Decreased screening and testing may lead to a future increase in sexually transmitted infections
Screening and testing for sexually transmitted infections (STIs) fell 63% for men and 59% for women in the first months of the COVID-19 pandemic, according to a new study by researchers at Penn State and Quest Diagnostics. The researchers said this could be the result of restrictions on direct patient care and the switch to telehealth and could lead to a possible future increase in STI cases.
This is the first national study to explore the impact of the pandemic on STIs since the Centers for Disease Control and Prevention (CDC) shared their analysis showing a record level of cases in the United States in 2019.
Due to social distancing measures and supply constraints, testing guidelines issued by the CDC during the pandemic recommended stopping STI testing except for patients with symptoms.
However, the researchers say these recommendations have been detrimental as risk-based screenings have been suspended in favor of symptomatic testing, even though the majority of people (80%) with chlamydia or gonorrhea are asymptomatic.
The research team looked at more than 18 million STI test results in patients aged 14 to 49, from January 2019 to June 2020, and found that the pandemic was negatively impacting screening for the sexual health.
Data from the study, published May 19 in the American Journal of Preventive Medicine, says asymptomatic and at-risk people may not have received timely screening or treatment for STIs during the pandemic, resulting in missed cases.
The fastest way for people to spread STIs is not to know they have one. Failure to detect asymptomatic cases could have negative repercussions for years to come. “
Casey Pinto, Assistant Professor, Public Health Sciences, Penn State College of Medicine
Pinto is also a researcher at the Penn State Cancer Institute. Early evidence shows that people continued to be sexually active with people living outside their households. Once testing returns to pre-pandemic levels, researchers expect to see an increase in the overall prevalence of STIs.
If so, it could likely lead to an increase in adverse health effects, such as pelvic inflammatory disease, infertility, and other STIs.
Analyzing data from Quest Diagnostics, which accounts for about 20% of pre-pandemic STI case reports in the United States, investigators found that by early April, testing had declined by about 60%, but that the test positive rate for chlamydia and gonorrhea infections had increased. The researchers said this could be due to CDC recommendations to screen only symptomatic patients.
In male patients, researchers noted increased rates of test positive for chlamydia (18%) and gonorrhea (41%) during the pandemic. Likewise, for patients during the pandemic, there was an increase in test positivity rates for chlamydia (10%) and gonorrhea (43%) infections.
According to the study, the number of cases varied across the United States and could be linked to the regional number of COVID-19 cases and how public and private entities have handled clinic closures.
The researchers found that despite an increase in the test positivity rate, there was a 26% drop in the number of chlamydia cases and a 17% drop in the number of gonorrhea cases overall from March 2020 to June. 2020.
According to the researchers, this may be the result of CDC recommendations to test only symptomatic patients, which means that many asymptomatic cases may have been missed.
“This research highlights the importance of maintaining resources for STI management even in the midst of a pandemic,” Pinto said.
“In the future, health care providers should strike a balance between responding to emerging crises and continuing to provide routine sexual health services. In addition, STI treatment and response efforts should be considered when allocating resources to manage public health emergencies.
Pinto, CN, et al. (2021) Impact of the COVID-19 pandemic on chlamydia and gonorrhea screening in the United States American Journal of Preventive Medicine. doi.org/10.1016/j.amepre.2021.03.009.