Sexually Transmitted Diseases in the Elderly: What You Need to Know BY SUSAN LETVAK and DIANNE SCHODER Letvak, S., & Schoder, D. (1996). Sexually transmitted diseases in the elderly: What you need to know: The young aren't the only ones at risk for STDs. Geriatric Nursing, 17(4), 156160. doi:10.1016/S0197-4572(96)80063-2 Made available courtesy of Elsevier: http://www.elsevier.com/wps/find/journaldescription.cws_home/623088/description#description ***Note: Figures may be missing from this format of the document

Sam, a 65 year old, had recently been admitted to a nursing home. When several lesions appeared on his penis and inner thighs several months after admission, the nursing staff diagnosed the condition as an irritative rash caused by incontinence and the use of incontinence pads. The nurses treated the lesions with a protective skin barrier, but there was no improvement. Only after reviewing medical records and consulting with the physician did they realize the truth: Sam had contracted genital herpes almost 20 years earlier and still suffered outbreaks. In this case proper treatment, infection control, and staff education were delayed because the nursing staff failed to quickly recognize a common sexually transmitted disease (STD). Most nurses would not be surprised to find themselves caring for a 24-year-old man with genital herpes, syphilis, or AIDS. How many, however, are prepared to recognize and provide counseling and care to an 80 year old with an STD? Would you even consider the possibility of an STD in an elderly patient? Many nurses might be surprised by the existence of STDs in elderly persons, but the incidence of STDs in this population is significant in terms of newly acquired diseases and residual complications from prior infections.1 Ageist attitudes cause many people—health care personnel not excepted—to assume that elderly persons are not sexually active or at risk for an STD. Sexual histories on older adults are often incomplete or completely lacking.² Failure to address the possibility of an STD in any patient could lead to lack of treatment and further transmission of the disease. Additionally, counseling on the prevention of STDs is imperative for all sexually active adults, of whatever age. Sexuality and the Elderly Human beings are sexual beings throughout their lives. In good health, a person may continue to be sexually active into the seventh, eighth, and even ninth decade.2 Some degree of sexual appetite is usually present throughout life.3 Although studies on sexuality in older adults are limited, one national sample reported that the average frequency of sexual activity in older adults is two to four times a month.4 Bretschneider and McCoys studied a group of healthy men over 80 years of age. Of this group, 29% were

having intercourse at least weekly, while 38% were not having sex at all. Enjoyment of sexual intercourse was characterized as moderate or great by a full 63% of the respondents.5 Older adults are also not necessarily monogamous. The national probability sample mentioned above found that between 2.5% and 3% of older Americans had two or more sexual partners in the previous year.4 Society has been slow to recognize the sexual needs and realities of its elderly population, and most adults-

again, including health professionals—have been socialized to not talk about sex. Identifying and intervening in sex-related problems, including diseases, is important for the nurse who cares for patients in this population. Sexually Transmitted Diseases STDs are infectious diseases acquired through sexual activity with an infected person. Some STDs, such as hepatitis B and HIV viruses, may also be transmitted by means of blood. Most people, although familiar with syphilis and gonorrhea, do not know that more than 30 etiologic agents that cause STDs may be transmitted by sexual and nonsexual means.1 When one deals with a sexually inactive elderly patient, one should remember that an STD