Sexually Transmitted Infections Among Individuals Over Fifty Years of Age in China

Although research on sex among elder individuals challenges cultural stereotypes, there is increasing epidemiologic and biologic research that reveals elders as a potentially important HIV risk group. 1 It is known that the prevalence of sexual activity declines with age among those over 50 (elders); however, clinicians often fail to elicit a complete sexual history from elder patients and patients may be hesitant about providing details regarding their sexual behaviors. 2Additionally, most sexual behavior surveillance programs focus on the 15-49 age group, perpetuating the assumption that elders have limited sexual risk.While health programs for young patients routinely include sexual health, there are fewer initiatives and public health programs for subsets of elders shown to be at risk for sexually transmitted infection (STI) and HIV.Existing research suggests that compared with younger individuals, elders may not only have a higher per-sex act risk of HIV acquisition, but also have a longer delay between start of symptoms and seeking care and more rapid disease progression. 1 The population in China is steadily aging, with elders comprising 18% of the population in 2000 and estimated to reach 32% of the total population in 2020. 3 Demographic changes of historic proportions have increased both the absolute and relative numbers of elders in China.Similar to reports from other countries, 4 elders in China constitute a growing proportion of total STI cases.Reported STI cases are defined by criteria set by the Chinese Ministry of Health and include both symptomatic and asymptomatic cases.In 1998, 3.8% of all reported STI cases were among elders in China; this proportion of elder STI cases increased to 9.1% in 2005 (Fig. 1). 5 The National STD Surveillance System of the Chinese CDC collects sentinel data on the incidence of five STIs; syphilis, gonorrhea, chlamydia, condylomata acuminate, and herpes simplex virus (HSV) infection.For these STIs, male elders account for 15.8% of all cases, and female elders make up 9.8% of all cases.There is male predominance in all reported STIs, with the exception of gonorrhea, where elder females account for approximately 20% of all cases, with elder men constituting less than 9% of sentinel cases.Recent data