Never too old for sex… and STIs
SINGAPORE — It is hardly a topic of dinner-table conversations but as more adults remain sexually active in their later years, so does their risk of acquiring sexually transmitted infections (STIs).
SINGAPORE — It is hardly a topic of dinner-table conversations but as more adults remain sexually active in their later years, so does their risk of acquiring sexually transmitted infections (STIs).
Although the incidence of STIs among those aged 50 and above has remained largely stable in recent years, doctors say social norms and lifestyles have evolved and sex education should be targeted at the older age groups.
For one, social media and online dating platforms have helped to link people here with those overseas that they might not otherwise meet.
More Singaporeans are working longer, and some travel frequently for work and maintain the same level of social interactions as the younger generation.
Then, there are those who engage in paid sex without taking sufficient precautions. Such was the case with a 73-year-old retired businessman, who agreed to an email interview on condition of anonymity.
After visits to commercial sex workers, he was diagnosed with primary syphilis last year after noticing a painless ulcer on his penis.
“It is very common for men to look for this kind of ‘entertainment’, especially at massage parlors or KTV clubs. None of my doctors had mentioned anything about these possible (STI) risks so it was all new to me,” he told TODAY.
RISING TREND FOR SOME DISEASES?
Compared to older populations in the West, general awareness of STIs is lower among Asians, said Dr Jonathan Ti, centre manager of Dr Tan and Partners (Robertson Walk Clinic).
Adults aged 50 and above make up about 5 to 10 per cent of newly diagnosed STI cases at the clinic, which sees six to eight patients aged above 70 each year.
Most of the patients are men and “a handful” are older women, said Dr Ti. Like the younger groups, the STIs commonly seen in older patients are chlamydia, gonorrhoea, herpes and, less frequently, syphilis, he said.
The above-50 age group accounts for 10 to 20 per cent of all recent STI cases at infectious disease physician Leong Hoe Nam’s practice. One of his oldest patients was in his 70s and had a penile sore.
The cases exclude latent syphilis, which can occur when the disease is not treated in the early stages and progresses to the hidden stage without symptoms. It is not uncommon for latent and tertiary (third) stage syphilis to take 20 to 30 years to present, said Dr Leong of Rophi Clinic at Mount Elizabeth Novena Specialist Centre.
The incidence of STIs in persons aged 50 and above has remained stable over the past few years, said the Department of Sexually Transmitted Infections Control Clinic (DSC Clinic), a specialist outpatient STI facility funded by the Ministry of Health.
In 2016, the incidence of STIs in persons aged 50 to 59 was 107.2 per 100,000 population. For those above 60, it was 53.7 per 100,000 population. The highest incidence rate was among young adults 20 to 29 years of age.
Comparable statistics over a longer period of time are not available, but a study published in 2013 noted a general rising trend of certain STIs such as the Human Immunodeficiency Virus (HIV), the Acquired Immunodeficiency Syndrome (Aids) and genital herpes among the older population.
The study, published in the Ministry of Health’s epidemiological news bulletin, looked at adults aged 50 and above between 1996 and 2011. It found that they accounted for about a quarter (25.5 per cent) of the newly diagnosed HIV/Aids cases – or 1,245 people – during that period.
In 2016, those 50 and above made up 27.4 per cent of 408 notified HIV/Aids cases in Singapore, according to ministry’s Communicable Disease Surveillance 2016 report.
Dr Leong believes there may be more undiagnosed and unreported cases among older adults, as they may resort to “unusual means” of treatment – seeking traditional medicine healers or overseas treatment, for instance.
Some people may be unaware of their infection. For instance, one in three men and two in three women are asymptomatic for urethritis, he said. Urethritis is the inflammation of the urethra caused by an infection.
“(Some doctors) may opt for ‘blanket treatment’ for all STDs, which would involve an injection plus some oral pills, without specifically diagnosing the actual condition, given that treatment is relatively harmless,” said Dr Leong. For example, polymerase chain reaction testing for chlamydia may be more costly than treatment.
SOCIAL MEDIA, CHANGING NORMS
The doctors said they have encountered patients who contracted STIs through people they met on social media and dating platforms.
With more acceptance here of LGBT (lesbian, gay, bisexual and transgender) relationships, they have also seen STI cases from this group.
Dr Leong has seen at least four cases of “sugar daddy” older men who passed sexually transmitted diseases (STDs) including HIV to younger men they got to know online.
Sex education should be targeted at both young adults and the older generation, said Dr Ti. Doctors and other medical professionals should help to educate their patients on such issues.
“For instance, they could include some general screening questions during their patients’ annual health checks that can identify STD symptoms or potentially risky exposure. Many patients I’ve seen and treated have told me they felt unfairly judged or even criticised by their doctors when it comes to matters of sexual health, which then becomes a missed opportunity for patient education,” said Dr Ti.
The 73-year-old retiree, who is undergoing treatment at Dr Ti’s clinic, said his experience with STI has made him “a lot more careful”. He has not told his wife, with whom he has not had sex in years, about his condition.
Although his ulcer has healed, he is currently on his second course of antibiotics as tests showed that the infection did not fully clear with the initial treatment.
“I wish I had more knowledge about the risk of infections before this happened. (Treatment) is not a difficult or uncomfortable process but I do have concerns as I know that syphilis can lead to long-term complications,” he said.
HOW TO REDUCE RISK
The Department of Sexually Transmitted Infections Control Clinic (DSC Clinic) advises the following practices to reduce the risk of STIs.
- Remain faithful to one’s spouse/ partner and avoid casual sex
- Individuals engaging in high-risk sexual behaviour, such as having multiple partners or engaging in casual or commercial sex, are strongly advised to use condoms to reduce their risk of STIs. Condoms should be used consistently and correctly during every sexual encounter
- Individuals who engage in high-risk sexual behaviours are urged to go for regular STI screening for early diagnosis and treatment (consult a doctor on the types and frequency of screening)
- Individuals with symptoms of STI should seek medical help early to avoid disease complications and to reduce disease spread
- Individuals who are diagnosed or being treated for STI should avoid sex until the infection is cured and rendered non-infectious