Global social distancing, which was a key element promoted by public health officials to prevent the transmission of the SARS-CoV-2 virus, has never been practiced to this extent in modern history. This practice has had many effects that go beyond slowing the transmission of COVID-19.
One area that social distancing has impacted is sexually transmitted disease (STD) and its related treatments. You might expect that social distancing would reduce STD rates. However, the data are more complex. Let’s take a look at the results.
STD testing declined during the COVID-19 pandemic
With the focus on containing the global pandemic, STDs and STD clinics didn’t receive much attention. COVID-19 emergency measures impacted non-emergency medical care including STD care. Prior to the COVID-19 pandemic, STD rates were increasing. A major concern is that diseases such as chlamydia, syphilis, and gonorrhea are asymptomatic and may therefore have been perceived as non-urgent and not prioritized.
There are several reasons for the decline in STD care and testing during the COVID-19 pandemic:
- Socioeconomic impacts such as job loss leading to insurance coverage disruption in some countries
- Decreased sexual activity may have led to reduced actual and/or perceived rates of risk
- Fears of COVID-19 infection
However, STDs didn’t disappear simply because of the arrival of the novel coronavirus. The U.S. Centers for Disease Control and Prevention estimates that approximately 20% of all Americans have an STD. Now that data on how the COVID-19 pandemic has affected STD rates have begun to emerge, it’s become apparent that the prevalence of infections may have increased.
An increase in STD cases?
Again, you might expect that exposure to STDs would lessen during social distancing and isolation measures, hence the incidence rate would decrease as well. But researchers note the lessons learned from the AIDS epidemic. As sexual health is a fundamental human need it’s implausible to assume sexual contact will cease for the duration of the pandemic.
As data emerged during the pandemic this viewpoint gained acceptance as higher numbers of STD cases were found by some researchers. But what are the explanations for an unexpected actual increase in cases? One possible reason for a rise in cases may be the prioritizing of symptomatic cases during the pandemic.
It is difficult to determine whether cases have increased overall on a large scale. Reports of declining case numbers have also emerged. This may be coincident with the decrease in testing during COVID-19 lockdown periods. Fear of COVID-19 and the protective measures implemented to control the virus have had an impact on STD/HIV transmission dynamics.
STDs, associated risks, and younger patients
Asymptomatic patients, typically adolescents and young adults, can be at greater risk from the complications posed by STDs than the general population. The associated risks arising from contracting an STI include:
- Infertility
- Pelvic inflammatory disease
- Susceptibility to subsequent human immunodeficiency virus (HIV) infection
Subsequent exposure of the STD to multiple partners
Younger women are at an increased risk of complications due to chlamydia and gonorrhea. Some public health officials call for routine testing. Routine testing for Chlamydia trachomatis has been pivotal to preventative care for adolescents for over 30 years.
The testing and treatment process for STDs is already a clinically challenging process that includes patient confidentiality, disclosure, and sensitive discussions between doctors, adolescents, and parents. During the COVID-19 pandemic, the adoption of telehealth services to provide care at a distance may have contributed to the rise in STD rates. While meant to add convenience, adolescents may have encountered increased challenges. Maintaining confidentiality is difficult when your parents are home listening to a video or phone appointment. It also made the collection standards of conventional STD care more difficult.
The positives and negatives of the pandemic on STD care
STD public health measures such as contacting the partners of infected cases may have been diverted due to the implementation of COVID-19 protective measures. Most likely, the pandemic led to disruption in manufacturing priorities, products, and services in these ways:
- COVID-19 testing limited the availability of the required materials for nucleic acid amplification testing
- Antibiotics were in short supply due to the increased demand by hospitalized patients
- The HPV vaccine as an established STI prevention measure was curtailed by pressure on clinic services and general disruption to public vaccination programs
On a positive note, the pandemic led to innovative measures for improvement in clinical care such as telehealth (except for adolescents) and advances in testing diagnostics and approaches. Such advancements can and should also be applied to the STD epidemic.
An STD epidemic?
While the pandemic may have resulted in some periods in which transmission rates of STD declined, overall, the social distancing and isolation measures lead to higher rates overall. The emergent data support this viewpoint. Some researchers warn that the “expected rebound in STI/HIV incidence will require an appropriate and timely public health response.”