Herpes Life Line

You’re never too old to get an STD

By Judy Rupp, commentary

Maria was offended when her daughter started to lecture her about safe sex. At age 78, she had been a widow for 11 years, and her relationship with Edward was filling an important need in her life.

“We are not going to get married,” she told her daughter, “because that would complicate matters with our property and our children. And I’m too old to get pregnant. So what is it that you’re so worried about?”

“STDs,” her daughter answered. “Sexually transmitted diseases.”

An AARP survey in 2007 found 85 percent of Americans 65 and older had some kind of intimate experience at least once a week; less than 5 percent considered themselves “too old” for sex. And sexually transmitted diseases are spreading rather rapidly among the senior set. According to Centers for Disease Control, at least 10 percent of new AIDS cases every year occur among persons age 50 and older.

One reason for the change in attitude among seniors regarding sex — if there has indeed been a change — may be the introduction of erectile dysfunction (ED) drugs Viagra, Cialis and Levitra. ED affects at least 25 percent of males by age 65, and that percentage increases with each passing year.

For many of the erectile problems facing older males, these drugs have a high rate of effectiveness. But they do not protect against sexually transmitted diseases.

Unlike the younger generations, most older Americans did not have the benefit of sex education in school. And after several decades of a monogamous relationship, they may not have bothered to inform themselves about STDs. One survey found 47 percent of women older than 50 knew little or nothing about AIDS.

The most reliable protection against STDs is the use of condoms. Women past child-bearing age do not think readily of condoms. And even with the help of Viagra, many older men may find them tricky to use effectively.

AIDS: There are more than 20 sexually transmitted diseases, and, while many of them can be cured easily with antibiotics, they often go undetected. And nearly all of them increase the risk of AIDS.

With a weakened immune system and thinning of vaginal walls, an older person may be more vulnerable than a younger person to HIV, and early symptoms are sometimes difficult to distinguish from changes associated with aging or with chronic medical conditions. Dementia, ordinarily a very late symptom of AIDS, is the presenting symptom for as many as 10 percent of cases in persons older than 60.

In addition to ignorance, seniors are hampered often by denial. A married man who is having extramarital gay sex or sex with a prostitute is not going to want to admit it to his family or even to his doctor. A widowed or divorced male who is dating regularly likewise may be reluctant to admit he is having sex with multiple partners.

Major risk factors for STDs, in addition to failure to use condoms, are: 1) sex with multiple partners and 2) sex with someone who is having sex with multiple partners. Both of these scenarios are becoming increasingly common among seniors in the community and even those in nursing homes and assisted living facilities. As Maria’s daughter reminded her, the rules of safe sex — including mutual monogamy — hold regardless of age.

SYPHILIS: Once the most feared of STDs, syphilis still is around and still highly contagious, although treatable with antibiotics. Left untreated, syphilis can lead to severe neurophysical impairments such as complete or partial paralysis, progressive dementia, blindness or deafness.

GONORRHEA, CHLAMYDIA: Gonorrhea often is detected by painful urination or discharge from the penis or vagina. More than a million infections occur each year in the United States, and about 60 percent of patients with gonorrhea also have a chlamydia infection. Chlamydia, the most commonly reported STD in the United States, can increase the risk of sterility, pelvic inflammatory disease and ovarian cancer as well as HIV.

HERPES: About 45 million Americans are infected with a herpes virus. Herpes simplex type 1 (HSV-1) usually causes cold sores and fever blisters around the mouth. Herpes simplex type 2 (HSV-2), is genital herpes.

It once was believed HSV-1 was transmitted primarily above the waist. A recent study found women who received oral sex were nine times more likely than abstinent women to become infected with HSV-1. Vaginal sex increased the risk six-fold. The study could not prove kissing was not the means of transmission.

HPV or human papillomavirus can be spread by intimate skin-to-skin contact that does not necessarily include sexual intercourse. That’s a type of intimacy probably relatively common among older adults. And it is not necessarily prevented by use of condoms.

Although usually manifested in genital or anal warts, HPV often exists with no symptoms or with warts that disappear after a few years. As a result, many individuals are infected without knowing it. On the other hand, only a few of the many strains of warts that can occur in the genital region or elsewhere on the skin are precursors of cervical cancer.

The important thing for health care professionals and adult children to keep in mind is sex is a drive that does not stop at a certain age, at least for most adults. Nor should it stop. Sexual intimacy provides pleasure and a sense of self fulfillment; and research has found regular sex helps prolong life.

Whatever message Maria gave to her daughter years ago, the message her daughter is giving back today is not abstinence but “keep yourself safe.”

Rupp is information and assistance case manager with the Northern Oklahoma Development Authority Area Agency on Aging.

Genital Herpes: A Common Infection
Women’s HealthBy Dr. Kenneth Noller, MD

Genital herpes is a sexually trans-mitted disease (STD) that affects approximately 50 million Americans. One in four US women has genital herpes, and up to 90% don’t know it. An outbreak of herpes sores is the most tell-tale sign of infection, but while some women will have several outbreaks a year, others will only have a few outbreaks in their lifetime, and many will have no symptoms at all.

The first outbreak usually occurs within 2–10 days of exposure to the herpes virus and is often longer and more severe than any that will follow. You may experience flu-like symptoms, such as swollen glands, fever, muscle aches, and chills. A painful cluster of small blisters—which turn into sores and heal without scarring—may form on the genitals, buttocks, or other areas, near the original place where the virus entered your body.

Herpes is most accurately diagnosed during an outbreak when a sample from a sore can be taken for lab analysis. If you notice herpes-related symptoms, contact your doctor right away. A blood test can also be used to detect the presence of herpes-fighting antibodies.

Outbreaks can be triggered by emotional or physical stress or when your immune system is worn down, such as after a cold or illness. Try to get plenty of rest, eat a balanced diet, and learn how to cope with stress to help you minimize flare-ups.

During an outbreak, try to keep sores clean and dry. A hair dryer on a low setting can dry sensitive or hard to reach areas. Wear loose-fitting cotton underwear and take aspirin or acetaminophen for pain.

Remember that you can spread herpes even when you’re not having an outbreak. Condoms may help prevent you from giving or getting herpes, but the virus can still be passed if a sore—or even a cold sore—comes in contact with skin on the genitals that is not covered by a condom.

Many people who have herpes experience a recurring group of symptoms, or a “prodrome,” a few hours before blisters appear. You may feel a tingling, itching, or burning sensation in the area where your outbreaks occur, or pain in your lower back, buttocks, and legs. It’s best to avoid sex if you notice prodromal symptoms.

Herpes infections in infants can cause serious problems, such as brain damage or eye problems. An infant can contract herpes if it is delivered vaginally while the mother is having an outbreak. Women may be prescribed medication to control outbreaks toward the end of pregnancy. Cesarean delivery may also be an option for women who have an active outbreak.

Genital herpes is a common and manageable disease, but there is no cure. Outbreaks and discomfort can be reduced with oral medications. Online or in-person support groups may help you cope with the disease.

April is STD Awareness Month. To learn more about herpes and other STDs, visit the American Social Health Association at http://www.ashastd.org.