She's 54 years old. She's spent most of her adult life in a long-term monogamous relationship. She's just been diagnosed with genital herpes.
This happens more often than you might think.
Even I -- who should know better! -- have been guilty of age bias when it comes to testing for sexually transmitted infections (STIs, also called STDs, for sexually transmitted diseases).
In my former practice, when a 20-year-old came in presenting with symptoms (discharge, discomfort, irritation) that might indicate an STI, I would automatically screen her. When a 50- or 60-year-old came to me with the same symptoms, I was more likely to ask before I tested: "Is this a possibility?" If she said "no," I tended to trust that. I was trusting my patients. They were trusting their partners.
Times have changed.
Over the past decade, STI rates among people 45 and older more than doubled. In April, the Centers for Disease Control and Prevention reported that senior citizens accounted for 24 percent of total AIDS cases, up from 17 percent in 2001.
Researchers point to climbing divorce rates at mid-life, the rise of online dating services, the increasing number of men availing themselves of treatment for erectile disfunction. And all of these are contributing factors, I'm sure. But in my experience, the most likely cause of the up-tick in STIs among women past their child-bearing years is lack of awareness and prevention.
If you know that pregnancy is not a possibility, why use a condom?
Unfortunately, the risk of contracting STIs -- including syphilis, gonorrhea, genital herpes, HPV, hepatitis B, and HIV -- does not end at menopause. In fact, sexually active postmenopausal women may be more vulnerable than younger women; the thinning, more delicate genital tissue that comes with age is also more prone to small cuts or tears that provide pathways for infection.
And -- it's not fair, but there it is -- with almost every STI, exposed men are less likely to experience symptoms, simply because they don't have the equivalent of a cervix and a vagina and the skin of a vulva. The kind, older gentleman who gave my 54-year-old patient genital herpes might honestly not have known he was infected.
These days, when a 50-or-60-ish woman shows up in my office with symptoms that point to a possible STI, I go ahead and screen. I'll say, "I understand this is not a likely outcome, but I want to make sure I'm checking all possibilities."
Worry about STI can be a real drag on sexual enjoyment. We'll talk about what you can do to insure that contracting an STI is not a possibility for you in my next post: "When Was the Last Time You Used a Condom?"