Public health: The incidence of sexually transmitted infections (STIs) among over-50 year-olds is increasing due to changing lifestyles and limited awareness of such diseases among this age group, according to recent patient figures.
Based on information collated by the Well Woman Centre, there is a clear trend of an increase of STIs such as herpes and gonorrhoea among older patients, according to the centre's medical director, Dr Shirley McQuade.
Of 42 women over the age of 50 who came in for general screening at one of the centre's clinics last year, two had chlamydia, two had trichomonas and one had herpes.
"That's a pretty high rate," said Dr McQuade. In 2003 there was only one incidence of herpes and no other STI among a comparable group of patients.
"In 2002 there were none in a similar number of such patients." She acknowledged the figures arise from a relatively small group of people but said the trend was significant.
"They [the clinic's patients] reflect the average population walking around Dublin yet all the emphasis is on screening younger people for STIs. We're missing the older people."
For example, many older women have not been screened for STIs by their GP even when being tested and treated for common infections such as bacterial vaginosis or thrush.
These patients may have been going to the same GP for years and would find discussing the possibility of having an STI "a conversation neither they nor the GP want to bring up", Dr McQuade said.
The level of awareness of STIs among older people was poor, she said.
"When I mention that I am looking for STIs these patients are sometimes quite taken aback. They can be quite shocked that I am even looking. We are talking about people who would consider themselves as low risk."
The lack of education about STIs back in the 1960s was partly to blame, she said, but current information aimed at this age group was also lacking. "There aren't any posters in the bathrooms of the National Concert Hall as far as I know and you don't see newspaper ads to go and get tested."
Based on her experience, she said the 40-50 year-olds seem to be slightly more aware. "There seems to be a cut-off point in the over-50s."
Depending on lifestyle, anybody could be at risk, she said. As to why the incidence of STIs is increasing in the over-50s, Dr McQuade said UK figures from a few years ago showed the greatest increase in rates of STIs was in the over-60s.
"It was attributed to people staying out of the country and travelling more. The Irish are just catching up on that."
For those who test positive the results could be devastating, said Dr McQuade, adding that any results are sent to the patient, not their GP. Herpes, in particular, is a difficult one as it can re-occur. "It's very difficult to counsel whether or not someone is infective so there is a chance they can pass it on to a regular partner."
Dr McQuade called for a national screening programme for STIs such as chlamydia, pointing out that 7-8 per cent of 2,000 people screened by the centre last year were infected with the bug. Symptoms include pelvic discomfort and vaginal discharge. "It can affect fertility in younger age groups but even in over-50s, when this is no longer an issue, they can get symptoms."
Chlamydia is the second most prevalent STI among the general population after ano-genital warts, according to the latest annual figures from the National Disease Surveillance Centre (NDSC). Non-specific urethritis and candidiasis are the next most common infections. STIs in the general population increased by 7.9 per cent in 2002 compared with 2001, according to the NDSC. Figures for the first quarter of 2003 show the largest proportion of cases of STIs is among the 20-29 year age group. Comparison of the national centre's annual reports for 2000, 2001 and 2002 show an increase in the incidence of STIs among over-40 year olds from 7 per cent to 8.2 per cent.
There is no NDSC data available for people specifically over 50 years of age.