Sexually transmitted infections such as syphilis and resistant gonorrhea have public health officials and staff at Canadian nursing homes and retirement communities taking note.
The Public Health Agency of Canada said reported rates of chlamydia, gonorrhea and syphilis have been steadily rising since the late 1990s.
Young Canadians continue to have the highest reported rates of infections, but increasing numbers are occurring among middle-aged and older adults.
"We have people up until their 80s coming to our clinics," said Jennifer Ronan, public health nurse at Hastings Prince Edward Public Health in Belleville, Ont.
Health officials in Alberta are dealing with outbreak levels of gonorrhea and syphilis. Syphilis is on the rise in Manitoba and Ontario reported a 30 per cent increase in the gonorrhea cases from 2013 to 2015, with 5,932 cases last year.
Ontario also had 1,055 cases of syphilis in 2015 and 39,022 of chlamydia.
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At Baycrest, a geriatric residence and health sciences centre in Toronto, occupational therapist Sylvia Davidson sees intimacy as an extension of her work helping clients with daily activities, such as after a hip fracture.
'They do want relationships, whether it's come about because of divorce or death, both men and women are interested because it's a part of life.' - Evelyn Burns-Weinrid
"Not being able to return to being intimate with your partner, because there's positioning issues, because I'm concerned about pain, I'm not sure if it's safe, those are the sorts of things that can really hinder the person's full recovery," Davidson said.
Some older adults are embracing drugs like Viagra for men and hormone creams to help with lubrication in women, Davidson said.
Evelyn Burns-Weinrid is a volunteer at Baycrest who works with Davidson to spread the word about intimacy as older adults live longer, healthier lives.
"We're aware of everything and sexually transmitted disease, we thought about it. We inquired about it. We were very careful," Burns-Weinrid said of her own relationship.
'I thought the person was OK'
STIs also gained a chance to spread among those who came of age when condoms were considered just for contraception, not HIV, Ronan said.
At the sexual health clinic, Ronan said nurses strive to create a warm, caring and lighthearted space for those coming in for testing and treatment. "A lot of times it's 'I didn't know I could get this or I thought the person was OK. I didn't think we needed to get testing,'" Ronan said.
Davidson and Burns-Weinrid want their clients to be aware of the range of intimacy options and the risks and rewards.
"They do want relationships, whether it's come about because of divorce or death, both men and women are interested because it's a part of life," Burns-Weinrid said.
"One of the things that people need to be aware of is, if you do get a sexually transmitted disease, if you already have a compromised immune system, if you have other medical conditions, that could mean that the treatment we would traditionally use that would very quickly address something like a syphilis or a chlamydia infection may not work as well in an older adult."
A healthy fear
But clinical trials and education on STIs among older adults is often lacking, according to a commentary from the Canadian Public Health Association.
Richard Schabas, medical officer of health at Hastings and Prince Edward Counties in Belleville, Ont., said his local health unit is clearly seeing an increase in gonorrhea and an increase in chlamydia.
"STIs as they go up, it's like a rising tide. It's going to raise all the boats. But we shouldn't forget that STIs are first and foremost a problem of young people."
Ronan wants those of all ages and sexual preferences to be aware that most people who have sexually transmitted infections don't have symptoms.
"It's just good habits to get into that if you're in the dating realm and you have different partners and you're having different casual relationships or starting a new relationship, you should get into the good habit of just coming and getting tested to see where you're at," Ronan suggested.
Complacency is also a concern now that HIV is more treatable, Schabas said. "Maybe that's removing what in some ways was a healthy fear. It's still a very serious disease, something that you want to avoid and likewise you want to avoid other STIs."