Sexual health screening tends to be treated as a young man’s concern. It is offered in a man’s twenties, occasionally in his thirties, and then quietly drops off the list — not through any deliberate decision, but because both patients and clinicians carry an unspoken assumption that the question stops being relevant somewhere around middle age.
The assumption is wrong, and the data across Canada and comparable countries has been showing it for years. Rates of sexually transmitted infection have risen among adults in their fifties, sixties and beyond. Divorce and bereavement bring people back into new relationships later in life; online dating has widened the pool considerably; and effective treatments for erectile dysfunction have extended active sexual lives well past the point previous generations expected. Meanwhile pregnancy is no longer a concern, so condoms often stop being used.
Why It Gets Missed
Several things converge. Older men are less likely to be asked about sexual activity at a medical appointment, and less likely to volunteer it. Clinicians, consciously or not, screen younger patients more readily. And the symptoms of an STI in an older man are easily attributed to something else — urinary burning gets put down to a prostate problem or a urinary tract infection, fatigue to age, joint aches to arthritis.
Syphilis is a particular concern here, because it has become considerably more common across all age groups in Alberta in recent years and because its progression is slow and its later manifestations are easy to mistake for other conditions. It is detected by a simple blood test and treated straightforwardly, but only if someone thinks to order the test. HIV is similarly under-tested in older adults, and later diagnosis means worse outcomes for reasons that have nothing to do with the treatment itself, which works well at any age.
There is also a generational element that deserves saying plainly. Men who came of age before sexual health was discussed openly often find the topic difficult to raise, and a lifetime of not discussing it with a doctor is a hard habit to break at seventy. That reticence is understandable, and it costs.
What Screening Involves
Nothing about the testing changes with age. Chlamydia and gonorrhea are checked with a urine sample. Syphilis, HIV and hepatitis are checked with a blood draw that can be taken alongside the cholesterol and glucose testing many older men are having anyway. Throat or rectal swabs are used where relevant and can be self-collected. There is no urethral swab involved in routine testing.
A reasonable prompt for screening is any new sexual partner, at any age. That is the entire threshold. It is not a judgement about a man’s circumstances or a comment on a new relationship — it is the same baseline check that would be sensible at twenty-five.
Folding it into a periodic health review often makes the conversation easier. A man coming in for blood pressure, PSA discussion or diabetes monitoring can have sexual health testing added without it becoming the centrepiece of the visit.
The Wider Picture
Later-life sexual health covers more than infection. Erectile function changes with age and with the medications commonly prescribed in later decades — blood pressure drugs, some antidepressants, treatments for prostate conditions. Testosterone declines gradually. Prostate surgery or radiation affects sexual function in ways that are worth discussing before and after rather than discovering afterwards. None of this is inevitable decline to be endured silently; much of it can be addressed.
Grief, the end of a long marriage, or the beginning of a new relationship in later life can also bring anxiety and low mood that intersect directly with sexual health. GPMMC is able to address both aspects within one clinic, which spares the awkwardness of explaining the situation twice in two different offices.
Dr. Raymond Nash provides sexual health assessment and confidential STI testing for men at every stage of life at Grande Prairie Men’s Medical Clinic. To book, visit gpmm.clinic or telephone (587) 416-8296. The content here is general information and does not substitute for an individual medical assessment.