STD fight lost amid coronavirus testing blitz
After an unprecedented push to test and track COVID-19, public health officials are grappling with a worrying side effect: a collapse in screening for sexually transmitted diseases that have been on the rise for years.
Tests for diseases like chlamydia and gonorrhea fell in many parts of the United States last year as COVID-19 drained resources and staff. Health officials say this gap in testing has prevented them from tracking or controlling disease outbreaks, which were already at record levels before the pandemic.
“It is clear that there has been massive disruption in testing, surveillance and clinical care and this is likely to worsen sexually transmitted infections,” said David Harvey, executive director of the National Coalition of STD Directors, who represents state and local health workers.
Many STD clinics closed their doors or reduced their working hours during lockdowns last spring. Staff who previously helped track infections have been reassigned to focus on COVID-19. And the labs that handle most STD tests have been forced to ration supplies to focus on the flood of incoming COVID-19 samples.
Investigation data from Harvey’s group shows that even in January of this year, 40% of STD programs were still operating with reduced staff due to COVID-19. This has led to cuts in services to detect and fight infections that can often spread with little or no immediate symptoms.
In Vermont, Daniel Daltry is one of only two full-time state employees who track HIV, hepatitis and other high-risk infections. Over the past year, he has spent most of his time dealing with COVID-19 while also training 160 new employees hired to help with coronavirus contact tracing.
Daltry and his colleague continued to trace contacts for syphilis and HIV throughout the epidemic.
“But anything else, we just couldn’t do it,” said Daltry, stressing that they don’t track diseases like gonorrhea.
As in other regions, Vermont has seen a drop in the number of confirmed cases of STDs, recording a 50% drop in reported chlamydia cases and a 90% drop in HIV from 2019 – largely, according to the experts, due to a reduction in testing.
This drop reflects national trends reported by the Centers for Disease Control and Prevention last fall.
Analyzing data from a national laboratory service, the CDC said in September that tests for chlamydia, gonorrhea and syphilis were down 30% to 50% last spring compared to the year before, before recovering somewhat in early summer.
Doctors usually discuss and screen for STDs as part of the routine care of sexually active adults and adolescents. Annual screening for common infections is recommended for high-risk groups, including women under 25 and gay and bisexual men. STD clinics often provide free or low cost testing and counseling.
Due to reporting disruptions, the CDC is behind schedule in compiling its annual STD figures and will not finalize the 2019 figures until later this month.
The agency warns that STDs have been on the rise for the past five years, hitting a record high number of syphilis, gonorrhea and chlamydia cases in 2018. Officials attribute the trend to an increase in unstable housing, drug use and social stigma, as well as reductions in sex education and social stigma. public health budgets.
“In order for our resources to be used and diverted to COVID, it is especially important that we now come back and say, ‘If you are sexually active you should be tested,'” said Dr Hilary Reno, CDC consultant and professor at the University of Washington. St. Louis School of Medicine.
Among the 130 STD testing sites in the Saint-Louis area, testing is still at about two-thirds of pre-pandemic levels, according to figures compiled by Reno.
One possibility for the declines is that months of social distancing have slowed down sexual activity. But Reno and other experts are skeptical.
The biggest dating sites and apps reported record usage in 2020, suggesting that many people may have continued to log on throughout the pandemic.
Dr Ina Park of the University of California at San Francisco thinks people could have waited a few months. “But then I think people hit their breaking point and opened their Tinder, Grindr, or whatever app and they started meeting people to hook up and have sex again.”
If left untreated, STDs can lead to serious long-term health complications. Chlamydia can damage the male and female reproductive systems and lead to pregnancy complications. Syphilis can also lead to pregnancy problems, infections in newborns, and – if not treated with antibiotics – organ damage and neurological problems in both men and women.
The CDC continues to report below-normal supplies for some test kits and lab chemicals used for STD screening, which overlap with COVID-19 supplies. If necessary, the CDC says providers may need to prioritize testing for groups most at risk, including pregnant women with multiple sex partners and sexually active gay and bisexual men.
Testing disruptions have led to workarounds at many STD clinics, including initial online consultations for people with symptoms and home sample collection for conditions such as chlamydia and gonorrhea. Recently, US authorities approved the first point-of-care test for these two infections that can be used in doctor’s offices and give results in about 30 minutes.
Public health officials hope that some of these new approaches can strengthen traditional services by trying to make up for lost time.
“This opens up another tool in the toolbox for people to access the services they need,” said Daltry, who heads Vermont’s STD surveillance program.