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Minggu, 17 Juli 2011

Why don't the over-50s get the safe sex message? New figures reveal huge rise in STIs


The middle-aged, middle-class woman sitting in my office was beside herself with worry. A mother of three in her late 50s , she was recently divorced. 
Like many women in her circumstances, in the five years since separating from her husband she had dabbled with dating, as it is now known. 
There had been 'a friend of a friend', and a gentleman she'd met via a website. Both relationships had ended  -  but both had been intimate. 
Then she had started experiencing discomfort  -  discharge, and pain on urinating  -  which is why she had come to see me. 


Danger: Tom Conti and Pauline Collins in 1989 film classic Shirley Valentine
Danger: Tom Conti and Pauline Collins in 1989 film classic Shirley Valentine
They had never used condoms as, she explained, 'I never did with my husband. I was on the Pill then, and I went through the menopause years ago  -  I thought there was no reason to'. 
After running some tests, I had to break the news to her that she was suffering from gonorrhoea, a sexually transmitted infection (STI). 
She was upset, embarrassed ( particularly, she admitted, as she had lectured her own children about safe sex), but also shocked. 
At her age, she didn't really think she had anything to worry about. How wrong she was. 
Many of my patients are respectable men and women in their 50s and 60s, newly single and sexually active for the first time in perhaps decades. 
We treat 18,000 people a year and, at a rough estimate, I'd say 80 per cent are from the top socio-economic backgrounds. 
Of course, mine is a private clinic on Harley Street  -  a consultation costs about £120 and STI screening upwards of £220. But the picture is the same elsewhere. 
For the past few years the Health Protection Agency, which monitors infectious diseases in Britain, has been warning about the staggering rise in STIs among baby-boomers. 
Its latest figures show chlamydia infections have increased by nine per cent in the past year, and by 138 per cent since 2001.
Genital herpes is up 15 per cent in the past year and 142 per cent in ten years, while gonorrhoea is up eight per cent in one year and 14 per cent since 2001. 
Cases of genital warts, caused by human papillomavirus, which is linked to a range of cancers, have risen by 62 per cent in the past ten years and by three per cent in the past year. 
And the diseases themselves are becoming more ferocious. Just last week, Swedish scientists announced the discovery of a strain of gonorrhoea that had become resistant to antibiotics. 
Of course, in numbers, infections among young adults and men who have sex with men are still far greater. But by putting our heads in the sand about this new, rapidly growing group, we are risking the health of a generation. 
Menopausal women are particularly vulnerable  -  before they married, usually in their early 20s, getting pregnant was the major fear (if, indeed, they ever had sex before they married  -  a sizeable number of women I see didn't). 
A typical patient is a newly single sixtysomething woman who has gone on holiday and had an affair, a la Shirley Valentine. Sadly, unlike Shirley, theirs is a less happy ending: in my office, and then on to a course of medication. 
But men are also similarly-naive  -  and by middle age, I do see a number of very worried men (and a few women) who have picked up infections by having relations outside their marriage. People make mistakes, and I'm not here to judge. 
These older adults were in secure, stable relationships during the Eighties  -  their first sexual experiences were in the relatively safe years before HIV and AIDS even existed. 
For many, the Sixties meant the Pill was, for the first time, easily accessible  -  and as teenagers and young people, this generation felt free to experiment. 
This group is once again enjoying sexual freedom, but without the benefit of having ever been the target of public-health campaigns to warn them of the dangers. Indeed, some patients are almost affronted when I suggest they always use a condom. 
To keep the sexually liberated over-50s infection-free, which will also save the NHS money in the long run, we need a dedicated awareness campaign that sends out the right messages. 
The Department of Health (DoH) provides a vast array of leaflets for young men and women (straight, gay and bisexual), those from black and ethnic communities and even sex workers and prisoners. 
These people all have needs that can't be underestimated. But there is a dearth of information specifically for those who are single, straight, of a certain age and sexually active. 
Looking at DoH websites, you could be forgiven for thinking that those over 55 don't have sex. And, unfortunately, cartoon characters and brash language just don't speak to fiftysomething businessmen and housewives. 
A lot of people feel silly and foolish to have picked up an STI, and I understand that. My priority is to make sure people are safe, not to bombard them with prurient questions. 
Fortunately, the most common infections are relatively easy to treat, but some are not. 
The hardest part of my job is calling people back with a positive result. It's always dismaying, especially with HIV, which is still a devastating diagnosis (one in ten new HIV cases in Britain is aged 50 or older). 
Times have changed and sex is no longer the preserve of the young. We should embrace the fact that older generations are no longer 'past it' and enjoy youthful, active lifestyles and sex lives that continue well into middle age. 
But STIs do not discriminate between 16 or 60-year-olds  -  we all need to be much more careful.

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