Sexually transmitted infections (STI) in the nation had been rising for a decade. Federal and state education, screening, and treatment efforts have shown positive results. While the general prevalence of STIs in Arizona has dipped slightly in the last two years, STIs in the 55+ community maintain an upward trend. I am honored to discuss this issue with Dr. Martinot about bringing awareness and possible policy changes to reduce the prevalence of STIs in the 55+ community. Dr. Martinot is a women’s health provider and an administrator of Affirm AZ, a grant broker agency that distributes federal and private grants for women’s health and sexual wellness/ STI prevention projects in Arizona. She is also an alumna of the ASU DNP program. The following is a recap of the interview on March 10, 2025.
Understanding the Policy Landscape and challenges
Dr. Martinot pointed out that although there are some STI screening guidelines, such as for HIV and Hepatitis C, that include older adults, there are no policies specifically targeting the 55+ age group. She attributes this gap to public health strategies prioritizing cost-effectiveness and population-level impact. Since STI prevalence is higher among younger, reproductive-age individuals, funding and public health initiatives often focus on that demographic. Additionally, outcomes for younger people, such as impacts on fertility and childbirth, are often perceived as more critical from a public health standpoint.
Research indicates that individuals over 55 who maintain sexual wellness experience improved overall health and well-being (Penhollow, 2024). Despite this, public health strategies often overlook the importance of STI prevention and sexual wellness for this demographic, missing opportunities to promote wellness and reduce future healthcare costs.
Health Policy’s impact on sexual health
Dr. Martinot indicated the U.S. Preventive Services Task Force, which recommends comprehensive sexual health history assessments during wellness visits for individuals up to age 65. Unfortunately, many providers do not conduct these conversations routinely, and individuals over 65 are excluded from the guideline entirely. Dr. Martinot suggests this is a critical oversight, as older adults often face challenges related to medications and bodily changes that impact sexual health.
Advocacy Approaches
She advocates for more provider training and comfort in addressing sexual health with older patients, emphasizing tools like the CDC’s guidelines for conducting comprehensive sexual health histories. By normalizing these conversations, healthcare providers can better support older adults’ sexual wellness.
The US Preventative Task Force (USPSTF) recommends a comprehensive sexual history with well visits (Van Epps et al., 2023). Despite the clear guidelines, Dr. Martinot notes that only one in five providers regularly discuss sexual health with patients. This is due to several barriers: societal discomfort with discussing sex, fear of saying the wrong thing, time constraints during wellness visits, and a lack of provider confidence or knowledge in addressing sexual health issues. Providers may avoid the topic if they feel unqualified to handle potential concerns, such as low libido, for which they may not have evidence-based answers. Dr. Martinot advocates for at least basic screening conversations during wellness visits, with referrals to specialists, when necessary, similar to how providers screen for but don’t necessarily manage conditions like diabetes.
Part of the policy change is direct funding to the organizations that support and spearhead the change. Dr. Martinot’s organization plays a proactive role in bridging these gaps by brokering funding for health projects and offering provider training. These efforts include outreach programs and keynote presentations focused on creating affirming environments for discussing sexual health. Dr. Martinot hinted that the recent federal funding cut may have affected their efforts. Legislative changes, such as Arizona’s expanded syphilis screening recommendations to women up to 44 years of age, may serve as the catalyst to encourage providers to be more attentive, even with older patients, thus improving overall sexual wellness outcomes. Dr. Martinot encouraged the writer to volunteer in these outreach projects and observe legislative sessions to identify other policy makers who may support the effort to include older adults in the targeted special populations of STI screening and prevention.
Reference:
Penhollow, T. M. (2024). Sexuality in older adults: Comprehensive strategies for clinicians and patient-centered care. American Journal of Lifestyle Medicine. https://doi.org/10.1177/15598276241293100
Van Epps, P., Musoke, L., & McNeil, C. J. (2023). Sexually transmitted infections in older adults: Increasing tide and how to stem it. Infectious Disease Clinics of North America, 37(1), 47-63. https://doi.org/10.1016/j.idc.2022.11.003.
Dr. Karen Martinot, Administrator of Affirm AZ
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Hi Claudia,
Thank you for sharing your thoughtful and well-organized reflection on your interview with Dr. Martinot. I found your focus on the rising rates of sexually transmitted infections (STIs) among adults 55 and older both timely and critically important, particularly given Arizona’s shifting demographics and the lack of targeted public health policies for this age group.
It was especially interesting to hear Dr. Martinot emphasize how existing U.S. Preventive Services Task Force (USPSTF) guidelines only recommend comprehensive sexual health assessments up to age 65, effectively excluding a population that is still sexually active and at risk for STIs. Clinically, this poses a significant challenge. In my own experience during wellness visits, older patients may be taking medications such as phosphodiesterase inhibitors or hormone replacement therapies, which indicate ongoing sexual activity. However, these encounters rarely include STI screening unless prompted by specific symptoms, which often leads to missed diagnoses. As Dr. Martinot highlighted, this disconnect between evidence and practice reflects broader systemic discomfort with discussing sexual health in older populations.
I also appreciated the mention of Arizona’s recent policy changes, such as the expansion of syphilis screening recommendations for women up to age 44. I wonder if there’s growing momentum at the state level to further expand guidelines and normalize screening for older adults as well. Did Dr. Martinot mention whether any Arizona lawmakers are championing legislative initiatives around STI prevention in the 55+ demographic? Given her involvement with Affirm AZ and its connection to federal and private funding streams, it would be powerful to see this issue framed as both a public health opportunity and a healthcare cost-saving strategy.
Your write-up left me reflecting on how providers like us could implement small, meaningful practice changes. For example, asking a simple, open-ended question like, “Are there any changes or concerns related to your sexual health you'd like to talk about today?” might open the door to more inclusive, patient-centered care. Normalizing these discussions is an essential step toward both prevention and improved quality of life.
Thanks again for bringing this important topic forward. I’ll be watching for policy changes in Arizona that support more inclusive STI screening practices across the lifespan.
References
Penhollow, T. M. (2024). Sexuality in older adults: Comprehensive strategies for clinicians and patient-centered care. American Journal of Lifestyle Medicine. https://doi.org/10.1177/15598276241293100
U.S. Preventive Services Task Force. (2021). Sexually transmitted infections: Screening. JAMA, 325(10), 962–969. https://doi.org/10.1001/jama.2021.1376
Arizona Department of Health Services. (2023). STD Screening Guidelines and Public Health Updates. Retrieved from https://www.azdhs.gov/prevention/std-education-and-resources/