Health officials have a message for middle-aged Canadians: Sexually transmitted infections are on the rise for those in their 40s and 50s.
"Don't just think about these infections as a concern of teenagers," says Dr. Tom Wong, of the Public Health Agency of Canada. "STIs are alive and well. The message we want middle-aged Canadians to take home is that it's important to think about your sexual health as you go about your relationships. Practise safer sex."
Wong says the numbers don't yet warrant a public health campaign. But rising rates of STIs among the middle-aged have drawn the attention of researchers and are prompting the agency to monitor the trend.
According to the Public Health Agency, the majority of reported STIs in Canada still occur in people under 25. Since 1997, however, middle-aged people have made up an "increasing proportion" of these cases.
In 2008, there were 82,919 reported cases of chlamydia in Canada in 2008, 12,723 cases of gonorrhea and 1,394 cases of infectious syphilis, the three "nationally reportable" STIs. All three have been on the rise over the previous 10 years.
Chlamydia and gonorrhea predominantly affect those under 30, while the majority of cases of infectious syphilis occur in a slightly older group. In 2007, the highest reported rate of infectious syphilis occurred in men aged 30 to 39 and in women aged 25 to 29.
But in an article that appeared in January in the journal Sexually Transmitted Diseases, four researchers reported that the rates at which these STIs were increasing between 1997 to 2007 in Canada were higher among the middle-aged, between 40 and 59, than among those 15 to 29.
Males are still "disproportionately represented" among those with STIs in the 40 to 59 age group, acccounting for 60 per cent of chlamydia cases, 88 per cent of gonorrhea and 93 per cent of infectious syphilis cases in 2007.
Younger females, however, continue to be the largest group of chlamydia sufferers, with those 15 to 29 accounting for over half of reported infections in 2007.
Wong says there are many possible reasons to explain why sexual infections are rising among middle-aged Canadians, including the fact that they are part of the baby boom cohort and account for approximately a third of the population.
But there is also, he notes, the ease of online dating, greater numbers of newly single people due to divorce or relationship changes, availability of drugs that cure erectile dysfunction and a phenomenon that he calls "safe-sex fatigue."
The top three STIs in 2007
|STI||15-29 age||% change||40-19||% change|
% change is for period from 1997 to 2007
Source: Public Health Agency of Canada
A study published in July 2010 in the Annals of Internal Medicine found that men who use erectile dysfunction drugs such as Viagra have higher rates of STIs in the year before and after use of these drugs.
The PHAC has posted two sets of guidelines on its website, one for health-care providers and another for educators, to raise awareness and provide technical assistance about STIs.
The problem, says Wong, is not a lack of information on the subject. The problem goes deeper in that middle-aged Canadians may not be paying heed to the information that exists, may not be using condoms, and may not be having those important discussions with their doctors.
Sexual health may also be a health-care blind spot among doctors and nurses who can be reluctant to raise the issue with their older patients.
And there is also the phenomenon of "sexual silence," particularly among middle-aged women, says Jane Greer, an administrator at the Hassle Free Clinic in Toronto, one of the busiest sexual health centres in the country.
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"It's always easier to have sex than to talk about it," she says.
For many women over 40 there can still be some embarrassment about sexual matters, which precludes them from raising problems with their family doctor. "You know, they might think, 'Oh, I can't see him, he delivered my children,' that kind of thing," Greer says.
Women who are single or newly single have a hard time negotiating sexual safety because "they might think, if I introduce condoms, then he will think I'm screwing around.
"When I do see women in that age group, there's a sense of 'I can't believe I'm here and what do I need to know,'" says Greer. "Some women are here because their partners are cheating on them."
Younger adults are more likely to use condoms than older adults partly because of the awareness about HIV in recent years.
But experts on sexual health say it's time for those 40 and over to talk more frankly about sex with their partners and to practise safer sex if they aren't already doing so.
Laura Wershler, a director with the Canadian Federation for Sexual Health, BASED in Calgary, says sexual protection is necessary, regardless of age, and there is no need to be shy when embarking on a new relationship.
"It's like having a conversation about drinking and driving, wearing a seatbelt, and using anti-virus software on your computer. If we could normalize conversations about sex and STIs, we would all be better for it," she says.
But while STIs are clearly on the rise among middle-aged Canadians, it's important to remember there are actually many more cases of STIs among younger adults.
"We are still seeing much greater numbers of young people with STIs than we are seeing middle-aged people with STIs," says Dr. Rita Shahin, associate medical officer of health at Toronto Public Health.
"The percentage increases may look dramatic, but the absolute numbers are much, much lower among the middle-aged compared to younger age groups."
She says, however, her advice is the same for both. "The big message is to use condoms, and if you are going to have a number of casual sexual partners, get tested for STIs regularly."