STIs are on the rise — but it’s not just frat bros and free-lovers feeling the burn.
While younger people still account for the majority of cases, studies show that some of the steepest spikes are happening in people 55 and up.
Experts have offered several explanations for the surge, but research suggests there’s a risk factor affecting many midlife and older women that has largely flown under the radar and could be playing a key role.
More than a million American women hit menopause each year — and it’s not just hot flashes and mood swings they’re facing.
The transition, which wraps up around age 52 on average, marks the end of reproductive years and is driven by a drop in estrogen as the ovaries slow hormone production.
While vaginal dryness and loss of elasticity are well-known symptoms, research from Ohio State University (OSU) shows that menopause can also weaken the vaginal tissue itself, making it more prone to tearing.
That vulnerability comes down to changes at the cellular level.
The vagina’s surface is made up of multiple layers held together by key proteins like desmoglein-1 (DSG1) and desmocollin-1 (DSC1).
“These proteins strengthen the vaginal lining and restrict pathogen access to deeper tissue, reducing the risk of infection,” Dr. Thomas L. Cherpes, associate professor of otolaryngology at OSU, wrote in The Conversation.
In their research, Cherpes and his colleagues found that postmenopausal women have significantly lower levels of DSG1 and DSC1 than women who haven’t gone through the transition.
To see how this might impact infection risk, the researchers removed the ovaries of mice in a lab to mimic estrogen loss in postmenopausal women. Compared to mice with intact ovaries, those without had far lower levels of DSG1 and DSC1 in their vaginal tissue.
The team also found that these mice were more vulnerable to infection with herpes simplex virus type 2 (HSV-2), which causes genital herpes. They were less able to clear chlamydia infections from the lower genital tract as well.
The findings help explain why postmenopausal women are more susceptible to STIs than their younger counterparts.
Notably, when Cherpes and his colleagues applied estrogen cream to the mice without ovaries, it restored the vaginal lining’s integrity and fully protected them from HSV-2 infection.
“While additional research is needed, findings from our lab suggest that estrogen-containing compounds used to relieve vaginal irritation and other symptoms of genitourinary syndrome of menopause can also reduce susceptibility to STIs among older adults,” Cherpes wrote.
Sex doesn’t stop — and neither do the risks
Americans might not like to talk about it, but older adults are still very much having sex.
A 2018 survey found nearly 40% of people aged 65 to 80 are sexually active, and almost two-thirds remain interested in sex.
More recent AARP data shows that 26% of 60- to 69-year-olds and 17% of those 70 and older have sex weekly.
“Hormone-replacement therapy, vaginal lubricants and the approval of sildenafil (Viagra) and its relatives have extended people’s sex lives,” Dr. Sandra Adamson Fryhofer told the American Medical Association.
But while more people are living longer and staying sexually active, more are also paying the price.
“Rates are highest in the under 25 age group, which accounts for about 50% of STIs, but we’re definitely seeing a rise in infections in the older population, particularly in people over 65,” Dr. Angelina Gangestad said in an interview with University Hospitals.
Between 2010 and 2023, the number of Americans over 65 diagnosed with chlamydia, gonorrhea or syphilis rose by roughly three-, five- and sevenfold, respectively, according to the Centers for Disease Control and Prevention.
Research also suggests women over 50 are at greater risk for HIV than their younger peers.
In addition to the effects of menopause, experts say several other factors are likely fueling the rise.
Condom use is significantly lower among older adults compared to younger people. One study found that just 3% of Americans aged 60 and older have used a condom in the past year.
Older adults also tend to have less knowledge about STIs, including how they spread, what symptoms look like and how to prevent them.
To make matters worse, research suggests that many doctors don’t ask older patients about their sex lives — and seniors aren’t exactly jumping to bring it up with their family or friends, either.
“No one wants to think about grandma doing this,” Matthew Lee Smith, an associate professor at the Texas A&M School of Public Health, told NBC News.
“You certainly aren’t going to ask grandma if she was wearing condoms — and that’s part of the problem, because every individual regardless of age has the right to intimacy.”
