STIs in Older Adults:
Where Does Your State Rank?

National STI Trends Among Older Americans

According to the latest data from the Centers for Disease Control (CDC), chlamydia, gonorrhea, and syphilis rates increased over five years among Americans aged 55 and older. In fact, compared to younger Americans, chlamydia rates increased fastest among people 55 or older!

Syphilis rates also increased by 54 percent among the oldest Americans. This is part of a larger nationwide trend: syphilis cases are actually higher today than they were in the 1950s, which is alarming to public health officials.

There are several possible reasons why STIs are increasing among older adults today. First, health providers may not talk to older patients about STI prevention or screening. They may believe that they only need to address STIs with younger patients, but according to a poll sponsored by AARP, 40 percent of adults aged 65-80 are sexually active.

Similarly, older adults may be less likely than younger populations to talk with their doctors about sex. The National Poll on Healthy Aging found that only 17 percent of sexually active seniors spoke with their providers about their sexual health in the two years before the survey. Of those who did, patients were more likely than doctors to initiate conversations. To reduce STI transmissions, doctors must talk with adults of all ages about risk factors and prevention methods.

Another reason that STI rates may be on the rise among older adults is the availability of treatment options for age-related sexual health problems like erectile dysfunction (ED). After Viagra hit the market in 1998, rates of STIs increased significantly, particularly among widowed men.

Finally, older adults may simply not be aware of their risk for STIs, having either forgotten or never received the necessary information about how to practice safe sex. Sexual education might not have included STI prevention when older adults were in high school, and they may not have received formal sex education at all. In a 2020 study, adults aged 65+ scored low on assessments of STI-related knowledge, and previous research has shown lower rates of condom use among adults over the age of 50. Since older adults are less likely to need to prevent conception, they may be less likely to use condoms, which can reduce the risk of STI transmission.

States with the Highest STI Rates Among Seniors

The CDC data reveals some interesting regional differences in the rates of STI infection and transmission among older Americans. Seniors in Washington, D.C. had the highest per-capita rates of all three STIs in our analysis—syphilis, gonorrhea, and chlamydia. Nevada, Alaska, and Louisiana were also among the states with the highest infection rates among older adults. Similarly, D.C., Hawaii, North Dakota, and New Jersey showed some of the greatest increases in STIs between 2018 and 2022.

Why are some states experiencing higher rates of STIs, especially among older adults? There are several possibilities. First, Covid-19 did not affect all states equally. Some suffered higher infection and hospitalization rates. These states could have experienced more significant healthcare service interruptions, affecting residents’ access to STI testing and treatment.

Many states have also suffered from a withdrawal of funding for STI prevention, limiting their ability to fight the rise of infections. Unfortunately, this problem is not likely to be resolved soon due to recent budget cuts under the national debt ceiling deal.

Syphilis: States With Highest Rates Among Adults 55+

Syphilis is an infection caused by the Treponema pallidum bacterium. Since 2018, the rate of syphilis among adults aged 55+ has increased dramatically. This infection spreads through direct contact with syphilitic sores called chancres, which occur around the genitals, anus, lips, and mouth. The sores are painless and often difficult to detect, contributing to the infection's spread. People with syphilis can also spread the disease to their unborn babies during pregnancy.

Washington, D.C., and Nevada are among the states with the highest rates of syphilis infection among adults 55 and older. D.C. officials point to staffing shortages caused by the COVID-19 pandemic. According to a recent report on STI rates in the district, the COVID-19 pandemic had a dramatic impact on the availability of disease screening and prevention. Similarly, Nevada officials attributed the recent uptick in infections to a decline in sex education and other preventative measures following budget cuts.

If you contract syphilis, it’s crucial to get treated quickly with antibiotics. Without treatment, syphilis can progress to a secondary stage, characterized by a rash and moist, warty patches on the genitals or underarms. The infected person may also experience fever, swollen lymph nodes, sore throat, headache, body aches, and fatigue. Untreated syphilis can affect multiple organ systems, including the brain, nerves, and eyes, such as in the case of organized crime leader Al Capone. In some cases, it can even be fatal.

Even if someone does not appear to be experiencing any symptoms, they can still transmit syphilis. Men who have sex with other men and people with multiple sexual partners are most at risk, but anyone who is sexually active, regardless of age, can be infected. You should get tested for syphilis if you have a new sexual partner, multiple partners in a short time period, or a partner who has had multiple partners.

Gonorrhea: States With Highest Rates Among Adults 55+

Gonorrhea is caused by bacteria that infect the mucous membranes in the vagina, urethra, rectum, or throat. It is spread through vaginal, anal, or oral sex.

Many people with gonorrhea have no symptoms. The most common symptoms are painful urination and abnormal discharge from the penis or vagina. Depending on where the infection takes hold, people with gonorrhea may also experience sore throat or anal itching, soreness, or bleeding.

Alaska was among the states with the highest rates of gonorrhea in older people. Alaska state officials cited limited testing and treatment options as primary contributors to elevated infection rates. In Georgia, where there was a 92 percent increase in gonorrhea infection rates among older adults, lawmakers have recently called for greater access to information and STI prevention methods.

Gonorrhea can lead to pelvic inflammatory disease (PID) in women or epididymitis in men if it is not promptly treated with antibiotics. In rare cases, untreated gonorrhea can spread to the blood and cause a life-threatening condition called disseminated gonococcal infection (DGI).

Chlamydia: States With Highest Rates Among Adults 55+

Chlamydia is an infection of the Chlamydia trachomatis bacteria. The infection is spread via vaginal, oral, or anal sex. Chlamydia is often called “the silent infection,” as it frequently causes no noticeable symptoms. In fact, among those diagnosed with chlamydia, only 10 percent of men and up to 30 percent of women are symptomatic. This makes the disease harder to prevent.

Left untreated, chlamydia can lead to pelvic inflammatory disease (PID) in women. In rare cases, this can progress to Fitz-Hugh-Curtis Syndrome and cause inflammation of the liver. Men are less likely to experience complications related to chlamydia but can develop infertility if they don’t receive treatment with antibiotics.

How to Practice Safe Sex as an Older Adult

Sexual activity is correlated with greater life satisfaction in older adults, but safe sex requires some planning and conversation before the big event. STIs like syphilis, gonorrhea, and chlamydia can be scary to consider, but there are several steps you can take to stay safe and enjoy sex. Here are a few quick tips for preventing STIs and improving your sexual health:

1. Talk to your partners about their sex lives: Before engaging in any type of sexual contact with a partner, find out if they’ve recently had an STI test and what the results were. Even if you or your partner haven’t had a new sex partner in years, testing can rule out asymptomatic infections. Also, talk to new partners about whether they’ve ever injected illegal drugs. Infections and viruses like HIV can be spread through needles.
2. Talk to your doctor: Your healthcare provider can be a great resource for sexual education and health tips, and they can assess whether you are healthy enough for sexual activity. Your doctor can advise you about issues like erectile dysfunction or vaginal dryness, which become more common as people age. Though it can be uncomfortable, talking about these issues with a doctor is important since they can also be signs of more serious conditions.
3. Get tested for STIs: Before having sex (including oral sex) with a new partner, it’s important for both people to get tested to minimize risk. Sometimes, STIs could be present and transmitted even if there are no symptoms. You can find a testing location near you through the CDC website, and you can learn more about how Medicare covers STI screenings at Medicare.gov.
4. Use condoms and lubricant during sexual activity: Unless you’re in a monogamous relationship with a person who’s been recently tested for STIs, you should always use a condom during sex. Use lubricant to prevent small cuts or tears in the skin, which can increase the risk of infection transmission.

Our Data

We accessed historical data from the Centers for Disease Control and Prevention’s NCHHSTP AtlasPlus database. Analysissincluded chlamydia, gonorrhea, and syphilis. Figures for syphilis are the aggregate of primary and secondary syphilis, early non-primary and non-secondary syphilis, and unknown duration or late syphilis, but do not include congenital syphilis. Demographic and geographic attributes within the data were compared across years to determine trends. To determine infection rates, we divided the number of cases among adults 55 and older by the population of adults 55 and older based on figures from the U.S. Census (and multiplied by 100,000).