EMBARGOED UNTIL 11 FEBRUARY 2005

'Consistently rising' rates of STIs and HIV in menopausal women and older adults are 'ignored'

The rates of STI and HIV infection are on the rise in adults over the age of 45. In spite of this, they are 'universally omitted from prevention programmes' and, although patients in this age group are physiologically predisposed to STI infection and the diagnoses are often muddled by the presence of other age-related conditions and natural changes in the body, menopausal women have ‘largely been ignored within the field of sexual health.

'Drs Faryal Mahar and Jackie Sherrard of the Department of Genitourinary Medicine at Radcliffe Infirmary, Oxford, write about the relevant concerns in the British Menopause Society's new book Sexual Health and the Menopause, published by the Royal Society of Medicine Press.

Scale of the problem
Data compiled by the American Center for Disease Control (CDC) and by the Health Protection Agency in the UK reveals that ‘a consistently increasing number’ of older adults are being infected with STIs, particularly HIV/AIDS. CDC data shows that '18% of people with HIV infection' are over 45 years of age, with heterosexual transmission as a risk in older adults rising as well, the authors write.

Male factors influencing predisposition
Menopausal women are perceived as a low-risk group, based mainly on the assumption that they are relatively sexually inactive and are in monogamous heterosexual relationships. However, many women are initiating new sexual relationships but as contraception isn’t a post-menopause issue, barrier methods are 'infrequent.' Although frequency of sexual activity does decrease with age, a 2001 study found that 80% of men over 50 were still sexually active, while 2% 'engaged in risky behaviour that placed them at risk of an STI.' Problems such as erectile dysfunction can make using a condom difficult and the inability for many people to admit there is a risk or report infection compounds the problem.

Female factors: oestrogen deficiency
The ‘gradual decline of immune function' and the presence of other diseases in older women may contribute to their predisposition to HIV and other STIs. Reduced vaginal secretions, thinning of the vaginal mucosa and the higher incidence of tears and abrasions 'lead to increased susceptibility to STIs, especially HIV,’ the authors report. Menopausal women taking hormone replacement therapy (HRT) are at risk because oestrogen is 'thought to enhance the pathogenicity of many urogenital organisms.’ Also, HRT in combination with progestogens will 'compound epithelial thinning,' increasing the chances of acquiring an infection through an abrasion.

HIV and the menopause
Ageing people who present with HIV are likely to have a 'shorter time progression to AIDS and death,’ although the specific reasons for this are being investigated. ‘Older adults (36%) are more likely to present with advanced HIV disease, including AIDS, compared with their younger counterparts (5%),' the book states. 'Clinical deterioration is more rapid among older HIV-infected people,' the difference thought to be attributed to a ‘more rapid loss of CD4 helper cells’ in this age group. Other conditions more common in the older population 'may have a deleterious effect on the progression of AIDS' and make it difficult to differentiate symptoms and diagnose in a timely manner.

The authors stress the importance of including this demographic when promoting healthy lifestyles and disseminating sexual health information. As people live longer and continue to engage in sexual activity later in life, the lack of knowledge needs to be addressed.

[ends]

Download Sexual Health and the Menopause
Introduction [PDF 99k]
Full article [PDF 339k]

The publication will be launched at a reception on Friday February 11 2005 at 10.30am at the RSM’s headquarters. For further information, including the full text, or to book a place at the launch, contact the RSM Press Office on 020 7290 2904 or media@rsm.ac.uk.

 

Note to editors:
About the BMS
The British Menopause Society (BMS) is a registered charity aimed at the medical profession and is open to healthcare professionals specialising in the menopause, including consultants, trainee gynaecologists, GPs and nursing professionals. BMS aims to increase the awareness of post-menopausal healthcare issues and promote optimal management through its conferences, road shows and publications.