COVID-19 Diagnoses Linked to Rise in STI Rates in Some US Counties

Higher rates of COVID-19-related mortality and incident infections are associated with county-level increases sexually transmitted infection (STI) rates in the United States, according to study findings published by Sexually Transmitted Diseases. 

Researchers conducted a nationwide, county-level ecologic study to determine the association between COVID-19 diagnoses, deaths and STI rates. Data were collected from the USA Facts database. The primary exposure was county-level incidence of COVID-19 infection, and the secondary exposure was county-level COVID-19-related mortality. The primary outcomes included aggregated diagnoses of chlamydia, gonorrhea, and syphilis per 100,000 persons in 2020. Primary outcome data were collected from the Centers for Disease Control and Prevention (CDC). Covariates included age, race, ethnicity, education level, rurality (urban, suburban, rural), employment rates, and income. 

Changes in STI rates were assessed via descriptive statistics, and Wilcoxon signed-rank testing was used to determine significance. Poisson regression models were used to determine associations between exposures and outcomes of interest. Incident rate ratios (IRRs) were calculated with bivariate models. Multivariable models were used to adjust for covariates. 

The researchers observed that STI rates changed significantly between 2019 and 2020 (P <.001). From 2019 to 2020, county-level chlamydia rates decreased by a mean (SD) of 38 (124) diagnoses and county-level gonorrhea rates increased by 16 (74.9) diagnoses.

After adjusting for covariates, the researchers found that every 1,000 additional COVID-19 diagnoses were linked to a 1.80% increase in the mean number of county-level chlamydia diagnoses in 2020 (IRR, 1.02; 95% CI, 1.01-1.03; P <.001). However, no statistically significant association was found between COVID-19-related mortality and chlamydia rates (IRR, 1.25; 95% CI, 1.00-1.56; P =.054). 

The adjusted analysis also showed that every 1,000 additional COVID-19 diagnoses was associated with a 5.00% increase in the mean number of gonorrhea diagnoses (IRR, 1.05; 95% CI, 1.04-1.06; P <.001). For every 1,000 additional 1,000 COVID-19-related deaths, there was a 57.9% increase in the mean number of gonorrhea diagnoses (IRR, 1.58; 95% CI, 1.10-2.27; P <.001). 

No significant associations were found between COVID-19 and syphilis diagnoses (IRR, 1.00; 95% CI, 0.97-1.02; P =.760). However, for every 1,000 additional COVID-19-related deaths, the mean number of syphilis diagnoses decreased by 74.2% (IRR, 0.26; 95% CI, 0.10-0.64; P =.004).

Limitations of this study include the lack of consideration for social restrictions and policy decisions related to the COVID-19 pandemic. Further, data were only available in aggregate for a single year, and STI diagnoses were unable to be stratified by gender identity, sex assigned at birth, or sexual orientation.

“Ongoing and future pandemic preparedness efforts should consider the impact that decisions made to reduce the burden of 1 disease may have on other infectious diseases of public health importance,” the researchers concluded.

This article originally appeared on Infectious Disease Advisor