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Covid-19: Sexually transmitted diseases surged in US during pandemic

BMJ 2022; 377 doi: (Published 20 May 2022) Cite this as: BMJ 2022;377:o1275
  1. Janice Hopkins Tanne
  1. New York

US cases of gonorrhoea, syphilis, and congenital syphilis declined at the beginning of the covid-19 pandemic in 2020, but then rose markedly for the rest of the year, the US Centers for Disease Control and Prevention (CDC) has reported. Chlamydia declined slightly. The CDC cautioned that the data may be an undercount because of the pandemic.12345

In 2020 there were 2.4 million cases of sexually transmitted diseases (STDs), the CDC said. This included 677 769 cases of gonorrhoea (a 45% increase from 2016), 133 945 cases of syphilis (a 52% increase from 2016), 2145 cases of congenital syphilis (a 235% increase from 2016), and 1579 885 cases of chlamydia (a 1.2% decrease from 2016.)

Leandro Mena, director of CDC’s division of STD treatment, said the pandemic had increased awareness of what was long known about STDs, “Social and economic factors—such as poverty and health insurance status—create barriers, increase health risks, and often result in worse health outcomes for some people. If we are to make lasting progress we have to understand the systems that create inequities and work with partners to change them.”

The CDC’s report said the decline in chlamydia, the most common STD, was most likely because of changes in screening rather than a drop in new infections. Cases were highest among young adults aged 15-24. Since chlamydia is usually asymptomatic, diagnosis depends on screening or routine preventive care. During the pandemic many health departments redirected employees to help control covid-19, thus reducing screening, and emphasised diagnosis and treatment of syphilis and gonorrhoea.

Syphilis continued to surge, leading to another year of increases in congenital syphilis, up 15% from 2019 and 235% from 2016. In 2020 there were 149 stillbirths and infant deaths, a 210% increase from 2016. Some 47 of the 50 US states reported at least one case of congenital syphilis in 2020, compared with only 24 states in 2011.

The most common missed opportunity in preventing congenital syphilis occurred because 41% of mothers did not receive timely prenatal care or syphilis testing. Primary and secondary syphilis (the most infectious phases) among women aged 15-44 increased by more than 156% from 2016 to 2020. Early data from 2021 indicate that primary and secondary syphilis and congenital syphilis are continuing to increase, with congenital syphilis cases already higher than in 2020.

Reported cases of gonorrhoea have increased 111% since the historic low in 2009. During 2019-2020, gonorrhoea cases increased among both men and women in 36 of the 50 states and in two US territories. Cases increased in most racial and ethnic groups, with the greatest increases among non-Hispanic Black and African American people and non-Hispanic people of multiple races.

Since 2013, cases of gonorrhoea have been higher in men than in women, reflecting cases in men who have sex with men and men who have sex with women. During 2019-2020, cases increased in both men and women but the increase was greater in women. Preliminary data for 2021 suggest that about one third of cases of gonorrhoea in 2020 occurred in men who have sex with men.

Gonorrhoea resistance to antibiotics can develop quickly and in 2020 about half of infections were resistant to at least one antibiotic. In December 2020, CDC updated gonorrhoea treatment guidelines and recommended a single 500 mg intramuscular dose of ceftriaxone for uncomplicated gonorrhoea.

More than half of STDs occurred in young people aged 15-24.

Rates of STDs are higher among minority groups than among non-Hispanic whites. In 2020, 32% of all cases of chlamydia, gonorrhoea, and primary and secondary syphilis occurred in non-Hispanic Black people, although they make up only about 12% of the US population. Men who have sex with men were disproportionately impacted by sexually transmitted disease. These disparities likely do not reflect differences in sexual behaviour but differences in access to quality healthcare and the likelihood that, since rates are higher in minority communities, community members are more likely to encounter an infected partner.

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