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). 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. The authors thank Alessandra Iadicicco, who made it possible to perform the study. The patients in this manuscript have given written informed consent to publication of their case details. None. The authors have no conflict of interest to disclose.

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