This week, the Annals of Internal Medicine reported a study in which older men taking erectile dysfunction drugs such as Viagra had twice the rate of sexually transmitted illnesses (STIs) than their non-medicated peers.
I’m not surprised.
I remember a man, almost an octogenarian, who presented with what seemed like a bad case of flu. His social history revealed unsafe sexual practices with women who were not his wife. Actually it seemed that he frequented the Caribbean islands for sex. Though I felt quite sheepish asking him about his sexual practices (hello, he has the flu) and then asking him to consent for an HIV test, I shouldn’t have felt self-conscious. I wouldn’t have batted an eye leading him down this path of diagnostic testing were he to be younger.  Turns out though that grandpa did have acute retroviral syndrome!
It made me think. How many elderly people present to their primary care physicians or other health care settings with non-specific symptoms or even highly suggestive STI symptoms yet still don’t get tested for HIV or other STIs? I’m sure it’s quite a number.
I recommended that his wife get tested as well though I don’t know if they had been sexually active. In light of this article, I don’t remember if he was using erectile dysfunction medications or not.
But that brings me to another observation this time about elderly women. A lot of us younger women are sometimes motivated to use barrier protection because we don’t want to get pregnant. I’m sure for some older women, once they’ve reached menopause, protection of any kind is the last thing on their minds.
I once took care of a feisty woman in her 70s. Past medical history read as you would expect. Coronary disease, diabetes, previous stroke, but then there was HIV/AIDS, a relatively new diagnosis for her.  She presented with an opportunistic infection that everybody initially thought was stroke. She would be wheeled into my office and I would basically scream at her because she was hard of hearing. She was a widow and I made the assumption that her husband had given her the virus because “he was sick for a while” before he died. It was actually quite challenging taking care of her.
Us younger ones have grown up with HIV over our heads like a Damascus sword. True many of us still engage in risky behaviour in spite of that. But these elderly patients? Sure they have most likely heard about HIV but I doubt they really ever thought of themselves as at risk. Well, hello world.
It’s a real problem though.  I know we don’t like to think of the residents of retirement communities and nursing homes shacking it up on a regular basis but they do. They also change partners often. The men have Viagra, the women are post-menopausal and uninhibited, and there they go, like teenagers. Seriously, we need public health campaigns directed at the elderly…and perhaps black box warnings on erectile dysfunction medications?
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