STI Testing and Rates of STI Diagnoses Before and During the COVID-19 Pandemic in a US HIV Cohort.

BACKGROUND

The COVID-19 pandemic affected sexually transmitted infection (STI) testing and diagnosis rates in the United States, but these patterns have not been well characterized among people with HIV.

METHODS

We analyzed medical records data of HIV Outpatient Study (HOPS) participants seen for HIV care from January 2019 to March 2021, with ≥1 CD4+ cell count and viral load test results recorded. We used Poisson regression models to estimate rate ratio (RR) and 95% confidence interval (CI) to compare STI testing and diagnoses rates on/after versus before March 1, 2020 (early COVID-19 pandemic [pandemic] vs. prepandemic).

RESULTS

Of 2311 eligible patients, STI tests (STI cases, primarily defined as test results that were positive) were as follows during the analysis time frame: 4991 gonorrhea (157), 4978 chlamydia (135), and 4216 syphilis (114). Comparing pandemic versus prepandemic periods, STI testing RRs were 0.78 for both gonorrhea (95% CI, 0.73-0.82) and chlamydia (95% CI, 0.73-0.83), and 0.93 for syphilis (95% CI, 0.88-0.99); diagnosis rates were not statistically different. Multivariable models showed reduced testing for gonorrhea (adjusted RR, 0.79; 95% CI, 0.72-0.87) and chlamydia (adjusted RR, 0.78; 95% CI, 0.71-0.86) for men who have sex with men, but not for other HIV transmission groups.

CONCLUSIONS

The fallout of the COVID-19 pandemic on sexual health may not be seen for some time. Despite reduced STI testing, rates of STI diagnoses did not decrease. It will take a return to more routine screening and improved access to sexual health care to uncover the true impact of undetected or untreated STIs.