Pandemic-related declines in testing, ‘sexual distancing’ cause dip in reported STDs
After hitting record highs for years before the COVID-19 pandemic, reported cases of chlamydia, gonorrhea and syphilis dipped below projections for 2020 in the United States, researchers reported.
According to the CDC, the lower rate of reported STDs was not unexpected and can be attributed to shifts in resources, declines in testing because of clinic closures related to the pandemic, and “sexual distancing” caused by stay-at-home orders.
“Before COVID-19, the United States was battling steep and sustained increases in STD cases. Gonorrhea, syphilis and chlamydia have been at record highs for the last five years,” Gail Bolan, MD, director of the CDC’s Division of STD Prevention, said during a CDC roundtable on Monday as the agency’s STD Prevention Conference got underway.
Bolan said preliminary data for 2019 showed that a trend in yearly increases in STD cases is expected to continue.
According to Hillard Weinstock, MD, MPH, chief of surveillance and data in the Division of STD Prevention, preliminary 2019 data showed there were 1.76 million cases of chlamydia, approximately 602,000 cases of gonorrhea and around 123,000 cases of syphilis reported last year in the U.S., with a 20% increase in syphilis cases among newborns. Those would represent increases compared with 2018 numbers for each of the three reportable STDs.
Weinstock said the increase continued, and reported STD cases in the first 2 months of 2020 surpassed 2019 levels, but “that changed by early March.” Compared with the same period in 2019, cases of chlamydia, gonorrhea and syphilis were down 53%, 33% and 33%, respectively, in the spring this year, according to the CDC.
Data for both years are still being compiled, however.
“The decrease may be underestimated,” Weinstock said.
As an example, the CDC noted that 28% of STD and HIV testing sites in the St. Louis region were closed — and 63% operated with modified services — during the height of COVID-19 restrictions. Only 8% of sites operated with no changes. As a result, testing for chlamydia and gonorrhea fell 45% overall, and the CDC estimated that 5,000 HIV tests were missed.
According to Bolan, many factors have contributed to the resurgence of STDs in the U.S., including social, cultural and socioeconomical circumstances such as discrimination, decreased condom use in high-risk groups and cuts in essential programs.
“COVID-19 compounded several of these factors and showed signs of exasperating pre-existing racial and ethnic disparities in health care,” Bolan said. “Despite these challenges, I believe it is possible to mitigate the current STD increases even in the midst of an STD pandemic it will require new commitment and innovation on the ground.”