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. 2025 Jun 2;20(6):e0325097.
doi: 10.1371/journal.pone.0325097. eCollection 2025.

Primary care screening for sexually transmitted infections in the United States from 2019 to 2021

Shiying Hao  1 , Esther E Velásquez  1 , William S Pearson  2 , Karen W Hoover  3 , Weiming Zhu  3 , Ilia Rochlin  4 , Ayin Vala  1 , Isabella Chu  1 , Robert L Phillips  5 , David H Rehkopf  1   6   7   8   9   10 , Neil Kamdar  1   11   12
Affiliations

Primary care screening for sexually transmitted infections in the United States from 2019 to 2021

Shiying Hao et al. PLoS One. .

Abstract

Background: Early identification and treatment of sexually transmitted infections (STIs) is critical to improve patient outcomes. Barriers to healthcare seeking are potentially exacerbated by COVID-19. This study examined trends in STI testing and positivity from 2019 to 2021 in primary care in the United States.

Methods: This is a retrospective study using the PRIME Registry, a national primary care EHR registry, from January 1, 2019-December 31, 2021. We calculated age-standardized monthly and annual testing rates for chlamydia, gonorrhea, syphilis, and human immunodeficiency virus stratified by gender and race/ethnicity. We also generated quarterly and annual rates for test positivity. Chi-square tests and 95% confidence intervals were used for comparison. 753 practices and 4,410,609 patients were included, with 180,558 having STI tests.

Results: We observed a substantial decline in testing rates for STIs from March-April 2020 (31% for chlamydia, 30% for gonorrhea, 23% for syphilis, 24% for HIV), followed by a rapid increase in May-June 2020 (64% for chlamydia, 65% for gonorrhea, 32% for syphilis, 48% for HIV). Testing rates per 100,000 decreased from 2019 to 2021 for chlamydia (3,592 vs 2,355 vs 2,181) while increased for gonorrhea in 2020 (2,129 vs 2,207 vs 2,057). STI testing rates from 2019 to 2021 for females and non-Hispanic Black or African American patients were higher than other groups. An increase in test positivity from 2019 to 2021 was observed for gonorrhea (0.4% vs 0.4% vs 0.5%) but no significant change for chlamydia (1.5% vs 1.6% vs 1.5%).

Conclusion: Testing rates for STIs substantially dropped during stay-at-home orders early in the pandemic and recovered after these were relaxed. Gender and race/ethnicity STI testing differences may reflect primary care's prioritization of higher risk populations. This study emphasizes the role of primary care EHR data in monitoring and an opportunity for closer collaboration with public health agencies.

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Conflict of interest statement

Neil Kamdar serves as a consultant at the University of North Carolina, Chapel Hill, Sheps Center for Health Policy, and the University of New Mexico, Department of Emergency Medicine. Other authors have no conflicting or competing interests. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Monthly number of tests per 100,000 patients for chlamydia, gonorrhea, syphilis, and HIV in the American Family Cohort from 2019 to 2021, age standardized to the U.S. standard population.
Error bars show the 95% confidence intervals. The vertical dashed line represents the beginning of the stay-at-home order in March 2020.
Fig 2
Fig 2. Monthly number of tests per 100,000 patients for chlamydia (left) and gonorrhea (right) tests in the American Family Cohort in 2019, 2020, and 2021, age standardized to the U.S. standard population.
Fig 3
Fig 3. Quarterly test positivity for chlamydia (left) and gonorrhea (right) in the American Family Cohort from 2019 to 2021.
Fig 4
Fig 4. Monthly number of tests per 100,000 patients for chlamydia, gonorrhea, syphilis, and HIV in the American Family Cohort from 2019 to 2021 by gender, age standardized to the U.S. standard population.
The vertical dashed line represents the beginning of the stay-at-home order in March 2020.
Fig 5
Fig 5. Monthly number of tests per 100,000 patients for chlamydia, gonorrhea, syphilis, and HIV in the American Family Cohort from 2019 to 2021 by race/ethnicity, age standardized to the U.S. standard population.
The vertical dashed line represents the beginning of the stay-at-home order in March 2020.
See this image and copyright information in PMC

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