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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 24  |  Issue : 3  |  Page : 79-82

Sexual behavior and increasing vulnerability of elderly population to sexually transmitted infections: Need for active interventions


1 Graded Specialist Dermatology, MH Meerut, India
2 Graded Specialist, Community Medicine, SHO Meerut, India
3 Associate Professor, Department of Dermatology and STD, Dr DY Patil Medical College, Kolhapur, Maharashtra, India
4 Graded Specialist Dermatology, MH Chennai, India
5 Prof and Classified Specialist, Community Medicine, SHO, Bengaluru, India
6 Asst Prof and Graded Specialist, Dermatology, CHAF, Bengaluru, India
7 Critical Care Matron CHSC, Pune, India
8 Burns Matron CHWC, Chandimandir, India
9 Paediatric Matron, CHAF, Bangalore, India

Date of Submission13-Jun-2021
Date of Decision27-Sep-2021
Date of Acceptance04-Oct-2021
Date of Web Publication01-Apr-2022

Correspondence Address:
Lt Col (Dr) Renu Kandpal
Graded Specialist Dermatology, MH Meerut, Meerut Cantt - 250 001, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jmms.jmms_91_21

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  Abstract 


Objective: The objective of the study was to study the pattern of sexual behavior and sexually transmitted infections (STIs) among the patients attending the STIs clinic in a tertiary care hospital in Western Uttar Pradesh. Materials and Methods: A cross-sectional study was carried out among all confirmed STI cases attending the STI clinic during the period of 1 year. Data were collected by means of personal interview using pretested pro forma with questions related to their sexual behavior and STIs. Relevant investigations were carried out for all cases. Data were entered in Excel sheet and analyzed by means of Epi Info version 7. Results: A total of 373 patients were reported with anogenital lesions. Out of these, 310 were confirmed cases of STI. Surprisingly, in the clinic, the attendance of elderly was 41 (13% of total cases). The attendance of older adults (>40 years of age) was more (178, 57.41%) in comparison to the younger population (132, 42.58%). Among the older population, males outnumbered female patients. Out of the total lesions, the most common genital lesion was herpes genitalis followed by balanoposthitis. Conclusion: We generally assume that, with increasing age, the chances of acquiring STIs are less, but in our study, most of them admitted to having regular sexual activity and this clearly indicated the vulnerability of the elderly population to STIs. We definitely need to focus on their sexual needs and sex education to prevent the increased rate of infections among them.

Keywords: Genital lesions/sexually transmitted infections, older adults, sexual behavior


How to cite this article:
Kandpal R, Viswanath H M, Phulari YS, Kumar M, Hiremath RN, Patil C, Sumathi A, Binakka P, Sarkar T. Sexual behavior and increasing vulnerability of elderly population to sexually transmitted infections: Need for active interventions. J Mar Med Soc 2022;24, Suppl S1:79-82

How to cite this URL:
Kandpal R, Viswanath H M, Phulari YS, Kumar M, Hiremath RN, Patil C, Sumathi A, Binakka P, Sarkar T. Sexual behavior and increasing vulnerability of elderly population to sexually transmitted infections: Need for active interventions. J Mar Med Soc [serial online] 2022 [cited 2022 Aug 9];24, Suppl S1:79-82. Available from: https://www.marinemedicalsociety.in/text.asp?2022/24/3/79/342392




  Introduction Top


Sexually transmitted infections (STIs) are responsible for a lot of burden of mortality and morbidity in developing countries like India, because of their direct and indirect effect on persons and public health. These are communicable infections, and hence they are a continuous threat to public health. According to the WHO, worldwide, every day, about 1 million STIs are acquired.[1],[2] Every year, there are more than 300 million new infections with one or the other STIs such as chlamydia, gonorrhea, syphilis, trichomoniasis, herpes genitalis, or genital warts.[1],[2] Most of these infections are asymptomatic or have mild symptoms. Sometimes, they present with the squeal of infections such as infertility, pelvic inflammatory disease, and infection in the newborn baby. Further, they also have a role in facilitating human immunodeficiency virus (HIV) infection transmission.[3] The clinical presentation, severity, and recurrences of the lesions reflect the sexual behavior of the individual. Most commonly affected population is the young adults and the adolescents. The reason behind this is their psychosexual development, inquisitiveness, and impulsiveness about their sexual behavior. However, in recent years, there is an increase in the incidence of the infections among the elderly population due to unhealthy sexual practices.[4],[5] Globally, the age duration of individuals is being prolonged. People are living more sexually active and healthy lives in the later part of life.[6],[7] Hence, it is the need of the hour to understand their sexual needs and STI services should be planned and provided to them. This study was therefore done to understand the profile and pattern of sexual behavior and STIs in the population attending STI clinics of a tertiary care hospital in Western Uttar Pradesh.


  Materials and Methods Top


This study was carried out at tertiary care hospital in Western region of Uttar Pradesh after obtaining approval from the Institutional Ethical Committee. Sample size included all the new and old cases attending our STI clinic directly or those referred by General Physician and Gynecologist during the period of 1 year. Informed consent from the patients was obtained. Data were collected by means of personal interview using pretested pro forma. All patients were subjected to VDRL, hepatitis virus panel test (HBsAg, anti-HCV antibody), and enzyme-linked immunosorbent assay (ELISA) test for HIV. Additional investigations were done based on requirement. Data were entered in Excel sheet and analyzed by means of Epi Info version 7.2.1.0.


  Results Top


Total confirmed STI cases were 310, which constituted about 1.16% of the total population visited the outpatient department (OPD) [Figure 1]. About 42.58% were younger patients (<40 years) and 57.41% were older adults (>40 years). About 84% were married/remarried. About 98% conveyed that they had single partner and 2% disclosed that they had multiple partners [Table 1]. The odds of history of previous STIs was 1.6 and was significant [Table 2]. Majority (52.70%) of males were referred directly to STI OPD, whereas majority (69.33%) of females were referred from other departments [Table 3]. The most common genital lesion was herpes genitalis (36.45%), followed by balanoposthitis (22.25%) and vaginitis (18.70%) [Table 1]. History of recurrence of these lesions was present in 78 patients, i.e., 25.16% of the patients. Sixty-three patients who reported in the clinic had genital lesions, but they were not STIs. In these patients, eight patients were VDRL reactive, 38 patients came out positive for hepatitis C, and five patients were reactive in ELISA for HIV.
Figure 1: Distribution of patients attending dermatology outpatient department

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Table 1: Sociodemographic factors and type of lesions among study participants

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Table 2: Contraceptive practice and sexually transmitted infections among study participants

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Table 3: Distribution of patients as per mode of approach to clinic

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  Discussion Top


In India, on average, around 6% of the population has one or more STI.[8],[9] There is a wide variation in the number depending on area to area. This study was done to understand the current situation of STIs in Western region of Uttar Pradesh. In our study, over a period of 1 year, 310 patients were diagnosed with STIs. Surprisingly, older adults (age group >50 years) outnumbered the younger adults. The ratio of younger to older population was approximately 1:2. Different studies show wide variation in this ratio. According to Lee DM et al., the ratio was approximately 2:5.[7] While a study carried out by Poynten et al. showed equal incidences among younger and older population among males and in females, the incidences were 20 times more in younger populations.[10] There was a male preponderance among the older adults. This was similar to studies done by Griffiths and David and Amin et al.[9],[11] However, in a study done by Singh et al. in developing countries, females were more commonly affected than males.[12]

Most of the patients left this column incomplete. We completed the column by taking their personal history. Based on the history, we found out that the majority of our older patients are sexually active on a routine basis. They all accepted that they had a good intimate relationship with their spouse or known partner. Although it had declined with age and less than the younger ones, it was not insignificant. It was the females who had more impact on the age. They reported less interest in sex. Another reason for this difference might be the hesitancy or embarrassment on the female part to discuss such history.

Among those, who were active, frequency was much lower in the age group more than 70 years. Various studies have also shown that sexuality is also directly related to the declining health and medications thereof for illness.[13] Those who do not have comorbidity or any illness were more active than those with poor health.

Ninety-eight percent of the adults had a single partner. This seems to be incorrect considering STI among them, as most of them were unwilling to disclose their multiple partners due to social stigma or STI may be acquired from another partner who might be having multiple sexual partners. Only 7% of the adults admitted to have more than one partner. Few admitted that they recently lost their spouse. This perhaps may be the reason for them to become sexually active again. Another common reason to have multiple partners was their uncontrollable sexual desire after a long gap of inactivity. Hence, their probability of acquiring STIs also increases.

We found out that about 90% of the total individuals were aware that infections can be transmitted from one person to another if proper protection is not used. In spite of this, most of the infected males had intercourse with their partners or spouse without the use of condoms. Even those who used the condoms also were just to prevent pregnancy. In females, in spite of having visible clinical lesions or symptoms, they were convinced that it is not a STI, and even if it is there, it is not due to their spouse or partners. All of the females refused that they have ever advised their partners to use condoms. The reason behind this may be due to male dominance in our society. Few of the females had a belief that they have achieved menopause which makes them less prone for these. As suggested by Sales et al. and Alencar and Ciosak, older people never perceive them prone for these infections, leading to delay in recognizing the symptoms.[14],[15] Further, empirical treatment with antibiotic is easily available at every general practitioner's clinic which has made them more carefree in comparison to younger ones.

In females, 32% gave a history of recurrence of vaginal discharge. According to them, it improves every time with a course of medication and recurs after the sexual intercourse. However, in none of the cases, the partner or the spouse reported for their treatment until it was specifically advised. In males, the most common disease of recurrence was herpes genitalis. Sexual intercourse without precaution while having the active lesion was the common history given by these patients. Most of them showed reluctance in taking counseling. According to them, they are aware of all the consequences of unprotected sex, and hence no additional knowledge will help them.

Most of the time, it is our poor communication which lead to misdiagnosis. Hence, being a health-care provider, following measures need to be taken to prevent STIs in older adults: removal of hesitancy on the part of the advisor followed by intensive IEC (Information, education and communication) activities to promote importance of sex education, information about changes in normal anatomy, and physiology of genital organs with age, detailed explanation on condoms, and counseling during regular checkups.


  Conclusion Top


Finally, we can say that we should stop stereotyping older adults and elderly as “sexually inactive” group. Age is no more a criterion for not having the sexual activity or the sex-related infections. This population cannot be ignored because in future these unnoticed infections can become a large problem to the society. Other than the patient, it is the health-care professional who should get rid of this presumption. A good communication is must between the health-care provider and the patient to curtail the transmission. This information can be used for making and implementing specific policies for this age group to prevent transmission of STIs.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Rowley J, Vander Hoorn S, Korenromp E, et al. Chlamydia, gonorrhoea, trichomoniasis and syphilis: global prevalence and incidence estimates, 2016. Bull World Health Organ 2019;97:548-62.  Back to cited text no. 1
    
2.
World Health Organization. Report on Global Sexually Transmitted Infection Surveillance, 2018. Geneva: World Health Organization; 2018.  Back to cited text no. 2
    
3.
Peterman TA, Newman DR, Maddox L, Schmitt K, Shiver S. Risk for HIV following a diagnosis of syphilis, gonorrhoea or chlamydia: 328,456 women in Florida, 2000-2011. Int J STD AIDS 2015;26:113-9.  Back to cited text no. 3
    
4.
Fileborn B, Thorpe R, Hawkes G, Minichiello V, Pitts M, Dune T. Sex, desire and pleasure: Considering the experiences of older Australian women. Sex Relation Ther 2015;30:117-30.  Back to cited text no. 4
    
5.
Smith ML, Bergeron CD, Goltz HH, Coffey T, Boolani A. Sexually transmitted infection knowledge among older adults: Psychometrics and test-retest reliability. Int J Environ Res Public Health 2020;17:2462.  Back to cited text no. 5
    
6.
Erens B, Mitchell KR, Gibson L, Datta J, Lewis R, Field N, et al. Health status, sexual activity and satisfaction among older people in Britain: A mixed methods study. PLoS One 2019;14:e0213835.  Back to cited text no. 6
    
7.
Lee DM, Nazroo J, O'Connor DB, Blake M, Pendleton N. Sexual health and well-being among older men and women in England: Findings from the English longitudinal study of ageing. Arch Sex Behav 2016;45:133-44.  Back to cited text no. 7
    
8.
Department of AIDS Control, Ministry of Health and Family Welfare Government of India. Prevention, Management and Control of Reproductive Tract Infections and Sexually Transmitted Infections. 2014.  Back to cited text no. 8
    
9.
Amin SS, Urfi, Sachdeva S, Kirmani S, Kaushal M. Clinico social AQ11 AQ12 profile of sexually transmitted infections and HIV at a tertiary care teaching hospital in India. Community Acquir Infect 2014;1:25-8.  Back to cited text no. 9
  [Full text]  
10.
Poynten IM, Grulich AE, Templeton DJ. Sexually transmitted infections in older populations. Curr Opin Infect Dis 2013;26:80-5.  Back to cited text no. 10
    
11.
Griffiths M, David N. Sexually transmitted infections in older people. Int J STD AIDS 2013;24:756-7.  Back to cited text no. 11
    
12.
Singh S, Singh SK, Singh TB. Awareness of sexually transmitted infection (STI)/reproductive tract infections (RTI) and HIV/AIDS in STI/RTI – Affected married women of rural areas of Varanasi district, Uttar Pradesh: A cross-sectional study. Indian J Sex Transm Dis AIDS 2015;36:114-6.  Back to cited text no. 12
    
13.
Field N, Mercer CH, Sonnenberg P, Tanton C, Clifton S, Mitchell KR, et al. Associations between health and sexual lifestyles in Britain: Findings from the third national survey of sexual attitudes and lifestyles (Natsal-3). Lancet 2013;382:1830-44.  Back to cited text no. 13
    
14.
Sales JC, Teixeira GB, Sousa HO, Rebelo CR. Perception of AIDS among the elderly in community center in Terezina-PI. Nursing Journal of Minas Gerais 2013;17:620-7.  Back to cited text no. 14
    
15.
Alencar RA, Ciosak SI. Late diagnosis and vulnerabilities of the elderly living with HIV/AIDS. Journal of School of Nursing 2014;49:229-35.  Back to cited text no. 15
    


    Figures

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    Tables

  [Table 1], [Table 2], [Table 3]



 

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