EXECUTIVE SUMMARY

The United States has seen increasing rates of sexually transmitted infections (STIs) for the past six years, but it is not yet clear if the trend has continued in 2020.

  • Emerging evidence may suggest that STIs are declining during the pandemic.
  • It is likely that early data are incomplete because of disruption in STI testing and contact tracing due to the pandemic.
  • Only 8% of STI clinics in the United States functioned under normal conditions after March 2020.

Rates of sexually transmitted infections (STIs) have increased in the United States for the past six years, but the big question is whether that trend continued in 2020, despite the COVID-19 pandemic.

Emerging evidence suggests it is unclear if rates are rising or falling.1

“The reality is we have no idea,” says Theodore Rosen, MD, professor and vice-chair of dermatology at Baylor College of Medicine in Houston. “Between 2014 and 2018, year over year, there were fairly significant increases in virtually all the STIs: gonorrhea, syphilis, chlamydia.”

Preliminary results for 2019 suggest the same trend continues. “For the first few months of 2020, it looked like that trend was going to continue. But from very preliminary nationwide data, from March to October, there was a massive decrease in STIs, on the order of more than 30%,” Rosen explains. “The question is whether this is real or an artifact.”

The decrease could be real and a consequence of people sheltering at home instead of going out to bars or parties. Also, some places, like New York state, ran public campaigns that encouraged people to practice virtual sex and self-pleasuring, Rosen says. “Two people can get on their computers at the same time, watching the same pornographic movie.”

New technology even offers some assistance with virtual sex. “An interesting device that is apparently selling out is where you can virtually control another person’s vibrator,” Rosen says.

Plus, many people have experienced anxiety, lost jobs, reduced self-esteem, and mild depression during the COVID-19 crisis. These could affect people’s interest in sexual activity, he notes.

“Those are all good reasons to have less STIs, so maybe the 30% reduction is real,” Rosen says.

But clinicians might not want to depend on that because there are other scenarios that could be playing out. For instance, it is possible that the number of STIs is down because fewer people are collecting those numbers and people have been less likely to undergo STI tests during the pandemic.

“Epidemiologists who used to trace these things have been deployed to do tracing for COVID and not STIs,” Rosen says. “There was a massive condom shortage because of manufacturing plants overseas having to shut down when so many of their workers got sick.”

In the United States, one-fourth of STI clinics closed since March because of a personal protective equipment shortage, such as masks, face shields, and gowns. “Only 8% of STI clinics in the U.S. actually function under normal conditions. The remaining two-thirds can function, but have greatly reduced hours or days because of people being out sick with COVID-19,” Rosen explains.

The result could be an increase in STIs because fewer people are being tested. Also, STI clinics are largely run by cities and counties that may cut finding when there is a budget crisis, he notes. The decrease noted in preliminary data could simply be the result of inaccurate or incomplete data collection.

“There are good reasons why there should be more STIs, and good reasons why there should be less STIs — and we really don’t know,” he adds. “We won’t know the truth until a year or two from now.”

Rosen has seen an increase of STIs in his practice. “I probably have seen more syphilis in the first six months since COVID-19 started in March than I did in the six months before the pandemic,” Rosen says.

REFERENCE

  1. Wiggins CJ, Rosen T. Sexually transmitted diseases in the COVID-19 era. Skinmed 2020;18:210-212.