Is it an STI — or Something Else?

Sexually transmitted infections are on the rise in older adults, and their symptoms can sometimes mimic other ailments

Kimberly Goad,

AARP

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Published November 25, 2024

illustration of a person in a medical waiting room with a question mark shadow

Rob Dobi

Shannon Dowler, a family physician who specializes in treating people with sexually transmitted infections (STIs), began noticing a change in her practice back in 2017. “The average age of my patients was suddenly very different,” says Dowler, M.D., who is based in North Carolina and is the author of Never Too Late: Your Guide to Safer Sex After 60.

The people seeking treatment for everything from HPV (short for human papillomavirus) to syphilis and gonorrhea weren’t teenagers and twentysomethings — the age group most commonly associated with STIs, also known as sexually transmitted diseases. They were decades older.

For instance, recalls Dowler: There was the 68-year-old woman who thought the painful burn she experienced when urinating was a urinary tract infection (UTI); it was herpes. And the 72-year-old man who returned from a cruise complaining of a rash only to discover that it wasn’t the result of too much time in the ship’s hot tub, as he suspected, but secondary syphilis.

8 Most Common STIs

Chlamydia
Gonorrhea
Hepatitis B virus (HBV)
Herpes simplex virus type 2 (HSV-2)
Human immunodeficiency virus (HIV)
Human papillomavirus (HPV)
Syphilis
Trichomoniasis

According to the CDC, chlamydia, trichomoniasis, genital herpes and HPV accounted for 98 percent of all diagnosed STIs and 93 percent of all new STIs in 2018.

Source: U.S. Centers for Disease Control and Prevention (CDC)

“The children of the sexual revolution are retiring at rapid rates, and they continue to teach us about sexual health,” Dowler says. “There is strong and clear evidence of rising rates of STIs in seniors. In fact, the older demographic has the most rapidly rising rates of any age group.”

According to the Centers for Disease Control and Prevention (CDC), cases of syphilis, gonorrhea and chlamydia more than doubled among people 55 and older between 2012 and 2022. During the pandemic alone, STD diagnoses overall rose roughly 5 percent, suggests a recent analysis of health insurance claims. The biggest increase (about 24 percent) was among people 65 and older; the second biggest spike (an estimated 16 percent) was seen in patients 55 to 64.

A more recent CDC report published this month finds that while the number of STI cases remains high in the U.S., the overall epidemic may be slowing. However, cases of both chlamydia and gonorrhea continued to climb among adults 65-plus between 2022 and 2023.

Why the uptick in older adults?

STIs are preventable and treatable, but research suggests many older people are unaware of their risk, and that’s keeping them from getting screened and practicing safer sex.

“Older adults may underestimate their risk for STIs because they have limited knowledge about the transmission of STIs, their signs and symptoms, and how to prevent them,” says Matthew Lee Smith, a professor at the Texas A&M University School of Public Health and a core faculty member of the Center for Community Health and Aging. “This may stem from a lack of formal sex education during primary and secondary school and limited opportunities to learn and talk about sexual health. Underestimating risk, combined with the limited risk for pregnancy, may prevent them from using condoms to prevent STIs.”

Signs and symptoms of an STI

Sores and/or itching around the genital area, vaginal or penile discharge and painful sex can all be signs of an STI. But there are other symptoms that are more subtle or mimic other conditions, making it easy to miss, ignore, or minimize an STI altogether.

“Because a person’s body is fighting a bacteria or virus, other symptoms of an STI may include flu-like symptoms— fever, chills, and body aches — diarrhea, frequent urination or skin rashes,” Smith says. And since these are hardly telltale indicators of an infection that’s been passed along through sex, many people ignore these symptoms or assume they are caused by something else, Smith explains.

What’s more, a large proportion of STI infections can be asymptomatic, meaning they occur without signs or symptoms, Smith points out. “This means the person may not know they have an STI and continue engaging in sexual activity that can transmit the STI to others,” he says.

Further complicating matters: STI symptoms can be mistaken for other age-related conditions, including some common symptoms of menopause.

“One of the challenges with older adults is that there are a lot of things that can go wrong ‘down there’ — from common things like UTIs to serious things like cancer,” Dowler says. “It’s part of what makes it so important to have an open dialogue with your provider about your risks and regular screening for STIs.”

That’s especially true since STIs can have serious consequences in older adults. For example, “a new herpes infection can result in hospitalization for meningitis,” Dowler says. “A lot of the head and neck cancers we see now are actually due to an old infection with HPV that has stayed in the body. Waiting out symptoms is never a good idea.”

When to see a doctor

The best time to get tested for an STI is before sex, not after.

“Anyone who is having new partners — or their partner is having new partners — needs regular STI screening,” Dowler says. “It’s critical before engaging in a new relationship to get tested to make sure you aren’t accidentally bringing an infection to the party.”

And don’t wait for your doctor to suggest STI screening or initiate conversation around sex. Research published in 2023 in The Lancet found that only 17 percent of older adults in the U.S. reported talking to their doctors about sexual issues in the past two years; 61 percent of these discussions were initiated by the patient.

Granted, talking about sex with your healthcare provider isn’t one of those things that gets easier with age. But doctors are under so many time constraints now that the topic can get glossed over, Dowler says. “Meanwhile, the doctor assumes that either the patient is not sexually active, not concerned, or not at risk because they didn’t bring it up,” she adds.

The conversation shouldn’t end with your healthcare provider, Smith says. Everybody, no matter the age, “should also ask potential partners if they have an STI, when they were last tested for an STI, and if they consistently use protection with partners,” he says. “While these conversations with healthcare providers and partners may be uncomfortable for all those involved, they are extremely important to identify risk, build trust and protect one another from STIs.”

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Kimberly Goad is a New York-based journalist who has covered health for some of the nation’s top consumer publications. Her work has appeared in Women’s Health, Prevention, Health and Reader's Digest.