

            At an organizational level, there should be standard practices for STI screening among seniors, physician education in effective communication of sexual well-being, and integration of sexual well-being in wellness programs among seniors. Healthcare organizations can reduce STI occurrence through these gaps, increase early diagnosis, and improve elderly patient outcomes.

References

Bansal, A., Relhan, V., Hegde, P., & Sahoo, B. (2021). Sexually transmitted infections in the elderly: A 6-year retrospective study in a tertiary care hospital in New Delhi. Indian Journal of Sexually Transmitted Diseases and AIDS, 42(2), 144. https://doi.org/10.4103/ijstd.ijstd_60_20

Crowley, J. S., Geller, A. B., & Vermund, S. H. (2021a). Preparing for the Future of the STI Response. In www.ncbi.nlm.nih.gov. National Academies Press (US). https://www.ncbi.nlm.nih.gov/books/NBK573150/

Crowley, J. S., Geller, A. B., & Vermund, S. H. (2021b). Supporting and Expanding the Future STI Workforce. In www.ncbi.nlm.nih.gov. National Academies Press (US). https://www.ncbi.nlm.nih.gov/books/NBK573165/

Garcia, M. R., & Wray, A. A. (2024). Sexually Transmitted Infections. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK560808/

Comerford, K. C. (Ed.). (2021). Visual Nursing: A Guide to Diseases, Skills, and Treatments (2nd ed.). Lippincott Williams & Wilkins.

Liang, X., Deng, Y., Xu, H., Peng, Z., Chen, P., Chen, Q., Xian, J., Chen, Q., & Yang, B. (2024). The trend analysis of HIV and other sexually transmitted infections among the elderly aged 50 to 69 years from 1990 to 2030. Journal of Global Health, 14. https://doi.org/10.7189/jogh.14.04105

National Academies of Sciences, E., Division, H. and M., Practice, B. on P. H. and P. H., States, C. on P. and C. of S. T. I. in the U., Crowley, J. S., Geller, A. B., & Vermund, S. H. (2021). Priority Populations. In www.ncbi.nlm.nih.gov. National Academies Press (US). https://www.ncbi.nlm.nih.gov/books/NBK573156/

Smith, M. L., Bergeron, C. D., Goltz, H. H., Coffey, T., & Boolani, A. (2020). Sexually Transmitted Infection Knowledge among Older Adults: Psychometrics and Test-Retest Reliability. International Journal of Environmental Research and Public Health, 17(7), 2462. https://doi.org/10.3390/ijerph17072462

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STI § Sexually transmitted infections in the elderly population. Include statistics, incidents, contributing factors, patient education needs, and treatment adherence issues.