Across the nation, and especially in communities that attract a lot of older Americans, the free-love generation is continuing to enjoy an active - if not always healthy - sex life.
At a stage in life when many would expect sexually transmitted diseases to be waning, aging baby boomers are once again busting stereotypes, setting records and breaking rules.
In the five years from 2005 to 2009, the number of reported cases of syphilis and chlamydia among those 55 and older increased 43 percent, according to an Orlando Sentinel analysis of data provided by the Centers for Disease Control and Prevention.
In the Sunbelt where retirees have formed large communities, the rise was even more dramatic.
For instance, in Arizona's Maricopa and Pima counties - home to large retirement communities just outside Phoenix - the percent of reported cases of syphilis and chlamydia increased twice as fast as the national average from 2005 to 2009. Reported cases were up 87 percent among those 55 and older in those counties.
In Central Florida, where The Villages and other retirement communities sprawl across several counties, reported cases of syphilis and chlamydia increased 71 percent among those 55 and older in that same period. And South Florida saw a 60 percent rise in those two sexually transmitted infections among the same age group, according to the Florida Department of Health.
In Riverside County, Calif., home to retirement Mecca Palm Springs, reported cases were up 50 percent over the five-year span, according to data from that county's health department.
The reported cases of syphilis and chlamydia among older adults outpaced the nation's average, according to the analysis. Among all age groups nationwide, reported cases of syphilis increased 60 percent between 2005 and 2009, while in the 55 to 64 age group it increased 70 percent. Meanwhile, the incidences of chlamydia rose 27 percent among all ages, and double that among those age 55 to 64.
As a result of the national trend among seniors, Medicare is considering providing coverage for STD screenings for seniors. In March, the Centers for Medicare and Medicaid office announced that it was looking into adding STD exams to the national health-insurance program, which already pays for HIV screenings. Medicare also is weighing the benefits of paying for behavioral counseling for sexually active seniors.
The factors driving the rise of STDs in the older set include Americans living longer, healthier lives and a new class of medications, which include Viagra, making more sex possible. Many older adults didn't get the safe-sex messages that younger generations received, say experts, so their condom use is lower. In addition, more seniors are living in group retirement communities where there's more socializing.
"These seniors may lose a spouse, then get lonely," said Dr. Jason Salagubang, a geriatrician on staff at Florida Hospital Apopka. "They're living in retirement communities with others in the same boat, and sparks fly."
Joanne Williams, director of Baltimore County Department of Aging, gets that and takes a proactive approach to STD education at the 20 senior centers she oversees.
"The discussion certainly happens here," Williams said. She applies a portion of the funds her agency receives from the state for health education promoting safer senior sex and getting tested.
Julia Gill, director of the Division of Disease Control for the Florida Department of Health, said the heavy marketing for sex-enhancing pharmaceuticals aimed at seniors is also pushing the trend.
Besides Viagra, other medications such as hormone replacements are helping seniors remain sexually active longer. Progesterone and estrogen creams help make sex more comfortable for women, while testosterone-replacement drugs boost libido in men and women.
Finally, a more open sexual attitude has contributed to the rising infection rate.
"The flower children who were in their 20s back in the 1960s are now in their 70s," said Salagubang. "They're the make-love-not-war generation, and old habits die hard."
Anna Fowlkes is of that generation. Five years ago, the 64-year-old widow, mother and grandmother from Baltimore, tested positive for HIV. She picked it up from a man she dated whom she'd known since her childhood. "We grew up together. We'd started going to church together. I never thought to ask," Fowlkes said.
Today, Fowlkes reaches out to other seniors by speaking to groups about her experience and showing a brief video she produced called "Senior Dating: Older, Wiser, Safer."
Just because seniors are older and wiser doesn't mean they're not susceptible to the same diseases as everyone else, Salagubang said. In fact, they're more susceptible.
As people age, their immune systems tend to weaken, and other health problems make them more prone to infection. Medications for heart disease, hypertension and diabetes also cause seniors to be more likely to pick up what's going around.
Because STDs often have no symptoms, they frequently go untreated and make seniors more prone to other infections, Salagubang said. And these infections will make other conditions, such as diabetes or heart disease, worse.
"If I think a patient may be sexually active, I suggest he or she gets screened," Salagubang said. "I let patients know that STDs and HIV are on the rise among seniors and are a lot more common than many seniors think."
Although older Americans account for a relatively small proportion of new STD diagnoses overall, providing them education and services to help protect them from infection is critical, said Rachel Powell, CDC spokeswoman.
"Many older Americans face unique prevention challenges, including discomfort in discussing sexual behaviors with physicians and partners, and discomfort discussing condom use," she said.
Given the changing sexual climate for seniors, Dr. Connie Micklavzina, a gynecologist at Winnie Palmer Hospital for Women & Babies in Orlando, Fla., has started asking her older patients more questions, including whether they would like to be screened for sexually transmitted diseases.
"Often I see a huge look of relief on their faces, because they are too embarrassed to ask," said Micklavzina, who's been in practice 25 years. "The responsibility of bringing this up should be on the practitioner, not the patient, to make the conversation easier."
But according to what she hears from seniors, Fowlkes said, that's not happening. "Doctors aren't asking seniors if they are sexually active. And if doctors don't ask, seniors don't volunteer the information."
Micklavzina also broaches the subject of condom use with patients. "I'm surprised by the number of women in their 50s and 60s who aren't insisting that their partners use condoms."
A study by sex researchers at Indiana University found that in the United States, condom use was lowest among men 50 and older. Men in their 50s reported using a condom only 28 percent of the time with a casual partner. By comparison, men in the 18-to-39 age range used a condom with casual partners at least 50 percent of the time.
Marcia Suss, a well-informed 68-year-old from Brooklyn, simply insists. "You have to be very careful because you don't know where the person you're going out with has been," she said. "If the person is not willing to get tested or wear a condom, then I'm not interested. I'm not looking to pick anything up because it's forever."
"We often assume that younger people are at greater risk for sexual health challenges like HIV and other sexually transmitted disease," said Michael Reece, director of Indiana University's Center for Sexual Health Promotion. "However, these data suggest that younger Americans are using condoms more consistently than older Americans."
The fact that older Americans aren't worried about preventing pregnancy accounts for some of the lower condom use, but this age group clearly needs more education about the risks of unsafe sex, Reece said.
According to a 2007 study reported in the New England Journal of Medicine, 67 percent of men and 39 percent of women aged 65 to 74 surveyed reported having had sex in the previous year; 38 percent of men aged 75 to 85 reported the same.
"We should not be profiling people based on their age, and making assumptions about their sexual activity," said Dr. Stacey Lindau, ob-gyn at the University of Chicago and author of the study. "Removing age-based profiling with respect to STD screenings is a good idea."
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