New research launched at the 29th EADV Congress has found that despite the COVID-19 lockdown restrictions, diagnosis of sexually transmitted infections (STIs), including gonorrhea, secondary syphilis and mycoplasma genitalium (MG), have increased.
The research, conducted in two main STI centers in Milan, Italy, compared the number of confirmed diagnoses of the most common STIs in patients with symptoms for the period March 15, 2020 to April 14, 2020 following social isolation measures adopted to control the epidemic, with the same period in 2019.
The results revealed that despite a 37% reduction in the total number of attendances—233 in 2019 vs 147 in 2020—the number of acute bacterial infections, most associated with men who have sex with men, increased during the observational period, including secondary syphilis and gonorrhea. Cases fell, however, in the non-acute cases, such as genital warts and molluscum contagiosum.
The study concludes that the COVID-19 pandemic, despite lockdown and advice on social/physical distancing, did not inhibit risky behaviors and that acute STIs actually increased.
"It was assumed that the lockdown would reduce the opportunity for sexual encounters and STIs. However, I was surprised by the number of new acute infections diagnosed in this short period of time. Gonorrhea and syphilis are typically more prevalent in people in their 30s, so infection may have increased because the concentration of COVID-19 morbidity and mortality in the elderly made the younger, more active, cohort feel protected and so less risk averse,” explained Marco Cusini, study co-author and researcher at La Fondazione IRCCS Ca' Granda Ospedale Maggiore di Milano Policlinico in Italy. “While it is unrealistic to prevent people from having sex, even in this extraordinary pandemic, close contact during sexual intercourse inevitably involves an increased risk of SARS-CoV-2 contagion. The findings show the importance of ongoing screening for STIs and the real benefit of having these types of services open and available during these unprecedented times."
While gonorrhea is still highly susceptible to the mainstay antibiotic treatment option ceftriaxone, the emergence of antimicrobial resistant gonorrhea remains of concern. Recommended combinations with antibiotics such as azithromycin should be avoided in the light of antibiotic stewardship, necessitating new treatment guidelines.
Gonorrhea is on the rise across Europe—in 2017 alone, there were more than 89,000 confirmed cases, which equates to 240 per day. The United Kingdom reported 55% of all cases (75 per 100,000) followed by Ireland (47), Denmark (33), Iceland (29), Norway (27) and Sweden (25). In 2018, there were 33,927 confirmed cases in Europe. The highest rate was observed in Malta (18 cases per 100,000 population), followed by Luxembourg (17), the United Kingdom (13) and Spain (10).
Gonorrhea is caused by the bacterium Nesisseria gonorrhoeae. It often, but not always, presents no symptoms in females and is mostly symptomatic in males. Common symptoms in men include urethral discharge and pain upon urination (dysuria), and women may present with odorless vaginal discharge, dysuria and pain during sexual intercourse. Symptoms usually appear between 1-10 days after infection. Secondary syphilis is a progression of the disease and symptoms, however is curable with treatment.
Republished courtesy of EADV, European Academy of Dermatology and Venereology.