What are the recommendations for safe sex and preventing sexually transmitted infections (STIs) in individuals aged 60 and above?

Safe Sex and STI Prevention for Adults Aged 60 and Above

High-intensity behavioral counseling and consistent condom use are strongly recommended for sexually active adults aged 60 and above who are at increased risk for sexually transmitted infections (STIs).

Risk Assessment for Older Adults

Sexually active older adults may be at risk for STIs due to several factors:

• Normal physiological changes associated with aging (decreased vaginal lubrication, longer time to attain erection) 1
• Psychosocial changes (loss of spouse/partner, re-entering dating scene) 1
• Risky sexual behaviors, including infrequent or no condom use 1, 2
• Multiple partners or new sexual partners
• Inconsistent use of barrier methods

Recommended Prevention Strategies

Behavioral Counseling

• The U.S. Preventive Services Task Force (USPSTF) recommends high-intensity behavioral counseling for all adults at increased risk for STIs 3
• Counseling should be tailored to the specific risk factors of older adults 4
• There is no evidence to support stopping screening at a specific age - persons continue to be at risk of acquiring STIs if exposed, regardless of age 3

Barrier Methods

1. Male Condoms

   • Use a new condom with each act of sexual intercourse 3, 4
   • Put on when penis is erect and before any genital contact 3, 4
   • Ensure no air is trapped in the tip 3, 4
   • Use adequate lubrication during intercourse 3
   • Use only water-based lubricants with latex condoms (oil-based lubricants can weaken latex) 3, 4
   • Hold condom firmly against base of penis during withdrawal 3, 4

2. Female Condoms

   • Consider when male condoms cannot be used appropriately 3, 4
   • Laboratory studies show effectiveness as a mechanical barrier to viruses 3, 4

Vaccination

• Hepatitis B vaccination is recommended for all unvaccinated patients being evaluated for STIs 3, 4
• Hepatitis A vaccination is recommended for men who have sex with men and people who use illegal drugs 3, 4

STI Screening Recommendations

• There is no specific age at which STI screening should stop 3
• For sexually active adults who are at increased risk, screening should continue regardless of age 3
• In the absence of direct evidence, physicians might consider stopping routine screening at menopause or at 55 years of age for those only at demographic risk, but should continue for those with behavioral risk factors 3

Special Considerations for Older Adults

1. Address physiological changes:

   • Recommend appropriate lubricants to address decreased vaginal lubrication
   • Discuss how normal aging changes may affect sexual function and increase STI risk 1

2. Overcome communication barriers:

   • Healthcare providers should initiate conversations about sexual health with older patients
   • Use non-judgmental language and approach the topic with sensitivity 5

3. Education needs:

   • Many older adults may have limited knowledge about STI prevention
   • Provide clear information about transmission routes and prevention methods
   • Explain that STI risk continues throughout life 2

Common Pitfalls in STI Prevention for Older Adults

1. Assumption that older adults are not sexually active

   • Sexual activity continues well into later years for many adults 1
   • Healthcare providers often fail to discuss sexual health with older patients

2. Focus on pregnancy prevention rather than STI prevention

   • Post-menopausal women may not use condoms due to lack of pregnancy concerns
   • Emphasize that condoms serve dual purposes of pregnancy and STI prevention

3. Stigma and embarrassment

   • Both patients and providers may feel uncomfortable discussing sexual health
   • Use matter-of-fact, medical approach to normalize these discussions

4. Lack of STI knowledge among older adults

   • Many older adults received limited sexual education in their youth
   • Provide age-appropriate educational materials specifically designed for this population

By implementing these evidence-based recommendations, healthcare providers can help reduce the rising rates of STIs among adults aged 60 and above while respecting their continued sexual health needs.