Love Safely

Sex is so good for us, on so many levels, that it’s tempting to overlook the risks. Nature designed it this way. This is why our species has survived and multiplied.

We are sexual beings, and can enjoy sex at any age. Although pregnancy is no longer a concern for older adults, sexually transmitted infections remain a risk any time there is sexual contact—even if a condom is used, and even if no intercourse occurs. No one gets a pass from this biological reality, no matter what our age.

Sexually transmitted diseases were once considered rare in older adults, but that is changing. The Centers for Disease Control and Prevention reports significant increases in STDs among adults 65 and over. Between 2010 and 2014, chlamydia infections increased by about 52 percent, syphilis infections rose by about 65 percent, and gonorrhea cases increased by more than 90 percent.

To put this in perspective, in 2014, the CDC reported 2,616 cases of these three infections in adults aged 65 and older. That’s less than 1 percent of the infections reported in adults age 20 to 24 that year. So while STDs are hardly an epidemic in older people, it’s still an alarming trend.

Oral cancers caused by the human papillomavirus are also on the rise for all ages. In fact, the incidence of mouth and throat cancers caused by HPV in men has now surpassed the incidence of HPV-related cervical cancers in women, according to a recent study in the Annals of Internal Medicine. Oral HPV infections are three times more common in men than in women, and, unlike cervical cancers, which can be detected by a Pap smear, there is currently no clinical screen for HPV-related oral and throat cancers.

HPV is by far the most common sexually transmitted infection. Researchers believe that almost every sexually active person has been infected by a strain of the virus at least once. Most infections clear up on their own, but persistent infections can cause genital or oral cancers.

Women now have the option to screen for the presence of HPV in cervical cells during routine cervical cancer screening says HPV researcher Rachel L. Winer, associate professor of epidemiology at the University of Washington. The HPV test, which was expanded into the clinical setting about five years ago, can be used in conjunction with the traditional Pap smear, which detects the presence of pre-cancerous or cancerous cells.

Current guidelines recommend screening for cervical cancer in women ages 21 to 65 years with cytology (a Pap smear) every three years or, for those women who want to lengthen the screening interval, a combination of cytology and HPV testing every five years. The guidelines recommend against screening for cervical cancer in women older than 65 if they have had adequate prior screening and are not otherwise at high risk for cervical cancer.

“Screening with Pap smears and/or HPV testing are very effective for preventing cervical cancers,” stresses Winer. More than half of invasive cervical cancers are diagnosed in patients who are not up to date with Pap screening or have never had a Pap smear, and one-quarter of women who should be screened are not compliant with screening guidelines.

“A positive HPV result can cause a lot of anxiety and concern,” says Winer. “It’s important for women and men to know that if the woman tests positive for HPV, it doesn’t mean that it’s a new infection. It could be a reemergence from a prior infection, perhaps from decades earlier. This is important from a relationship perspective. It doesn’t mean that either partner has been unfaithful.”

Winer notes many possible reasons for the increased incidence of sexually transmitted infections in older adults. Baby boomers initiated the sexual revolution. We have been, and continue to be, more sexually active than our parents’ generation. We are in better health. Divorce and dating are more common. So is Viagra. Scientists have developed more sensitive screening methods. And even within a long-term, monogamous relationship, a virus picked up decades earlier can resurface.

Sex carries risk. That could change in the future with vaccines and other advances—but we already have the capacity to learn the facts, get tested, talk openly with our intimate partner, make love, and be kind. At every age.

Teri Thomson Randall is a journalist, photographer, and filmmaker residing in Seattle. Her writing experience spans the arts and sciences, including staff writing positions at the Journal of the American Medical Association and Pasatiempo, the weekly arts magazine of the Santa Fe New Mexican. She holds graduate degrees in microbiology, science communication, and film production.


HPV vaccine helps protect today’s teens

The development of the human papillomavirus vaccine presents a tremendous opportunity to prevent HPV-related genital and oral cancers in young people. Older adults can play an important role by promoting the vaccine for their children and grandchildren, says Rachel L. Winer of the University of Washington.

The vaccine protects against nine types of HPV, including the seven most carcinogenic types that cause most cervical cancers. It also provides protection against some anal, penile, vaginal, and oral cancers, Winer says. The vaccine is recommended for girls and boys, she adds, so “talk to your grandsons, too!”

The vaccine protects recipients and their partners. But as of last year, only 65 percent of girls and 50 percent of boys in the U.S. had completed the vaccine, which requires two or three doses (depending on age).

The CDC’s Advisory Committee on Immunization Practices currently recommends the HPV vaccine for routine vaccination at age 11 or 12 years. (It can be started at age 9.)

The CDC also recommends vaccination for females ages 13-26 and males ages 13-21 who have not been adequately vaccinated previously. Vaccination is also recommended through age 26 for gay, bisexual, and other men who have sex with men, transgender people, and for immunocompromised persons (including those with HIV infection) not adequately vaccinated previously.

Ideally, adolescents should be vaccinated before they are exposed to HPV. However, people who have already been infected with one or more HPV types can still get protection from other HPV types.

Older adults can also receive some protection from the vaccine, Winer says, even if they were infected with one or more HPV types earlier in life. Insurance does not cover the vaccine in older adults, she notes, but for people who are concerned about exposure to new infections, the vaccine “may still be a reasonable choice.” If you believe you are at risk, it’s worth discussing with your doctor.

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