Sexually transmitted diseases in the elderly. Review of 28 cases

ARTICLE

Sir,

People over the age of 65 represent an increasingly large proportion of the population. In fact, ageing brings about some decrease in sexual arousal and activity [1] related to physical illness or medication needed to control a health condition [2]. Nevertheless, it is encouraging to find out that many elderly continue to be sexually active until their sixties, seventies and even eighties [3]. Information concerning the incidence of sexually transmitted infections in old people is sparse. Six retrospective studies have been published before [4-9]. They confirmed that the incidence of sexually transmitted diseases in patients over 65 years was significant for both newly acquired disease and for residual complications. Beyond that, there are sporadic case reports of HIV infection in older persons [10, 11], emphasising the persistence of risk behaviour in this population.

We carried out a retrospective study of patients aged over 65, who attended our hospital unit for sexually transmitted diseases, between September 1991 and January 1999. Out of the 28 patients, 21 (75%) were males and 7 (25%) were females, aged between 65 and 87 (an average of 70.1 years). Fourteen patients (50%) were married, 8 (28.6%) widowed, 5 (17.9%) single, and 1 (3.5%) divorced. As far as their sexual activity is concerned, we could define three groups. A first group with 5 (17.9%) patients, 1 male and 4 females, who denied any sexual contact in the previous 6 months; a second group including 13 (46.4%) patients, 10 males and 3 females who had one sexual partner; a third group with 10 (35.7%) males who have had two to six partners. All males who had more than one partner admitted contact with prostitutes and of these, 8 had never used a condom and 2 used it only occasionally. All the 28 recorded patients declared themselves to be heterosexual. The diagnosis found in these 28 patients were late latent syphilis in 15 of them (53.6%), genital warts in 6 (21.4%), primary syphilis in 3 (10.7%), candida balanitis in another 3 (10.7%), gonococcal urethritis, secondary syphilis and herpes genitalis, 2 cases each (7.1%), chancroid and hepatitis B one patient each (3.5%).

Total patient new attendance at our sexually transmitted diseases unit, during the study period, averages 200 per year. As we expected, elderly patients represent a small proportion (1.4%) of our workload. However, we have been able to confirm that the elderly retain, indeed, sexual interest and activity. We have also ascertained that risk behaviour still exists among the elderly population. We conclude that dermatovenereologists need to be further aware of sexual activity in the elderly. They should always perform a complete sexual history and counsel patients regarding high-risk sexual practices.

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