We are living longer, good psychophysical conditions are maintained over time and active sexual life is also extending compared to the past. However, greater sexual longevity is still a little-discussed topic, it is experienced with the utmost discretion and talking about it creates great embarrassment. This “taboo” at the same time increases i risks for the health, especially regarding the possible transmission of sexual diseases. This is highlighted by the data that emerged from various studies presented during the X National Congress of the Interdisciplinary Society for the study of Sexually Transmitted Diseases (SIMaST), which was recently held in Rome.
The Sexually Transmitted Infections (STI) are increasing in the general population, in Italy as in the rest of the world, and this trend does not only include young people, who also constitute the most relevant component, conditioned by very limited knowledge, by social media, by the abuse of alcohol and substances; among the groups involved there is also the population over 65. Among more mature people, in fact, the level of guard is lowered and sometimes the shame of admitting that one still has a sexual life prevails.
The risks of sex in adulthood
Sex continues to be an integral part of life even in older age, but it remains a taboo topic: both for doctors and for people. You may be ashamed to talk about your sexual activity in front of your partner or your doctor, which can be completely satisfactory thanks to the improvement in the control of the main disorders linked to aging, such as the reduction of desire. And if things go well, the risk of contracting sexual diseases is certainly not the first thing on your mind.
Many years have passed since certain information was learned, including regarding the HIV virus. A certain level of negligence can occur in the protection of sexual health, for example by neglecting the use of a condom, which is a lifesaver when it comes to sexually transmitted diseases, perhaps for fear that it will accentuate any erectile problems already present.
“The healthy aging of the population affects the social and sexual sphere and this implies an increased risk of contracting an STI even for people over 65”, underlines the professor Laura AtzoriDirector of the Dermatology Unit of the University Hospital of Cagliari. «If asking questions about the most intimate sphere always requires great sensitivity, when faced with an elderly person, embarrassment can prevent the doctor from taking proper consideration of the symptoms, which are often attributable to pathologies more characteristic of the elderly, not sexually transmitted. Urinary tract disorders, arthralgia, asthenia and easy fatigue, but also the appearance of skin and mucous membrane manifestations typical of diseases such as syphilis, gonorrhea, HIV can be underestimated and attributed to something else. Modesty involuntarily increases when faced with an elderly person and it becomes difficult to ask them to undress completely to visit the anogenital area in search of warts.”
In fact, 23% of STI cases diagnosed in Italy from 1991 to 2021 involved people over 45 years of age, considering all adults in a single group. In the USA, new HIV cases among people over 50 already represent 17%; in the Netherlands it is estimated that it will reach 73% in 2030. A Norwegian study published in the journal The Lancet healthy longevity described the trend of sexually transmitted infections in people aged 60 to 89 recorded between 1990 and 2019 as sharply increasing in as many as 204 states, with greater susceptibility towards HIV infection than younger people. A recent Chinese study found that 19% of women over the age of 64 tested for papillomaviruses (HPV) were positive for oncogenic genotypes and that of these women, 16% had undiagnosed cervical cancer. «These data show us that the diagnostic pitfalls of STIs in the elderly must not be underestimated, we need guidelines, specific screening campaigns, and training even in old age», specifies Professor Atzori.
Papilloma Virus, the importance of getting vaccinated
Among the risks associated with mature age there is also the high prevalence of Papilloma Virus, a particularly contagious infection, for which even an incomplete intimate relationship may be sufficient. The importance of prevention is evident from the possible consequences: HPV is an oncogenic virus and is associated with 99% of cervical cancers, 90% of anal canal cancers, 75% of vaginal and vulvar cancers , without forgetting that 70% of head and neck cancers and 60% of penile cancers are associated with it. A vaccine has been available since 2008.
«The 2022 data reveal a vaccination coverage of 39% among females and 32% among males for the 2010 age cohort, far from the desired 95%, but useful in limiting the spread of the virus», he explains Barbara SuligoiCOA Director of the ISS and President of the SIMaST Congress. «Recent data from the Istituto Superiore di Sanità , in fact, have revealed a 53% reduction in warts in young people aged 15-24 in 2022 compared to 2019, significantly higher than the 24% which concerns those over 24 years old. ».
Early diagnoses possible thanks to new tests
One of the main problems in the detection of Sexually Transmitted Infections is that they often remain latent for a long time: the chlamydiafor example, in 3 out of 4 cases it is asymptomaticso many girls don’t notice until the consequences become apparent. The importance of imposing therefore emerges screening campaignsquick and easy access to tests, greater awareness. New diagnostic systems and home-made tests can represent important opportunities in this regard.
«Undetected and untreated infections can have serious complications, which especially affect women and newborns», highlights the Professor Manola ComarProfessor of Clinical Microbiology and Director of the specialization school in Microbiology and Virology at the University of Trieste. «In 2016, WHO launched its global strategy to address STIs with better surveillance through more precise diagnostic tests. In recent years, the advent of molecular and mass spectrometry instruments and molecular tests on multiplex platforms has revolutionized the approach: in particular, the latest technological advances have paved the way for the development and improvement of rapid point-of-tests. care (POC) in the area, then to be confirmed in the laboratory. Tools based on antigen and DNA/RNA detection have revolutionized the field, enabling faster and more sensitive diagnosis than traditional microscopy or culture and highlighting the possibility of screening in at-risk groups. Furthermore, the rapid tests recently put on the market, capable of detecting the presence of antimicrobial resistance for STIs, represent an important step forward in the fight against antibiotic resistance.”
Prevention with screening, the case of Chlamydia
There prevention through screening constitutes one of the main tools for the control of STIs, which, if not diagnosed and treated promptly, can cause serious consequences, especially in terms of fertility and oncological diseases. Great attention to this aspect emerged in the round table – promoted with the non-conditioning contribution of Gilead Sciences – dedicated to complications from Chlamydia trachomatis infectionpresent in 7% of young women and remaining asymptomatic in 3/4 of cases, resulting in diagnostic delays. In women it rapidly extends through the cervical canal and affects the uterine cavity and the tubes, while in men it affects the prostate. It is currently one of the leading causes of male and female sterility.
From SIMaST a handbook for prevention
Having assessed the widespread misinformation that affects all ages, the SIMaST has created a guide with the aim of expanding knowledge of prevention, risks and possible remedies. “The Vademecum for the prevention of Sexually Transmitted Infections it is training material that can be downloaded directly from our website”, he underlines Luca BelloPresident of SIMaST. «With this booklet, in which several specialists from the ISS, the ASL City of Turin and the Navy collaborated, we intend to inform about risky behaviors, raise awareness of ways to prevent contagion and recognize the symptoms and signs of a potential STI in progress. Through illustrations, links and useful information we analyze the different STIs, the possible consequences and we warn the populations most at risk, such as children under 15, women, the immunosuppressed and last but not least those who use alcohol and drugs”.
Source: Vanity Fair
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