Decreases in Reported Sexually Transmitted Infections During the Time of COVID-19 in King County, WA: Decreased Transmission or Screening?

Abstract

Background: In response to the COVID-19 pandemic, Washington State's Stay Home, Stay Healthy (SHSH) order was implemented on March 24, 2020. We hypothesized that pandemic mitigation measures might reduce sexually transmitted infection (STI) screening and/or transmission.

Methods: We used King County, WA STI surveillance and sexual health clinic (SHC) data from January 1, 2019, to July 31, 2020. We calculated mean weekly case counts for gonorrhea, primary and secondary (P&S) syphilis, male urethral gonorrhea, and early latent (EL) syphilis for 3 periods in 2020: pre-SHSH (January 1-March 23), SHSH (March 24-June 5), and reopening (June 6-July 31). Primary and secondary syphilis and male urethral gonorrhea were used as proxies for sexual behavior, and EL syphilis was used as a proxy for STI screening. We compared SHC visits (2019 vs. 2020) and SHC gonorrhea treatment practices (across 2020 periods).

Results: Compared with January to July 2019, from January to July 2020, reported cases of gonorrhea, male urethral gonorrhea, P&S syphilis, and EL syphilis decreased by 9%, 5%, 16%, and 22%, respectively. Mean weekly case counts of gonorrhea, male urethral gonorrhea, and EL syphilis decreased pre-SHSH to SHSH, but all returned to pre-SHSH levels during reopening. Sexual health clinic visits during SHSH were 55% lower in 2020 than in 2019. In the SHC during SHSH, ceftriaxone treatment of gonorrhea decreased, whereas cefixime/cefpodoxime treatment and gonorrhea treatment with no testing increased.

Conclusions: Decreases in reported STIs concurrent with COVID-19 SHSH may reflect a true decline in STI transmission. However, the larger decreases in asymptomatic infections indicate that much of the observed decrease was likely due to decreased screening.

Figure 1

A, Weekly gonorrhea cases reported in King County, WA, comparing 2019 (dashed line) and 2020 (solid line) across 3 COVID-19 pandemic mitigation periods: prepandemic, stay-at-home order (Stay Home, Stay Healthy), and reopening (Safe Start). During Stay Home, Stay Healthy, gonorrhea cases in 2020 were lower than the same period in 2019. B, Weekly urethral gonorrhea cases among men reported in King County, WA, comparing 2019 (dashed line) and 2020 (solid line) across 3 COVID-19 pandemic mitigation periods: prepandemic, stay-at-home order (Stay Home, Stay Healthy), and reopening (Safe Start). During Stay Home, Stay Healthy, urethral gonorrhea cases in 2020 were lower than the same period in 2019 but had returned to same level in Safe Start. C, Weekly primary and secondary (P&S) syphilis, reported in King County, WA, comparing 2019 (dashed line) and 2020 (solid line) across 3 COVID-19 pandemic mitigation periods: prepandemic, stay-at-home order (Stay Home, Stay Healthy), and reopening (Safe Start). During Stay Home, Stay Healthy, P&S syphilis cases in 2020 were lower than the same period in 2019 but were slightly higher during Safe Start. D, Weekly early latent/early nonprimary nonsecondary syphilis reported in King County, WA, comparing 2019 (dashed line) and 2020 (solid line) across 3 COVID-19 pandemic mitigation periods: prepandemic, stay-at-home order (Stay Home, Stay Healthy), and reopening (Safe Start). During Stay Home, Stay Healthy, and Safe Start, early latent cases in 2020 were lower than the same period in 2019.

Figure 2

A, Weekly gonorrhea (solid line) and urethral gonorrhea cases among men (dashed line) reported in King County, WA, comparing 2020 across 3 COVID-19 pandemic mitigation periods: prepandemic, stay-at-home order (Stay Home, Stay Healthy), and reopening (Safe Start). During Stay Home, Stay Healthy, weekly mean gonorrhea and urethral gonorrhea cases among men significantly declined compared with prepandemic and were not significantly different in reopening compared with prepandemic. B, Weekly early syphilis, including primary, secondary, or early latent/early nonprimary nonsecondary syphilis (solid line), and early latent/early nonprimary nonsecondary syphilis (dashed line) reported in King County, WA, comparing 2020 across 3 COVID-19 pandemic mitigation periods: prepandemic, stay-at-home order (Stay Home, Stay Healthy), and reopening (Safe Start). During Stay Home, Stay Healthy, weekly mean early syphilis and early latent syphilis cases significantly declined compared with prepandemic and were not significantly different in reopening compared with prepandemic.

Figure 3

A, Weekly visits at the Public Health—Seattle & King County Sexual Health Clinic comparing 2019 (dashed line) and 2020 (solid line) across 3 COVID-19 pandemic mitigation periods: prepandemic, stay-at-home order (Stay Home, Stay Healthy), and reopening (Safe Start). During Stay Home, Stay Healthy, and Safe Start, clinic visits in 2020 were lower than the same period in 2019. B, Weekly visits with prescribed gonorrhea treatment at the Public Health—Seattle & King County Sexual Health Clinic comparing 2020 across 3 COVID-19 pandemic mitigation periods: prepandemic, stay-at-home order (Stay Home, Stay Healthy), and reopening (Safe Start). Because clinic policy changed during Stay Home, Stay Healthy, oral (black line) gonorrhea treatments (cefixime or cefpodoxime) increased in use and ceftriaxone (gray line) decreased. C, Weekly visits with prescribed gonorrhea treatment without laboratory testing at the Public Health—Seattle & King County Sexual Health Clinic comparing 2020 across 3 COVID-19 pandemic mitigation periods: prepandemic, stay-at-home order (Stay Home, Stay Healthy), and reopening (Safe Start). Because clinic policy changed during Stay Home, Stay Healthy, gonorrhea treatment without laboratory confirmation increased.