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

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.

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.