STD Rates Escalate for British Boomers in Middle Age

By John Gever
BIRMINGHAM, England, 1 july 2008-- When it comes to sexually transmitted disease, aging baby boomers here appear to think erroneously that they are well past the hazards of their youth. For example, the combined rate of chlamydia, genital herpes, genital warts, gonorrhea, and syphilis among patients 55 to 59 years old increased by a factor of 3.18 (95% CI 2.15 to 4.70) from 1996 to 2003, reported Babatunde Olowokure, M.B.B.S., Ph.D., of the United Kingdom Health Protection Agency, and colleagues online in Sexually Transmitted Infections. There were smaller but still significant increases in STD infections during this period, as expressed in rate ratios, among all other age groups older than 45:
44 to 49: 2.12 (95% CI 1.77 to 2.53)
50 to 54: 2.54 (95% CI 1.96 to 3.27)
60 and over: 1.76 (95% CI 1.24 to 2.50)
The findings came from clinic records in England's West Midlands region. During the study period, the clinics treated 4,445 STD cases among people 45 and older.
Similar increases in non-HIV STD rates have previously been reported for older Americans.
For example, from 1996 to 2006, rates of chlamydia among men ages 45 to 64 tripled, according to CDC statistics. They doubled among women in this age group over the same period.
Dr. Olowokure and colleagues blamed the STD increases in their older clinic population on a variety of factors.
Foremost among them is what the researchers called the "almost universal omission [of older people] from national prevention programs," as well as physiological changes that increase their susceptibility to infection.
But Dr. Olowokure and colleagues also cited several behavioral and cultural changes that may increase the baby boomer generation's exposure to STDs.
They include:
An attitude that condoms are primarily for contraception, not preventing STDs.
Increasing frequency of unprotected sex while traveling abroad.
The rise of the Internet and its use in facilitating sexual encounters.
Increasing availability of erectile dysfunction drugs.
More frequent sex between people of different age groups.
In an interview, Dr. Olowokure said the findings may well be a late effect of the "sexual revolution" of the 1960s and 1970s.
"This particular age group grew up at a time when attitudes toward sex and sexual relationships were a lot more liberal [than previously], and it may be that those attitudes have carried across and are now being manifested in terms of a higher number of people presenting with sexually transmitted infections," he said.
More prosaically, it's also possible that older people in the West Midlands have become more proactive in seeking treatment for STDs, Dr. Olowokure said.
The researchers found significant upward trends in rates for each specific STD they analyzed. The increases ranged from a factor of 1.59 (95% CI 1.33 to 1.90) for genital warts to 6.61 for gonorrhea (95% CI 4.26 to 10.25).
In absolute terms, the gonorrhea incidence for men 45 and older was 14 per 100,000 in 2003, compared with about 2 per 100,000 in 1996, the researchers reported.
Rates for men were generally much higher than for women, they said.
Dr. Olowokure cautioned that in some respects, the West Midlands middle-aged population is not representative of boomers elsewhere, and hence the results may not be fully generalizable.
Other limitations of the study included reliance on attendees at clinics which may underestimate the infection rate in older individuals, newer diagnostic tests over the study period, and lack of data on the overall number of people seeking care in these clinics, which means there was no accurate denominator.
Chlamydia in their study was always more common in men than in women during the study period. By contrast, CDC statistics in the United States show that chlamydia in the 45-to-64 demographic was formerly more common in women than men, although it is now more common in men in this age group.
Dr. Olowokure said STD prevention programs need to begin targeting older people. The basic messages should be the same as are now directed to the young, but delivered through different media.
He added that health professionals need education on talking to their older patients about risks of STDs.
No external funding was disclosed. The authors reported no potential conflicts of interest.
Primary source: Sexually Transmitted InfectionsSource reference:Bodley-Tickell A, et al "Trends in sexually transmitted infections (other than HIV) in older people: analysis of data from an enhanced surveillance system" Sexually Transmitted Infections 2008; DOI: 10.1136/sti.2007.027847.