Most singles over age 50 think they’re no longer at risk for sexually transmitted infections (STIs). In 2009, AARP asked older singles how committed they felt to condoms. Only one in five said they used them every time, 32 percent of the women, 12 percent of the men.
And they’re right—-almost.
Age is, indeed, a key risk factor for syphilis, gonorrhea, chlamydia, herpes, genital warts, and HIV, and STIs are by far most prevalent among those under 30. Risk after 50 is much lower—compared with twenty-somethings, around 90 percent lower.
In addition, singles over 50 aren’t into condoms because, compared with young adults, they’re less likely to engage in the main route of STI transmission, vaginal intercourse. With age, intercourse fades from the erotic repertoire. After 50, men’s erections become iffy, and the drugs are less effective than advertised. In older women, menopausal changes—vaginal dryness and atrophy—often make intercourse uncomfortable or impossible even with lubricant. As a result, older couples who remain sexual become more interested in sex without intercourse: hand massage, oral sex, and sex toys. (Gonorrhea can infect the throat and herpes the lips (cold sores), but most other STIs are rarely transmissible orally.)
So older daters generally assume they don’t need condoms. Or do they?
Public health authorities insist they do. As 50 has become the new 30, older adults’ STI rates have risen. Since 2005, risk of syphilis among older adults has jumped 67 percent, chlamydia 40 percent, which is why health officials recommend condoms every time for everyone who dates until both lovers test STI-free and pledge monogamy.
I’m 63, married, and monogamous, but if I were single, here’s how I’d approach the issue. Despite the urgency of male lust, I would try not to jump into bed with a hot new friend. I’d want to get to know her over several dates before getting to know her in the Biblical sense.
I’d gently inquire about her sexual history—the more lovers, the greater the STI risk.
I’d declare my history with illicit drugs and probe hers. The vast majority of heterosexuals infected with HIV have a history of IV drug use. And people reckless enough to abuse opiates, cocaine, and methamphetamine are often sexually reckless as well. Of course, new friends might lie about their STI risk. So I’d carry condoms, and if we had intercourse, I’d insist on using them.
Ideally, I’d raise the issue of STIs before we first disrobed, declare myself uninfected, ask the woman about her situation, and offer to make a date of getting mutually tested. Many county health departments offer free STI testing. If she were willing and we both tested negative, guess how I’d suggest celebrating.
If she declared herself infection-free, and said testing wasn’t necessary, I’d gently insist on testing. One never knows.
If she said she was being treated for anything other than HIV, I’d commend her honesty, and use condoms until she tested infection-free.
If she had a history of herpes, I’d ask about her last eruption. If it happened more than five years previously, I’d assume her immune system had suppressed the infection and I’d feel comfortable not using condoms. I’d also ask if she could identify her “prodrome,” the tell-tale itching, tingling, or discomfort in the spot where the sores erupt the day or so before they appear. If she said she could recognize her prodrome and was confident no sore was imminent, I’d feel comfortable not using condoms.
Now about HIV. Here are the facts about transmission: Condoms used properly reliably prevent it. Unless you have bleeding gums or a canker sore, HIV is very unlikely to be transmitted by oral sex. And even without condoms, HIV is one of the less transmissible STIs. So I’d like to respond rationally and tell an HIV-positive prospective lover that if I’d be fine making love—if we used condoms religiously. But I’m not always rational, and HIV is scary. So I think I’d express openness to a sexual relationship, but postpone sex for a while, until I’d calmed down about her being HIV-positive. Then I’d use condoms every time.