STI and HIV Screening in Older Adults

Background: Recent studies indicate that cases of STIs and HIV among older adults (50 years of age and older) have increased, refuting the stereotype of the sexually inactive older adult.

Methods: A search for articles published between 1990 and 2013 was performed in PubMed, EMBASE, CINAHL, and Web of Science databases. Additional articles were identified via manual searches of reference lists and database searches for articles that cited the previously identified articles. A study was included in the review if it investigated STI or HIV testing rates, influences, or barriers among adults 50 years of age or older, or communication between older adults and health care providers regarding sexual health and HIV or STI testing.

Results: There is limited research on this topic and considerable diversity in the populations studied and outcomes measured. The search process yielded 20 articles meeting the eligibility criteria. Routine HIV testing of older adults is inconsistent with national recommendations. Risk-based STI screening in this population is also infrequent. Older adults are more likely to seek testing for genital symptoms than to be screened for STIs while asymptomatic. HIV testing among older adults is associated with their perceived risk of contracting HIV and influenced by encouragement from health care providers. Studies report that few providers collect routine sexual histories from older adult patients, due in part to their personal discomfort with discussing sexual issues. In contrast, studies indicate that older adults are receptive to sexual history-taking, and many prefer the provider initiating the discussion.

Conclusions: There are missed opportunities to identify asymptomatic STIs and HIV in older adults. Stereotypes regarding sexual activity among older adults and assumptions that sexual health discussions will be offensive and/or embarrassing have hindered providers from identifying older adults at higher risk for HIV and STIs and subsequently testing them.