STIs in over-65s have surged 20% but 75% of care home staff have had zero sexual health training

Although younger age groups still account for higher absolute numbers, the rate of increase is steepest among the oldest cohort, contradicting long-standing assumptions about risk distribution.

UKHSA's annual STI surveillance reports provide the clearest picture of what is happening — and of where the system is falling short. Between 2017 and 2019, diagnoses of all STIs among people aged 65 and over increased by approximately 20%.

While the absolute numbers remain smaller than in younger age groups, the rate of increase is significant, particularly given the size and growth of the older population.

Late diagnosis is more than just a statistical concern; it has direct consequences for individuals and the health system. Older adults diagnosed late with HIV or other STIs are more likely to experience complications, require hospital admission, and need more intensive treatment. Infections that could have been managed easily in their early stages become chronic, complex, and expensive.

There are also broader quality-of-life implications. Untreated STIs can exacerbate existing health conditions, contribute to cognitive decline, and undermine mental health. For individuals already navigating ageing, bereavement, or loss of independence, these impacts are profound.

Underlying many of these issues is what advocacy organisations describe as the 'asexuality myth' — the deeply embedded assumption that older people are no longer sexually active. This belief shapes clinical practice in subtle but pervasive ways.

The advert was widely praised for acknowledging that older people have romantic and sexual lives at all. Yet the humour rests on the premise that later-life intimacy is something to be laughed off, politely ignored, or treated as vaguely uncomfortable. Even when acknowledged, older people's sexuality is framed as an exception as opposed to a norm the system must plan for.

The consequence is that clinicians might avoid taking sexual histories from older patients, fearing embarrassment or assuming irrelevance. Symptoms that might prompt STI testing in a younger patient are attributed to ageing, medication side effects, or chronic conditions in an older one. Opportunities for early diagnosis are missed, not through malice, but through habit and training gaps.

The Terrence Higgins Trust has repeatedly highlighted this issue in its work on sexual health in later life, warning that age-based assumptions are contributing directly to late HIV diagnoses and preventable harm.

It is impossible to separate these service gaps from the broader context of public health funding. Analysis by the Health Foundation shows that more than £1 billion was cut from the public health grant between 2015 and 2021. This translates to a reduction of around 24 percent in real terms.

Sexual health services are discretionary and locally commissioned. Thus, these reductions translate directly into clinic closures, reduced outreach, and tighter eligibility criteria, with older adults rarely prioritised.

Because sexual health services are commissioned locally, these cuts have resulted in stark regional variations. Some areas have managed to protect clinics and outreach services, while others have seen closures, reduced hours, and tightened eligibility criteria. Older adults, who are rarely prioritised in service specifications, are often the first to fall through the cracks.

The result is a postcode lottery in which access to testing, treatment, and specialist support depends heavily on where someone lives instead of on their clinical need.

Examples of real-terms public health funding cuts by local authority | Sources: Health Foundation analysis; Institute for Fiscal Studies

The pattern is consistent across multiple analyses: areas with higher deprivation, poorer health outcomes, and faster ageing populations have typically experienced the largest proportional reductions. Coastal and post-industrial regions, many of which also have higher concentrations of older residents, have been particularly affected.

Because sexual health services are discretionary rather than mandated, they are often among the first areas to be scaled back. Clinics have closed or merged, outreach services have been withdrawn, and eligibility criteria have tightened. All this has gone ahead with minimal assessment of the impact on older adults.

The result is a postcode lottery in which access to testing, treatment, and specialist sexual health support depends less on clinical risk than on local authority balance sheets.

It is tempting to attribute STI rates among older adults to changing social norms or personal responsibility. But the data points elsewhere. The consistent patterns of late diagnosis, training gaps, and service exclusion all point to systemic shortcomings.

The system has failed to update its assumptions, its training frameworks, and its commissioning priorities in line with demographic realities. In doing so, it has created avoidable harm for a growing segment of the population.

Digital services must be complemented by accessible offline alternatives, particularly in rural and deprived areas. And public health funding decisions should reflect demographic need, not outdated stereotypes.

Britain's population is ageing. That reality is no longer in question. What remains unresolved is whether the systems designed to protect public health are willing to adapt.

The data clearly shows the following:

• Older adults are sexually active.
• Infections are rising.
• Diagnoses are coming too late.
• The structures responsible for prevention and care are failing to respond.

This is not a marginal issue. It is a predictable outcome of policy choices — and one that will only intensify as the population continues to age.

Britain is in the midst of a demographic shift that is reshaping almost every aspect of public policy, from pensions and housing to social care and the NHS itself. Yet the topic of sexual health is one area that remains stubbornly frozen in outdated assumptions.

Data from the UK Health Security Agency (UKHSA) shows that diagnoses of sexually transmitted infections (STIs) among people aged 65 and over have risen by more than 20 percent in recent years. In some categories and demographics, the increases are far steeper, including a 68 percent rise in gonorrhoea diagnoses among men aged 65 and over between 2017 and 2019, and double‑digit year‑on‑year increases in chlamydia diagnoses among both men and women aged 65+ between 2022 and 2023.

Despite this, sexual health policy, commissioning frameworks, and frontline training continue to treat sex as something that primarily concerns the young.

This crisis is not driven by individual behaviour, but reflects institutional failure and the cost of a system that has failed to adapt to an ageing society.

The scale of the demographic shift alone should have prompted a rethink long ago. The Office for National Statistics projects that by the early 2030s, more than one in five people in England will be aged 65 or over. Improved life expectancy, later-life divorce, new relationships after bereavement, and the widespread availability of treatments for erectile dysfunction have all contributed to sustained sexual activity well into older age.

Yet sexual health services, public messaging, and clinical training have remained largely age-blind, or worse, age-exclusionary. Prevention campaigns overwhelmingly target younger cohorts. Routine sexual history-taking in primary care often stops once a patient reaches a certain age. Testing thresholds and clinical suspicion drop sharply after midlife.

This matters because sexual health risk does not disappear with age. Condom use tends to decline in later life, in part because pregnancy is no longer a concern. Many older adults report embarrassment about discussing sexual health with clinicians, while clinicians themselves frequently assume such discussions are unnecessary. These mutually reinforcing assumptions create a perfect environment for undetected transmission.