The Rise of STIs during the Pandemic
The Centers for Disease Control and Prevention (CDC) reports that one in five people in the United States suffer from one or more sexually transmitted infections (STIs), such as chlamydia, gonorrhea, syphilis, and HIV. With the arrival of the COVID-19 pandemic, the United States saw increases in infections like chlamydia, gonorrhea, and syphilis. The deflection of some medical funding and resources to COVID-related care has also made STI testing and treatment difficult to access. In general, attention moved away from sexual health and other initiatives to tackle the pandemic.
Sexual activity still occurs during lockdowns and social distancing. Furthermore, with clinic closures, medical staff shortages, and lack of testing, many cases of STIs have gone undetected. Despite the continued threat of COVID-19, individual patients, healthcare providers, and public health decision-makers can increase awareness and take preventive measures to mitigate the impact of COVID-19 on STI rates.
How Has COVID-19 Impacted STD Rates?
Before the pandemic, rates of STIs represented one of the poorest health outcomes in the United States. The rapid emergence and spread of COVID-19 in early 2020 caused a temporary and “artificial” dip in STI cases because of healthcare interruptions. Consequently, limited testing diminished access to treatment, and funding cuts likely increased the proliferation of various STIs, especially among minority and other underserved populations.
Unfortunately, many people who have otherwise relied on reproductive health clinics for their sexual health have been left out. The unfortunate outcome is that people with undetected sexually transmitted diseases (STDs) are not getting the testing and treatment they need. Further spread of STIs is not the only consequence. STIs left untreated can lead to more serious complications, such as infertility, pelvic inflammatory disease, and the heightened risk of HIV infection.
Even patients who could make STI-related appointments have faced difficulties due to shortages of reagent testing kits. Before the pandemic, most patients testing for chlamydia or gonorrhea could conveniently provide urine samples in clinics and outpatient labs. Since the pandemic, the demand for reagents for COVID-19 tests increased, leading to more STI screenings relying on urogenital swabs. This form of specimen collection must still occur at a clinic, and it can be painful for some men. Such conditions can contribute to the decrease in testing overall.
Certain segments of the population have been hit especially hard by the recent STI surges, particularly individuals aged 15-24, who have experienced the most significant spike in infections. Unfortunately, many young people with STIs are asymptomatic, which increases the likelihood of unprotected sexual activity that often results in unintentional transmission and reinfection.
Women constitute another group that has suffered higher rates of STIs. Increased infections undoubtedly have an impact on infertility rates. They also put more women at risk for human papillomavirus (HPV) and cervical cancer. They can also lead to increased cases of penile cancer in men.
Among young people and women, syphilis cases have likely risen. Although testing remained steady during the early phases of the pandemic, presume active infection increased significantly among these demographic groups. However, research findings are inconclusive as to the exact impact of the COVID-19 pandemic on syphilis rates.
Awareness and Prevention Strategies
STI prevention often starts with awareness of the prevalence of STIs and knowing your health status. Understanding how pervasive STIs are can encourage individuals to get tested regularly and take precautions when engaging in sexual activity. Prevention also involves supporting open discussions about sexually transmitted diseases, increasing trust among partners, and eliminating stigmas around infection. Also, patients should be assertive in finding an available medical provider who advocates strongly for their healthcare needs.
Healthcare providers can help their patients advocate for their sexual health and care during a face-to-face or virtual office appointment. Physicians and other medical professionals can do their best to make patients feel comfortable during visits. They can also center medical conversations on the Five Ps:
- Partners
- Past history of STIs
- Practices
- Pregnancy prevention
- Protection from STIs
From a public health standpoint, medical providers and local health departments can find ways to increase access to STI testing and treatment. For example, expedited partner therapy (EPT) works with patients diagnosed with chlamydia or gonorrhea by giving medications to the patients to distribute to their sexual partner(s) without a physical examination. In areas with reduced clinic hours and lockdowns, strategies like EPT can make treatment more available, especially to more vulnerable community members.
Research and materials for this article were compiled, written, and distributed on behalf of the National Public Health Information Coalition. The views and opinions expressed in this blog are those of the various authors and do not necessarily reflect the official policy or position of the National Public Health Information Coalition or its members.
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