COVID-19-related nationwide lockdown did not reduce the reported diagnoses of Chlamydia trachomatis and Neisseria gonorrhoeae in Finland

Sexually transmitted infections, the epidemic that persists after the COVID-19 pandemic: an analysis of the primary care electronic health records covering about 5 million people in Catalonia

BACKGROUND

The aim of our study is to analyse the trends in the diagnosis of sexually transmitted infections (STIs) during the COVID-19 pandemic.

METHODS

We conducted an observational retrospective population-based study using data from primary care electronic health records spanning from January 2016 to December 2022 (involving 5.1 million people older than 14 years). We described the daily number of new STI diagnoses from 2016 to 2022; as well as the monthly accumulation of new STI diagnoses for each year. We compared the monthly averages of new diagnoses in 2019, 2020, 2021 and 2022 using the T-test. Finally, we performed a segmented regression analysis of the daily number of STI diagnoses.

RESULTS

We analysed 200,676 new STI diagnoses. The number of diagnoses abruptly decreased coinciding with the lockdown. Overall in 2020, we observed a reduction of 15%, with higher reductions for specific STIs such as gonorrhoea (-21%), chlamydia (-24%), and HIV (-31%) compared to 2019. Following this drastic drop, which was temporarily associated with the lockdown, we observed a rapid rebound. In 2021, the number of STI diagnoses was similar to that of 2019. Notably, we found a considerable increase in 2022, particularly for non-specific STI, which lack laboratory confirmation (67% increase). HIV was the only STI with a reduction of up to -38% in diagnoses at the end of 2022 compared to 2019.

CONCLUSIONS

After a significant reduction in 2020, the number of STIs recorded in primary care rapidly rebounded, and the current trend is similar to that of 2019, except for HIV. These findings underscore the dynamic impact of the COVID-19 pandemic on STI diagnoses and highlight the importance of ongoing monitoring and public health interventions in the post-pandemic period.

Impact of the coronavirus disease 2019 pandemic on the diversity of notifiable infectious diseases: a case study in Shanghai, China

The outbreak of coronavirus disease 2019 (COVID-19) has not only posed significant challenges to public health but has also impacted every aspect of society and the environment. In this study, we propose an index of notifiable disease outbreaks (NDOI) to assess the impact of COVID-19 on other notifiable diseases in Shanghai, China. Additionally, we identify the critical factors influencing these diseases using multivariate statistical analysis. We collected monthly data on 34 notifiable infectious diseases (NIDs) and corresponding environmental and socioeconomic factors (17 indicators) from January 2017 to December 2020. The results revealed that the total number of cases and NDOI of all notifiable diseases decreased by 47.1% and 52.6%, respectively, compared to the period before the COVID-19 pandemic. Moreover, the COVID-19 pandemic has led to improved air quality as well as impacted the social economy and human life. Redundancy analysis (RDA) showed that population mobility, particulate matter (PM2.5), atmospheric pressure, and temperature were the primary factors influencing the spread of notifiable diseases. The NDOI is beneficial in establishing an early warning system for infectious disease epidemics at different scales. Furthermore, our findings also provide insight into the response mechanisms of notifiable diseases influenced by social and environmental factors.

The impact of the COVID-19 pandemic on chlamydia infection in South Korea: a comparison between the pre-pandemic and during-pandemic periods

Background

Prior to COVID-19 pandemic, a yearly upward trajectory in the number of chlamydia infection cases was observed in South Korea. However, in response to the COVID-19 pandemic, Korea implemented several public health and social measures, which were shown to have an impact on the epidemiology of other infectious diseases. This study aimed to estimate the impact of the COVID-19 pandemic on the incidence and number of reported chlamydia infections in South Korea.

Methods

Using the monthly number of reported chlamydia infection data between 2017 and 2022, we compared the trends in the reported numbers, and the incidence rates (IR) of chlamydia infection stratified by demographic characteristics (sex, age group, and region) in the pre- and during COVID-19 pandemic period (January 2017-December 2019 and January 2020-December 2022).

Results

We observed an irregular downward trajectory in the number of chlamydia infection in the during-pandemic period. A 30% decrease in the total number of chlamydia infection was estimated in the during-pandemic compared to the pre-pandemic period, with the decrease greater among males (35%) than females (25%). In addition, there was a decrease in the cumulative incidence rate of the during COVID-19 pandemic period (IR: 0.43; 95% CI: 0.42-0.44) compared to the pre-pandemic period (IR: 0.60; 95% CI: 0.59-0.61).

Conclusions

We identified decrease in the number of chlamydia infection during COVID-19 pandemic which is likely due to underdiagnosis and underreporting for the infection. Therefore, strengthening surveillance for sexually transmitted infections including chlamydia is warranted for an effective and timely response in case of an unexpected rebound in the number of the infections.

[Sexually transmitted infections under the influence of the COVID-19 pandemic]

Sexually transmitted infections (STI) in Germany are constantly rising. STI screening and testing decreased during the coronavirus disease 2019 (COVID-19) pandemic due to redistribution of public health resources. During the pandemic, there was a decline in the diagnosis of STIs. A minor aspect of this could be explained by reductions in the number of sexual contacts and therefore actual reduced infections, but the greater aspect seems to be due to underdiagnosis. A dramatic surge of infections is expected in the next few years. It is of utmost importance to resume STI screening for early detection and treatment and thereby lowering the transmission of STIs.

Impact of COVID-19 Pandemic on the Incidence of Sexually Transmitted Infections in Northern Finland in 2019 to 2022

The coronavirus SARS-CoV-2 (COVID-19) pandemic led to major restrictions in daily life and social contacts in Finland in March 2020. The effect of these restrictions on sexually transmitted infections (STIs) is unclear. The aim of this study was to analyse the incidence and positive rates of sexually transmitted infections in Northern Finland between 2020 and 2021 and compare these with the years prior to the pandemic. Numbers of positive Chlamydia trachomatis, HIV and hepatitis C samples were lower in 2020 to 2021 than in previous years, whereas more gonorrhoea and syphilis was found during pandemic than in previous years. The number of new cases of C. trachomatis reported each month decreased in the first months of the pandemic, but exceeded the prior pandemic-level in autumn 2020. When the mean positive sample rates were compared with the years 2015 to 2019, there was a significant decrease in positive C. trachomatis (p < 0.001) and hepatitis C (p < 0.001) sample rates in both 2020 and 2021. The positive rates for Treponema pallidum in 2020 did not differ significantly (p = 0.38) from previous years. In conclusion, these results show that sexually transmitted infections occurred despite recommendations for social distancing during the COVID-19 pandemic. Thus, easy access to STI testing should always be available, even during exceptional circumstances.

Use of healthcare reimbursement data to monitor bacterial sexually transmitted infection testing in France, 2006 to 2020

BackgroundDiagnoses of bacterial sexually transmitted infections (STIs) have increased in France since the 2000s. The main strategy to control STI transmission is recommending/facilitating access to condom use, testing, and antibiotic treatments.AimThis study analyses the evolution of STI testing in the private sector in France from 2006 to 2020.MethodsNational health insurance reimbursement data were used to determine numbers and rates of individuals aged ≥ 15 years tested for diagnoses of chlamydia, gonorrhoea and syphilis in the private sector in France and to describe their evolution from 2006 to 2020.ResultsUpward tendencies in testing were observed from 2006 to 2019 for all three STIs. The highest testing rates were identified in people aged 25‒29-years old. The observed testing-increase from 2017 to 2019 was twice as high in young people (< 25 years old) as in older people. In 2019, chlamydia, gonorrhoea and syphilis testing rates were respectively 45.4 (+ 21% since 2017), 41.3 (+ 60%), and 47.2 (+ 22%) per 1,000 inhabitants. For all STIs combined, the number of tested individuals decreased by 37% between March and April 2020 during the first COVID-19 epidemic wave and lockdown in France.ConclusionImprovements found in STI testing rates may have resulted from better awareness, especially among young people and health professionals, of the importance of testing, following prevention campaigns. Nevertheless, testing levels remain insufficient considering increasing diagnoses. In 2020, the COVID-19 pandemic had a considerable impact on STI testing. Partner notification and offering diverse testing opportunities including self-sampling are essential to control STI epidemics particularly in exposed populations.

Trends in risk behaviors and sexually transmitted infections among youth presenting to a sexually transmitted infection clinic in the United States, 2013-2017

Background: Sexually transmitted infections (STIs) are increasing among adolescents and young adults (AYA) across the United States. However, data are scarce on trends in condom use, number of partners, and other STI risk factors among AYA. The present study evaluated associations between sexual behaviors and STI diagnoses over time among AYA. Methods: We evaluated linked encounters of AYA aged 13-26 attending an urban Northeast public STI clinic from 2013-2017. Demographics, risk behaviors, self-reported past year and lifetime STI, and STI diagnosis during clinic encounter (positive test for urine, oral, or anal chlamydia; urine, oral, or anal gonorrhea; urine trichomonas; HIV; and syphilis) were extracted from electronic health records. We estimated prevalence and performed trend analyses of the repeated cross-sectional data. Cochran-Armitage and Kruskal-Wallis trend test were conducted for categorical and continuous variables, respectively. Results: Among 3822 encounters, clinical STIs demonstrated statistically significant increases including chlamydia (+9%, p = 0.001), gonorrhea (+5%, p = 0.008), and syphilis (+3%, p = 0.006) all of which significantly increased over time, as did any STI (+10%, p < 0.001). HIV and trichomonas rates remained low and unchanged. Self-reported STI increased as well, both past year (+9%) and lifetime (+14%). Greater proportions of AYA reported multiple partners (+9%, p < 0.001), and condomless oral (+12%, p = 0.001) and vaginal/anal (+7%, p = 0.001) sex. Conclusion: Among AYA presenting to a STI clinic, the proportion who engaged in condomless sex and had multiple partners increased over a 5 year period, which corresponded to increased STI prevalence during this period. Preventions efforts for AYA should continue to emphasize the importance of condoms and partner selection.

Sexual transmission of infections across Europe: appraising the present, scoping the future

Objectives: Our journal partnered with the Europe section of the International Union against STI (IUSTI) at a workshop held at the 18th European AIDS Conference in London on 30 October 2021. The workshop reviewed epidemiological trends and discussed STI care provision within HIV services across Europe. Methods and Results: We started by highlighting trends in bacterial STIs reported to the European Centre for Disease Prevention and Control from countries in the European Union/European Economic Area. This showed that notifications of bacterial STIs reached an all-time high in 2019, but are expected to be impacted by the COVID-19 pandemic in 2020-2021. We then reviewed the evolving relationship between STIs and HIV and pointed out how antiretroviral treatment and pre-exposure prophylaxis remain highly effective against HIV transmission despite the rising incidence of STIs. Within emerging concepts in STIs, we appraised the benefits and risks of asymptomatic screening for chlamydia, and also considered the potential perils of routinely testing for agents that lack a defined role in disease. Finally, we discussed standards of STI care for people living with HIV, informed by a brief survey of IUSTI Europe country representatives and members of the Euroguidelines in Central and Eastern Europe network. Conclusions: The survey indicated substantial variability and identified key improvement targets: fighting barriers to effective service provision and access, increasing diagnostic capability and taking leadership in driving up the quality of care. We must not forget the STI-related needs of the many people who will be living with HIV for decades into the future.

A Nationwide Observational Study of Chlamydia trachomatis Infections in Denmark during the COVID-19 Pandemic

The aim of this study was to determine whether COVID-19 restrictions had an impact on Chlamydia trachomatis infections compared with 2018 and 2019. A retrospective nationwide observational study was performed using monthly incidences of laboratory-confirmed chlamydia cases and number of tests, obtained from Danish national surveillance data. Testing rates and positivity rates were compared using Poisson and logistic regression. The first Danish COVID-19 lockdown (12 March to 14 April 2020) resulted in a reduction in the number of chlamydia tests performed (rate ratio 0.72, 95% confidence interval  0.71–0.73) and a consequent reduction in the number of laboratory-identified cases (66.5 vs 88.3 per 100,000 population during the same period in 2018 to 2019). This period was followed by a return of testing and test positivity close to the level seen in 2018 to 2019. The second Danish COVID-19 lockdown (17 December to 31 March 2021) resulted in crude incidence rates of laboratory-confirmed chlamydia infection that were similar to the crude incidence rates seen during same period in 2018 to 2019. In conclusion, the Danish COVID-19 restrictions have had negligible effects on laboratory-confirmed C. trachomatis transmission.

Potential impact of the COVID-19 pandemic on the national and regional incidence, epidemiology and diagnostic testing of chlamydia and gonorrhoea in Sweden, 2020

The COVID-19 pandemic has challenged the societies and health care systems globally, and resulted in many social and physical distancing restrictions to limit the spread of SARS-CoV-2. These restrictions have also likely affected the frequency of intimate contacts and the spread of sexually transmitted infections (STIs). Compared to most other countries, Sweden especially in Spring-Autumn 2020 pursued mainly milder voluntary, that is, not mandatory enforced by laws, recommended restrictions and the impacts of these on society and spread of STIs remain largely unknown. We describe the potential impact of the COVID-19 pandemic on the national and regional incidence, epidemiology and diagnostic testing of chlamydia and gonorrhoea in Sweden in 2020. Compared to 2019, we found a significant decrease in incidence of chlamydia (-4.5%) and gonorrhoea (-17.5%), and in diagnostic testing (-10.5% for chlamydia, -9.4% for gonorrhoea) in 2020. However, the decrease in chlamydia incidence, which has mainly been decreasing in the last 10 years, was not significant when compared with the average incidence in 2017-2019. The largest decrease in national incidence of both infections was observed among young and heterosexual patients, however, some Swedish regions showed an increased incidence, particularly of chlamydia. Increased "internet-based self-sampling" testing approach partly compensated for a decreased attendance at STI clinics. Studies, including sexual behaviour, prevention, reasons for attending STI health care, STIs in different anatomical sites and management of STIs, are required to elucidate the impact of COVID-19-associated social and physical distancing restrictions on sexual activity and the incidence and epidemiology of chlamydia and gonorrhoea in Sweden.

Effects of the Covid-19 pandemic on head lice and scabies infestation dynamics: a population based study in France

BACKGROUND

Lockdowns and physical distancing have dramatically limited the circulation of SARS-CoV-2 and other common communicable infections. However, little is known about their impact on head lice and scabies.

OBJECTIVES

To assess the impact of the 2020 French National lockdowns (March 17^th -May 11^th , and Oct 30^th -Dec 15^th ) and physical distancing recommendations (from February 2020) on the head lice and scabies infestation dynamics.

METHODS

The weekly sales of topical head lice treatments, topical scabies treatments, and oral ivermectin were extracted from the IQVIA database (60% of all French retail pharmacies) and analysed over a 5-year period (March 2016 - December 2020). A periodic regression model was fit to drug sales before the COVID-19 period (i.e. 2016-2019) and extrapolated afterwards in order to compare the sales observed in 2020 to the expected sales.

RESULTS

A decrease of the sales of tracer topical treatments for head lice and scabies was observed from March 2020, synchronously with the first French national lockdown. For the period March 2020-December 2020, the mean reduction in observed versus expected sales were 44% and 14% for head lice and scabies topical treatments, respectively. On the other hand, the observed decrease of oral ivermectin sales after March 2020 was much lower (4%), probably because of studies reporting the potential positive effects of this drug on the Covid-19 infection.

CONCLUSION

COVID-19 lockdown and physical distancing reduce circulation of head lice and scabies in France. Further studies are needed to assess long term impact of these social behaviour changes.

Impact of the SARS-COV-2 Pandemic Lockdown on Sexually Transmitted Urethritis in a Spanish Health Region

Background The incidence of sexually transmitted diseases (STD) has increased in recent years, especially in the young population. Urethritis is one of the most common clinical presentations of STD in emergency departments. During the SARS-COV-2 pandemic, in Spain lockdown lasted almost three months, and mobility was greatly restricted. This is the first study of these characteristics conducted in Spain. Methods A cross-sectional study of all patients treated for clinical symptoms of urethritis between March and June 2019 and between March and June 2020 was conducted. We evaluated patients' sociodemographic and clinical variables. Results Seventy-nine patients were included in the study: 37 in 2019 and 38 in 2020 of whom 94.9% were men. The main symptoms were urethral discharge (59.5%) followed by dysuria (26.6%). Risky sexual relations were reported by 63.2% of patients in 2019, and this percentage decreased to 43.9% in 2020. Conclusions The number of patients attending an emergency department in our health region for urethritis did not undergo any variations between 2019 and 2020. No significant reduction in the number of cases of urethritis was observed, probably because people continued with unsafe sexual relations despite the social restrictions and difficulties posed by the lockdown.

The impact of the coronavirus disease 2019 epidemic on notifiable infectious diseases in Taiwan: A database analysis

Introduction

The impact of the COVID-19 pandemic on the incidence of notifiable infectious diseases (NIDs) in Taiwan remains unclear.

Materials and methods

The number of cases of NID (n = 42) between January and September 2019 and 2020 were obtained from the open database from Taiwan Centers for Disease Control.

Results

The number of NID cases was 21,895 between January and September 2020, which was lower than the number of cases during the same period in 2019 (n = 24,469), with a decline in incidence from 102.9 to 91.7 per 100,000 people in 2019 and 2020, respectively. Fourteen airborne/droplet, 11 fecal-oral, seven vector-borne, and four direct-contact transmitted NID had an overall reduction of 2700 (−28.1%), 156 (−23.0%), 557 (−54.8%), and 73 (−45.9%) cases, respectively, from 2019 to 2020. Similar trends were observed for the changes in incidence, which were 11.5 (−28.4%), 6.7 (−23.4%), 2.4 (−55.0%), and 0.3 (−46.2%) per 100,000 people for airborne/droplet, fecal-oral, vector-borne, and direct-contact transmitted NID, respectively. In addition, all the 38 imported NID showed a reduction of 632 (−73.5%) cases from 2019 to 2020. In contrast, 4 sexually transmitted diseases (STDs) showed an increase of 903 (+7.2%) cases from 2019 to 2020, which was attributed to the increase in gonorrhea (from 3220 to 5028). The overall incidence of STDs increased from 52.5 to 56.0 per 100,000 people, with a percentage change of +6.7%.

Conclusion

This study demonstrated a collateral benefit of COVID-19 prevention measures for various infectious diseases, except STDs, in Taiwan, during the COVID-19 epidemic.