(65) Impact of COVID-19 pandemic on STIs in young adults

Background: The COVID-19 pandemic adversely affected young adults' reproductive health services, resulting in fluctuating positivity rates prompting a need to better understand the prevalence and trends of sexually transmitted infections in this young adult 18-24 years cohort seen a large urban free community clinic system of nine school-based and family planning clinics.

Methods: Retrospective chart review of patients categorized based on the year of their visit: 2019 (pre-pandemic), 2020 (phase 1), and 2021 (phase 2). Time-to-treatment (TTT) was evaluated based on the date of screening, matched with STI diagnoses and dispensed medications. To ensure data accuracy, we identified potential outliers with TTT exceeding 30 days and conducted targeted chart reviews. Patients for whom treatment could not be confirmed through this process were classified as untreated.

Results: The study included 26,895 patients over three years, with 18% fewer patients seen in phase 1 compared to the pre-pandemic year. Fewer patients were tested and tested positive for both CT and GC in 2020 (930 of 5702, 16.3%; 332 of 5768, 5.8%) than in 2019 (1244 of 6767,18.4%; 412 of 6762, 6.1%) and 2021 (1179 of 6271,18.8%; 604 of 6264, 9.6%) (p < 0.001). Proportion of tested patients with positive syphilis and HIV tests remained similar pre-COVID (53 of 5977, 0.0088%; 8 of 5974, 0.0013%), in phase 1 (45 of 5013, 0.0089%; 8 of 4925, 0.0016%), and phase 2 (60 of 5679, 0.01%; 10 of 5630, 0.0017%) (p = 0.581 and 0.83). Time-to-treatment of positive CT results was shortest pre-pandemic at 6.6 days (SD 20.2) vs. 7.7 days (SD 43.7) in phase 1, and 8 days (SD 26.9) in phase 2, though the differences were not statistically significant (p = 0.056). Fewer patients went untreated for CT in 2020 and 2021 (2.8% and 2.2%) than in 2019 (p= 0.004). In contrast, TTT for GC was shortest in 2020 (2.9 days, SD 10.3) as compared with the pre-pandemic year (4.6 days, SD 15.8) and phase 2 of the pandemic (4.7 days, SD 14.4) (p = 0.0011). No significant differences were found in patients untreated for GC through the three years of study (2.4%, 2.1%, and 3.8%, p = 0.253).

Conclusions: While STI testing rates among young adults declined during the start of the COVID-19 pandemic, positivity rates for GC and CT also decreased. GC and CT positivity increased again in phase 2. Adverse treatment outcomes, such as prolonged TTT or untreated cases, were not observed for CT or GC in phases 1 or 2. There were no significant changes in the positivity rates of HIV and syphilis over the three years of study. While some studies have reported increased rates of syphilis and gonorrhea in post pandemic phases, this was not observed in this cohort.