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This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: AJPH.2009.160119v1 99/11/2055    most recent Submit a response View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Smith, K. P. Articles by Christakis, N. A. PubMed PubMed Citation Articles by Smith, K. P. Articles by Christakis, N. A. Related Collections Aging Other Infections Prevention Sexual Health Men's Health Mortality

Kirsten P. Smith, PhD and Nicholas A. Christakis, MD, PhD, MPH

Kirsten P. Smith is with the Department of Health Care Policy, Harvard Medical School, Boston, MA. Nicholas A. Christakis is with the Department of Sociology, Harvard University, Cambridge, MA, and the Department of Health Care Policy, Harvard Medical School, Boston, MA.

Correspondence: Correspondence should be sent to Kirsten Smith c/o Nicholas Christakis, Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115 (e-mail: christak{at}hcp.med.harvard.edu). Reprints can be ordered at http://www.ajph.org by clicking the "Reprints/Eprints" link.

Objectives. We assessed whether widowhood is associated with risk of diagnosis with a sexually transmitted infection (STI) among older adults in the United States and whether the associations observed in men differed before and after the introduction of sildenafil, the first oral erectile dysfunction medication approved by the Food and Drug Administration.

Methods. We used Cox proportional hazards regression to analyze the time to first STI diagnosis in a random sample of married, Medicare-eligible couples aged 67 to 99 years in 1993 (N = 420 790 couples).

Results. Twenty-one percent of male and 43% of female participants lost a spouse during the 9-year study period. Only 0.65% of men and 0.97% of women were diagnosed with an STI. Widowhood was associated with an increased risk of STI diagnosis for men only, with the largest effects found 0.5 to 1 year after a wife's death. Effects for men were larger after the introduction of sildenafil.

Conclusions. Widowhood in older men, but not women, increased the risk for STIs, especially in the postsildenafil era. Clinicians should address sexual health issues with older patients, especially bereaved men taking erectile dysfunction medications.