UCLA

Background: With the aging of the Baby Boomer population, sexually transmitted diseases (STD) are becoming an important issue among older people. Better physical health at older ages and changing psychosocial norms have led to sexual activity later in life. Despite engaging in high-risk sexual behavior, testing and treatment is still infrequent. With the paucity of information on STDs in older people, this study was undertaken to examine the risk in this demographic, challenge existing assumptions on the topic, inform surveillance and prevention strategies, and provide a basis for future research in the area.

Methods: Routine surveillance data that captures all cases of syphilis, gonorrhea, and chlamydia reported to the Los Angeles County Department of Public Health between January 1, 2000 and December 31, 2011 was utilized for analyses. The rate per 100,000 of STDs over time among older people (50 and over) was examined and compared to younger populations. Predictors of repeat infection were assessed to identify the high-risk groups among older people. Appropriate treatment documentation among older people was investigated to ascertain areas of need in STD case follow-up and treatment.

Results: During the study period, rates of early syphilis, gonorrhea, and chlamydia significantly increased for older people and at a rate similar to younger populations. Older men who have sex with men (MSM) and who have sex with both men and women (MSM/W) as well as those co-infected with other STDs were at highest risk for repeat infections. Documented, appropriate treatment of older gonorrhea and chlamydia cases increased over the study period but remained lower compared to younger populations. Neurosyphilis was significantly associated with older age and delayed treatment.

Conclusions: There is a need to improve STD screening among older people by educating both providers and the demographic of interest. Programmatic improvements such as quality improvement and implementation of electronic reporting mechanisms are necessary to ensure better treatment information of older cases, who tend to be low priority for health department investigations. Future studies on high-risk behaviors of older people and providers’ knowledge and attitudes are necessary to inform additional STD prevention strategies for this demographic.