Disrupted Sexual Health Care During The Coronavirus Pandemic In 2020: The Impact On Sti Positivity Among Sexual Health Clinic Attendees

Background Dutch Sexual Health Clinics (SHCs) had to downscale services during the first coronavirus wave, but continued to provide essential STI/PrEP care including testing for persons at highest risk for (symptomatic) gonorrhoea, infectious syphilis (syphilis) and HIV. We describe STI positivity among SHC attendees between 2011–2020. Methods National SHC surveillance data contained information on demographics, sexual behaviour, STI testing and diagnoses. We split 2020 into periods: 1 January-12 March (pre-lockdown), 13 March-31 May (lockdown) and 1 June-31 August (post-lockdown). Chlamydia, gonorrhoea, syphilis and HIV positivity (n positive/N tested) trends were explored by gender and sexual contact. Results In 2020, weekly numbers of consultations varied between 2,803 and 3,515 pre-lockdown, 564 and 1,298 during lockdown and 1,084 and 1,976 post-lockdown. Relatively more MSM, PrEP users and clients notified for or with symptoms of STI were seen during- and post-lockdown compared to pre-lockdown. Chlamydia positivity was around 18% among heterosexual men and 15% among women from 2016–2019, and increased to 21.1% and 16.6% respectively in 2020. Positivity increased during lockdown, up to 32% among heterosexual men, followed by decreases post-lockdown to pre-lockdown levels. Among MSM, the increase during lockdown was smaller, only slightly affecting overall positivity in 2020. Gonorrhoea positivity also increased during lockdown, causing further increasing trends among heterosexuals from 1.8% in 2011 to 2.2% in 2020 and among MSM from 9.0% to 12.1%. Syphilis positivity among MSM fluctuated between 2.0% and 2.9% in 2011–2020. Positivity peaked (6.7%) during lockdown, while the number of diagnoses was similar to pre-lockdown. In contrast, HIV positivity continued to decrease from 2,0% to 0,3% among MSM in 2011–2020. Conclusion Prioritising persons at highest risk caused decreases in diagnoses, especially chlamydia and gonorrhoea, but increases in positivity. More information is needed to understand transmission dynamics, including testing at GPs, self-testing and sexual behaviour during coronavirus pandemic.