Limitations of CDC's STD Testing Guidelines

Oluwatoyin (Toyin) Adeyemi, MD, attending physician of infectious diseases at Cook County Health and Hospital System, discusses the Centers for Disease Control and Prevention’s (CDC) sexually transmitted disease (STD) testing guidelines.

Interview Transcript (slightly modified for readability)

“The CDC [STD] testing guidelines do end at 65 [years of age]; however, there really is no clear rationale for that because we do know that providers tend to underestimate how sexually active older adults [can be]. There are tons of population data that show and support that older adults are sexually active, and we do know that our patients do get infected even later in life, for a lot of reasons. There are a lot of people, and in our system we continue to test [them,] regardless [of age]. But if you have an adult [patient], you should test all the way to 75 [years of age] if they are sexually active.

The HIV prevalence, wherever you are in the country, is more than 1%. So, once you have an HIV prevalence of over 1%, and you have an adult [who] is sexually active, there is a reason to test, because you will still find infections. The other thing is, really asking about other risk groups. They find that sometimes, as people get lonely as they get older, substance abuse may go up [and] needle sharing may happen. Again, some of those risk-reduction messages that we target at the youth really may not be [shared] in residential facilities, nursing homes, or [with] people who are just trying to cope with loneliness, social isolation, and polypharmacy, and just not feeling great about their health.

So, we in our health system continue to test [for STDs]. I do think, therefore, [that for] adults who [are] living with HIV already, we do need to talk about screening for other sexually transmitted infections, and doing routine testing. In our system, like many settings, as part of the routine care, we do syphilis testing, [as well as] urine gc chlamydia testing, just to be able to identify other infections that the older adults may have.

I do think that ending [STD] screening at 65 [years of age] will allow us to miss a lot more people who are living with HIV or [are] newly infected after the age of 65.”