STIs and the COVID‐19 pandemic: the lockdown does not stop sexual infections

Abstract

Editor In December 2019, a novel coronavirus (SARS‐CoV‐2) emerged in Wuhan, China, responsible for an aggressive interstitial pneumonia. 1 Italy was the first Western country to be hit by the coronavirus disease 2019 (COVID‐19), and on 9 March, our Prime Minister announced a nationwide lockdown, strictly forbidding any contacts outside cohabitants, except for urgent or medical reasons. In compliance with the ministerial decree, all scheduled visits were suspended, maintaining hospital access only for emergencies. While the initial guidelines to reorganize medical activities during the pandemic were focused on the management of inflammatory, autoimmune and neoplastic disorders, scarce attention was paid to sexually transmitted infections (STIs) and STI clinics. We report here data of our STI clinic, one of the 12 Italian clinical sentinel sites for the surveillance of STIs, which is located in the Provincia Autonoma di Trento, the Italian district most affected by COVID‐19 (cumulative incidence: 1007.77 cases/100 000 inhabitants). 2 During the lockdown (9 March – 4 May), we diagnosed, by NAATs, 9 Chlamydia trachomatis infections and 2 Neisseria gonorrhoeae infections (one of these patients experienced a reinfection during the lockdown despite a negative‐tested partner), and 4 cases of syphilis (Table 1). Table 1 Age, sex, disease, onset of symptoms and history of exposure in the described population during the Italian lockdown (9 March‐4 May) Patient Age Sex STI DoD S.O. RRSB Note 1 25 M C. trachomatis 11 March 12 February NO Condom breaking 2 26 M C. trachomatis 25 March 16 March NO Known infection in the partner 3 32 M C. trachomatis 25 March 15 March YES 4 30 M C. trachomatis 8 April 25 April YES 5 26 M C. trachomatis 8 April 14 March YES Unprotected sexual intercourse on 9 March 6 31 M C. trachomatis 29 April 29 February YES N.gonorrhoeae 3 years before 7 28 F C. trachomatis 10 March N.S. YES Known infection in the partner 8 21 F C. trachomatis 22 April 21 March NO Known infection in the partner 9 21 F C. trachomatis 1 May 23 March YES 10 38 M N. gonorrhoeae 16 March 6 March YES 2 N. gonorrhoeae infections during lockdown with negative‐tested partner 11 29 M N. gonorrhoeae 25 March 15 March YES 12 45 M Syphilis (Primary) 4 May 21 March YES Ongoing HIV‐PrEP 13 59 M Syphilis (Latent) 24 April NS NO Last negative serology dated 2016 14 21 F Syphilis (Latent) 3 April NS NO Unprotected sexual intercourse in December 2019 15 53 F Syphilis (Latent) 10 April NS NO DoD, date of diagnosis, F, female; M, male; N.S., no symptoms; PrEP, pre‐exposure prophylaxis; RRSB, referred risky sexual behaviour during lockdown; S.O., (referred) symptoms/signs onset; STI, sexually transmitted infection. John Wiley & Sons, Ltd This article is being made freely available through PubMed Central as part of the COVID-19 public health emergency response. It can be used for unrestricted research re-use and analysis in any form or by any means with acknowledgement of the original source, for the duration of the public health emergency. Concerning the urethritis and cervicitis, symptoms were reported by 10 of 11 patients, while the last patient was asymptomatic but underwent testing because her partner had recently received a diagnosis of C. trachomatis infections. Regarding the cases of syphilis, 3 were latent, and 1 was primary. Of these 15 STIs, 9 patients referred risky sexual behaviour during lockdown. In the same period in 2019, we had diagnosed 17 STIs: 6 C. trachomatis infections, 7 N. gonorrhoeae infections, 1 concomitant infection of C. trachomatis and N. gonorrhoeae, and 3 latent syphilis. Therefore, the incidence was comparable, despite the unlimited number of daily accesses possible in 2019. Common sense suggests that social isolation and the closure of leisure venues may significantly reduce the opportunity for casual sexual encounters, and some authors suggested that quarantine and social distancing measures might reduce the incidence of STIs in the future. 3 However, our recent experience strengthened the lesson learned from the AIDS epidemic: ‘not having sex is not an option’. Even though resources from health systems are often redirected in response to an outbreak, crucial healthcare services should remain accessible during public health emergencies. 4 Therefore, we suggest that visits of STI patients should not be cancelled, making use of teledermatology where possible and visiting any doubtful cases. Moreover, patients should not be discouraged to seek STI screening, because risky behaviours do not seem to decrease during the pandemic and, not least, a delay in diagnosis could result in sequelae and complications. Finally, our key message is a reiteration, referred to STIs, of the WHO Director‐General’s words during the pandemic: ‘We have a simple message for all countries: test, test, test’. 5 All authors have agreed to the contents of the manuscript in its submitted form. Funding sources None. Conflict of interest The authors have no conflict of interest to disclose. References 1 Huang C , Wang Y , Li X et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395: 497–506.31986264 2 https://www.epicentro.iss.it/coronavirus/bollettino/Bollettino‐sorveglianza‐integrata‐COVID‐19_16‐giugno‐2020.pdf (last access 23 June 2020). 3 Alpalhão M , Filipe P . The impacts of isolation measures against SARS‐CoV‐2 infection on sexual health. AIDS Behav 2020; 1–2. [Epub ahead of print] 10.1007/s10461-020-02853-x 30903450 4 Tran NT , Tappis H , Spilotros N , Krause S , Knaster S . Inter‐Agency Working Group on Reproductive Health in Crises. Not a luxury: a call to maintain sexual and reproductive health in humanitarian and fragile settings during the COVID‐19 pandemic. Lancet Glob Health. 2020; 8: e760–e761.32330429 5 https://www.who.int/dg/speeches/detail/who‐director‐general‐s‐opening‐remarks‐at‐the‐media‐briefing‐on‐covid‐19–‐16‐march‐2020 (last access 22 May 2020).