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Sexually transmissible infections and characteristics of
men aged 60 years and over attending a public sexually
transmitted diseases (STD) clinic in South Australia
Carole Khaw
A,B,D
, Bin Li
A,C
and Russell Waddell
A
A
Clinic 275, STD Services, Infectious Diseases Unit, Royal Adelaide Hospital, 275 North Terrace, Adelaide,
SA 5000, Australia.
B
Medicine Learning and Teaching Unit, School of Medicine, Faculty of Health Sciences, University of Adelaide,
Frome Road, SA 5000, Australia.
C
Discipline of Public Health, University of Adelaide, North Terrace, SA 5000, Australia.
D
Corresponding author. Email: carole.khaw@adelaide.edu.au
Abstract. Background:With society ageing, sexually transmissible infections (STIs) in the older population are of
interest from an economic, health-related and social burden perspective. Few studies on STIs in men older than 60 years of
age exist. Methods:A retrospective study was performed looking at characteristics of, and STIs in, 29 106 men (of which
689 were older than 60 years of age), at first presentation, visiting the only South Australian public sexually transmitted
diseases (STD) clinic over a 13-year period. Results:Older men [men who have sex with men (MSM) and men who have
sex with women (MSW)] were less likely than younger men to have been tested for HIV. Conclusion:There is a need for
increased HIV testing in older men.
Received 8 August 2014, accepted 29 May 2015, published online 3 Augsut 2015
Introduction
Sexually transmissible infections (STIs) have primarily been a
health concern in young people in terms of incidence and health
consequences,
1
but the potential for increased STI diagnoses in
older adults exists due to ongoing sexual activity.
Although STIs in older persons remain uncommon, rates
appear to be increasing in the population group who are aged
50 years and above.
1,2
Sexually transmissible infections in older adults are of
interest from economic, social burden and health-related
points of view.
3
Few studies on STIs and characteristics in
older men 60 years of age exist. A retrospective study was
conducted to investigate this at the only public STI clinic in
South Australia.
Methods
We performed a retrospective study of data from our electronic
database, looking at various characteristics of men visiting the
clinic between 1 Jan 2000 and 31 Dec 2012. Information was
initially collected via a health questionnaire and included race,
marital status, previous STIs, circumcision, previous testing
for HIV, reason of visit, partner number and STI diagnosis at
first presentation. This was entered into the electronic database,
collated and analysed.
A comparison of the characteristics and STI diagnoses was
made between older men [both men who have sex with men
(MSM) and men who have sex with women (MSW)] aged
60 years and above and their younger cohort aged 18–59 years,
at first presentation.
Standard descriptive statistical data analyses were performed
using STATA version 11 (StataCorp, College Station, TX, USA).
Results
As shown in Table 1, key findings of significance are
summarised. The percentage of younger Asian men (MSM
and MSW) attending the clinic was greater than that of their
older counterparts. A greater percentage of older MSM and
MSW were married or in a de-facto relationship compared with
younger MSM and MSW. Similarly, older MSM and MSW
were more likely to have been divorced, separated or widowed
compared with the younger cohort.
Older men (MSM and MSW) were more likely to have had
previous STIs compared with younger MSM and MSW.
Older MSM and MSW were also more likely to have been
circumcised compared with the younger cohort.
Of note, older MSM and MSW were less likely to have had
HIV testing in the previous 12 months compared with younger
MSM and MSW.
The percentage of older MSW who presented with symptoms
and who were referred was greater than that of younger MSW,
but younger MSW tended to present more as a contact of a STI
compared with older MSW. Statistically significant differences
(P<0.05) were only noted between younger and older MSW
CSIRO PUBLISHING
Sexual Health Letter
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with respect to chlamydia (P<0.001), syphilis (P<0.001) and
warts (P<0.05), as indicated in Table 1.
Discussion
Lack of availability of detailed epidemiological data on STIs
in the older population is an issue in the Asia-Pacific region,
including Australia.
3
Previous studies have reported that the frequency of STIs
has been increasing in the older population.
4–6
Our study only
demonstrated statistical differences of significance in the
rates of chlamydia, syphilis and warts between older MSW
and younger MSW visiting the clinic. The study was a
retrospective analysis of records from a STD clinic and may
not be completely representative of the local male population.
The population attending the clinic may have different
characteristics compared with those who do not.
In our study, older men (MSM and MSW) were less likely to
have had HIV testing in the previous 12 months compared with
younger men. This is consistent with data indicating that older
adults are half as likely to be tested for HIV as their younger
counterparts.
7
Potential exists in greatly impacting HIV
transmission among older sexually active adults by increasing
testing rates in this age group, with important implications for
HIV prevention and management of this age group.
More detailed follow-up studies are necessary in the future.
Conflicts of interest
None declared.
Acknowledgements
The authors would like to thank the staff at Clinic 275, STD services for
their contribution and hard work in data collection over the study period.
Table 1. Summary of sociodemographic, clinical, sexual behaviour and sexually transmissible infection (STI) testing characteristics among male
patients at their first presentation, by sexual preference according to age group, 2000–2012
MSM, men who have sex with men; MSW, men who have sex with women; SEIFA, socioeconomic indexes; n, number; OR, Odds Ratio; CI, Confidence
Intervals
MSM MSW
18–59 years 60 years OR 95% CI 18–59 years 60 years OR 95% CI
n%n%n%n%
n 4908 94.1% 188 3.6% 23509 96.1% 501 2.1%
Race
Indigenous Australian 63 1.3% 0 0 222 0.9% 0 0
Asian 397 8.1% 4 2.1% 0.23 0.87–0.64 1055 4.5% 10 2.0% 0.42 0.22–0.79
Caucasian 4311 87.9% 184 97.9% 1.00 21057 89.7% 475 95.0% 1.00
Other 133 2.7% 0 0 1152 4.9% 15 3.0% 0.58 0.34–0.97
Marital status
Never married 3876 79.1% 69 36.7% 1.00 16755 71.4% 60 12.0% 1.00
Married/defacto 690 14.1% 45 23.9% 3.66 2.49–5.38 4561 19.4% 252 50.5% 15.43 11.62–20.48
Divorced/separated/widowed 332 6.8% 74 39.4% 12.52 8.85–17.71 2156 9.2% 187 37.5% 24.22 18.05–32.51
Reason for visit
Asymptomatic 2544 51.8% 91 48.4% 1.00 9314 39.6% 179 35.7% 1.00
Symptomatic 1686 34.4% 77 41.0% 1.28 0.94–1.74 11163 47.5% 276 55.1% 1.29 1.06–1.56
Contact 464 9.5% 15 8.0% 0.90 0.52–1.57 1964 8.4% 10 2.0% 0.26 0.14–0.50
Referrals 214 4.4% 5 2.7% 0.65 0.26–1.62 1068 4.5% 36 7.2% 1.75 1.22–2.52
Previous STI
Yes 1352 27.6% 79 42.0% 1.91 1.42–2.56 4829 20.5% 150 30.0% 1.65 1.36–2.01
No 3556 72.5 109 58.0% 1.00 18680 79.5 351 70.1% 1.00
Circumcision
Yes 2452 50.5% 127 67.9% 2.08 1.52–2.84 10309 44.3% 273 55.2% 1.55 1.29–1.85
No 2410 49.5% 60 32.1% 1.00 12976 55.7% 222 44.8% 1.00
HIV testing in previous 12 months
Yes 1591 32.4% 37 19.7% 0.51 0.36–0.74 4277 18.2% 69 13.8% 0.72 0.56–0.93
No 3305 67.3% 150 79.8% 1.00 19196 81.7% 431 86.0% 1.00
Number of partners in past 3 months
1 1538 31.3% 56 29.8% 1.00 11717 49.8% 275 54.9% 1.00
2 or more 3111 63.4% 119 63.3% 1.05 0.76–1.45 9989 42.5% 153 30.5% 0.65 0.53–0.80
STI
Gonorrhoea 269 5.5% 7 3.7% P= 0.296
A
256 1.1% 6 1.2% P= 0.817
B
Chlamydia 317 6.5% 14 7.5% P= 0.590 2170 9.2% 8 1.6% P<0.001
Syphilis 63 1.3% 3 1.6% P= 0.710 41 0.2% 5 1.0% P<0.001
Non specific urethritis 121 2.5% 4 2.1% P= 0.769 527 2.2% 11 2.2% P= 0.945
Warts 427 8.7% 12 6.4% P= 0.266 3402 14.5% 52 10.4% P<0.05
Mean SEIFA decile 3.23 3.48 P<0.05 3.30 3.19 P= 0.297
A
Pvalue for comparison of 18–59-year-old MSM and >60-year-old MSM with respect to STI listed.
B
Pvalue for comparison of 18–59-year-old MSW and >60-year-old MSW with respect to STI listed.
BSexual Health C. Khaw et al.
The views expressed in the submitted article are our own and not an official
position of our institution or funding bodies.
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