‘I caught herpes after re-entering the dating scene aged 46’
We don’t stop having sex after 40, but we do tend to stop talking about it. And, as the soaring rates of midlife STIs suggest, we might also stop practising safe sex.
The number of sexually transmitted infection cases in over 45s has doubled in the last decade, and across all ages recent data from the Office for Health Improvement and Disparities shows a staggering 76 per cent rise in syphilis alone.
The mum regaining her mojo
Ellie*, a stylist from Essex, emerged from the dregs of a bitter divorce in 2019. It was two decades since she’d last been single and the dating scene had changed beyond recognition.
“My marriage hadn’t been physical since the birth of our second son 10 years earlier,” says Elllie. Egged on by friends she bravely uploaded her profile to dating apps, first Bumble and then Hinge, and discovered the flirty messages had awakened something: her libido.
“I suppose I felt alive again,” she admits. Her first post-divorce sex was with a “weedy-looking” divorced teacher. “The act itself – in his poky bachelor flat – wasn’t earth-shattering, but just being intimate was thrilling after years of celibacy.” Ellie started dating more men, and also some women, on the more risqué hook-up app Feeld. “I thought ‘Why not?’ Life is short.” Ellie was fully enjoying her “wild time” until she met Rory, a music promoter.
“I have revisited this night many times in my head and I do remember Rory muttering something like he ‘might have a cold sore coming’. Regrettably, I didn’t pay attention.”
They were both tipsy when he performed oral sex on her. A week later Ellie noticed a smattering of cold sore-like, fluid-filled blisters around her labia and vulva. A devastating appointment at a genitourinary medicine GUM clinic confirmed it was the herpes virus. “All I knew about herpes was that it lasts forever. I burst into tears.”
Herpes simplex virus type 1 (HSV-1) usually causes oral herpes, while HSV-2 usually affects the genitals. Because of how it was transmitted, however, Ellie’s HSV-1 affects her genitals. In tears, she rang Rory, who was “cagey”, and they never spoke again.
After a five day course of the drug Aciclovir, Ellie’s blisters cleared up, but she’s suffered five herpes attacks in the last three years.
“As soon as I feel the tingling [in the genitals], usually when I’m stressed or run down, I take the pills. I can’t have sex during an attack, not that I would want to. It’s something I have to live with, along with telling new partners. No one has rejected me so far, and I once dated a man who responded with ‘I’ve got it too’. It’s more common than you would think, though it’s hardly a conversation I enjoy – or ever expected to have.”
Contracting herpes in this way, says Dr Rashid Bani, a medical director of YourSexualHealth, is “unfortunate” though not unheard of. “There are dental dams (protective gum shields) available specifically for female oral sex,” he says, although admits they’re not widely used.
The midlife man who’s a ‘player’
Oral sex is indeed the most common way syphilis is contracted, says Dr Deborah Lee, a sexual health doctor at Condoms UK. “Any sexual encounter can result in transmission, kissing and close bodily contact – even if there is no vaginal or anal penetration, or if the partner did not ejaculate,” she warns. What’s more, half those infected are asymptomatic, like Richard*, 48, who lives in Sevenoaks and works for an international bank. He describes himself as “a bit of a player” since his long term-relationship ended six years ago. He only discovered he had syphilis after he was treated for gonorrhoea.
“I noticed a sort of wetness which at first I thought was urine, but there was also a funny ‘clogged’ feeling in my penis which burned when I tried to pee. When I did pee, it was cloudy for the first bit, then painful and there was a greenish discharge. I found a sexual health clinic near work and felt quite sheepish being told I had gonorrhoea, but the doctor was totally non-judgemental and treated me with an antibiotic injection.”
When Richard got it again a couple of years later he was treated with a single pill. That’s when he decided to have a full STI screening and was shocked to test positive for syphilis.
“I had no symptoms and thought syphilis was a Victorian disease, but antibiotics sorted it. I took some time off dating after that. Now, I’m much more pro-condoms and it’s so easy to order free STI tests online, post the samples back and be texted results the same week, for peace of mind.”
The rise of midlife STIs
Theories to explain the explosion in midlife sexually-transmitted infections include rising divorce rates, easy access to Viagra and the prevalent use of dating apps.
“People are meeting new partners in later life but they’re possibly less educated about safe sex because most health campaigns are aimed at the young,” says Dr Bani. “Casual sex, with people you don’t necessarily know well, has become the norm. I find my older patients are generally more embarrassed talking about sex and less likely to go for regular testing. Many STIs are asymptomatic, so infections quickly spread.”
Dr Shazia Malik, a consultant gynaecologist, suggests other reasons for midlifers being vulnerable to STIs. “People in this life stage aren’t worried about contraception, so overlook that condoms are needed for safe sex at any age.” And it’s not just careless singletons driving the statistics, but married people having affairs, she points out. “Between 30 and 50 per cent of people in long-term monogamous relationships engage in sex with external partners.”
Get tested regularly
“Younger people, and those in the LGBT+ community tend to be more used to being proactive about regular STI screenings,” says Dr Bani. “Midlife hetrosexuals should get in the habit because several STIs are asymptomatic, so spread unknowingly.”
“Don’t engage in unprotected sexual contact with partners who haven’t been tested regularly and recently,” Dr Malik advises. “Keep in mind that some STIs have an incubation period of up to two weeks.”
Tests are available at your GP, or a local sexual health or GUM clinic. Many areas in the UK have free NHS testing via post. You’ll need to google what’s available. And there are many nationwide private clinics, such Dr Bani’s and the gynae health company Daye where Dr Malik works has recently launched a diagnostic tampon for women’s STI screening.
“Remember that STIs are very common and usually easily treatable with one to two weeks of antibiotics,” Dr Malik reassures. “Patients should ask that their samples be tested for antimicrobial resistance (AMR) so they can obtain antibiotics that will be effective.”
Some of the STIs that have shown resistance to antibiotics include gonorrhoea, chlamydia, mycoplasma genitalium, and syphilis. But other treatments are available for these.
“It’s really important to complete your full treatment cycle, even if you feel better,” says Dr Malik. “Viral infections like herpes and HIV can be managed with antivirals but are not curable,” she adds. “Modern HIV medications make the viral load in your system undetectable, which means you are highly unlikely to pass the infection on to a partner.”
What to do if you’ve been exposed to HIV
Post-exposure prophylaxis (PEP) is available to anyone who’s been exposed to HIV.
“Ideally it’s taken within 24 hours of being at risk, and certainly within 72 hours,” says. Dr Bani. PEP is available from local NHS sexual health clinics, or if it’s out of hours, A&E departments have them.
“There are guidelines, so before you are prescribed PEP, the doctor will ask about the person you had sex with, what type of sex it was (oral, anal or vaginal), whether the person was infected with HIV and if so what their viral load was, says Dr Bani. So if you’ve been exposed, do your best to find this out.
The dangers of leaving STIs untreated
Leaving STIs untreated can have severe consequences for fertility and for pregnant women but for those not planning families, there are risks too. “Untreated STIs such as chlamydia and gonorrhoea can also lead to an increased susceptibility to HIV,” says Dr Malik.
In rare cases, gonorrhoea can cause sepsis. “Untreated syphilis can cause long-term neurological, nerve and heart problems, and you can get eye complications from gonorrhoea and chlamydia,” says Dr Bani.
How to stay safe
Be honest and talk
The sex therapist Harrie Wilson says communication is key for navigating safe sex. “Midlifers were taught about sex as teenagers, when the focus was on reproduction. Talking about sex can be especially difficult for some women as sexual assertiveness has often – unhelpfully – been viewed as ‘aggressive feminism’. But talking results in more satisfying, and safer, sex. Being candid about our sexual health and history establishes trust.” she says.
Use condoms
“Always use a male or female condom and don’t forget barrier methods for oral sex including oral-anal sex (rimming) too,” says Dr Bani. Wilson says midlife men can fear condoms may hinder their ability to maintain an erection. “Be open with your partner, or with a sex therapist if you’re concerned ,” she says.
Keep sex toys clean
Dr Bani warns that he’s treated patients who have caught herpes, chlamydia, and syphilis from sex toys. “Keep them clean, wash after each use, and don’t share them,” he says, and use a condom on penetrative sex toys.
*Names have been changed
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