title: Association between widowhood and risk of diagnosis with a sexually transmitted infection in older adults.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115, USA.
authors.forename: Kirsten P
authors.initials: KP
authors.lastname: Smith
authors.forename: Nicholas A
authors.initials: NA
authors.lastname: Christakis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D010879:Piperazines / Q000627:therapeutic use; D015995:Prevalence; D016016:Proportional Hazards Models; D011687:Purines / Q000627:therapeutic use; D012307:Risk Factors; D012749:Sexually Transmitted Diseases / Q000453:epidemiology*; D000068677:Sildenafil Citrate; D018454:Spouses; D013450:Sulfones / Q000627:therapeutic use; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D014665:Vasodilator Agents / Q000627:therapeutic use; D017805:Widowhood
chemical_list: D010879:Piperazines; D011687:Purines; D013450:Sulfones; D014665:Vasodilator Agents; D000068677:Sildenafil Citrate