In a recent study published in the journal Emerging infectious diseases, The researchers analyzed data from the Genitourinary Medicine Clinic Genitourinary Medicine STI Activity Surveillance System, an English surveillance system that monitors sexually transmitted infections (STIs) in the country. Their findings revealed that in just over a year after restrictions related to the coronavirus disease 2019 (COVID-19) were eased, positive diagnoses of gonorrhea increased by almost 64% (13,715 to 22,471) despite increases in testing STDs increased by only 5.6%. These findings suggest that COVID-19 restrictions and associated social distancing may have inadvertently suppressed the transmission of gonorrhea and other STIs, and underscore the need for policy measures aimed at preventing their resurgence after the pandemic.
Letter: Gonorrhea rebound after lifting of COVID-19 precautions, England. Image credit: Giovanni Cancemi / Shutterstock
Gonorrhea and the unexpected benefits of lockdown
Gonorrhea, colloquially known as “clap,” is a sexually transmitted infection (STD) caused by the bacterium Neisseria gonorrhoeae. While symptoms include pain or burning during urination, discomfort in the testicles (in men) or vagina (in women), discharge or bleeding, the disease is often asymptomatic and undetectable without a clinical diagnosis.
Gonorrhea is one of the most common STIs in the world today, with surveys estimating that 0.8% of all men and 0.6% of all women are living with the disease. Between 33 and 106 million new cases of the disease occur each year, although most are mild and treated with antibiotics such as injectable ceftriaxone and oral azithromycin.
The coronavirus disease 2019 (COVID-19) pandemic has forced many national governments, including those of the United Kingdom (UK), to impose restrictions and ‘lockdowns’, legally enforcing social distancing to prevent the spread of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2 virus). An unintended side effect of these restrictions may have been to prevent STD transmission through disruptions in medical health services due to the overwhelming number of COVID-19 cases that may have failed to report these positive results.
“The COVID-19 pandemic caused significant disruption to sexual health services (SHS) in England (including reduced testing), contributing to a 33.5% reduction in new sexually transmitted infection (STI) diagnoses in 2020 (n = 311,480) compared to in 2019 (n = 468,260)’.
After the lifting of lockdown restrictions in England in July 2021, there was a rebound in SHS, representing an almost 24% increased rate of STD diagnoses (2022) compared to lockdown (2021). Worryingly, positive gonorrhea diagnoses have increased by more than 50% compared to COVID-19 times, but potential modes of transmission and populations at risk have so far remained unexplored.
About the study
In the present study, researchers use data from the Genitourinary Medicine Clinic’s STI Dataset Activity Surveillance System to elucidate trends in gonorrhea testing and diagnosis in England following the lifting of COVID-19 restrictions. Data from January 1, 2019 to December 31, 2022 were collected and analyzed, adjusting for patient anthropometric and sociodemographic variables (age, gender, and sexual orientation).
Study findings
The findings of the present study reveal that while gonorrhea testing increased by 5.6% after the SHS recovery, new gonorrhea diagnoses increased by 63.8% compared to pandemic times. The results of the study highlight that people aged between 15 and 24 are at the highest risk of contracting the disease (141% increase) after the restrictions were lifted. Worryingly, the incidence of gonorrhea was highest (229.0% increase) in those between the ages of 19 and 20.
Stratifying the findings by sexual orientation revealed that gay and bisexual men had the highest prevalence and gay women had the highest new incidence of the disease (104.7% increase; 2,577 to 5,274) between 2021 and 2022. geographic stratification showed that gastroenteritis increases were most significant in North East England (194%) and South West England (226.0%). However, all regions across the country experienced statistically significant increases compared to the times of COVID-19 containment.
Total number of gonorrhea diagnoses and tests and positivity rate in the Gonorrhea Recovery Study after lifting of COVID-19 precautions in England, 1 January 2019–31 December 2022. A) Total number of diagnoses and tests. Bars indicate the total number of gonorrhea diagnoses. The purple line shows the total number of gonorrhea tests. B) Positive rate of gonorrhea tests. Well, fourth. The scales for the y-axes differ substantially in their underline patterns, but do not allow direct comparisons.
conclusions
The present study reveals the STD-preventing side effect of COVID-19-related restrictions and highlights the alarming resurgence of STDs, particularly gonorrhea, after these restrictions were lifted. It further identified the age groups (15-24) and sexual orientations (men who have sex with men and women who have sex with women) who are at the highest risk of contracting the bacterial infection after restrictions are lifted.
“It remains to be seen whether the increases in gonorrhea diagnoses will be short-lived due to the lifting of restrictions, whether pre-COVID-19 levels of diagnoses will return, or whether another trend will be observed. Continued close surveillance, a better understanding of the factors leading to the increase in gonorrhea diagnoses, and public health messages (especially to young people) are needed to focus efforts on controlling and preventing gonorrhea transmission.”
