The Quest 2020 Health Trends Study® has revealed declining rates in gonorrhea and chlamydia screenings, while positive tests increased, an issue that needs urgent public health attention.
As screening rates went down for gonorrhea and chlamydia during the COVID-19 pandemic, weekly positivity rates increased, according to Quest Diagnostics’ 2020 Health Trends Study®. The results were published in the American Journal of Preventive Medicine.
Harvey W Kaufman, MD, FCAP, senior medical director, and lead of Quest Diagnostics 2020 Health Trends®, conducted the study with colleagues. The study examined patients aged 14 to 49 years, with 1.36 million tests administered to female patients, and 4.7 million tests administered to male patients. Testing was conducted between January 2019 and June 2020 by a national reference clinical laboratory.1
Researchers reported that testing for chlamydia and gonorrhea reached the lowest point in April of 2020, with rates in relation to baseline levels decreasing 59% for women and 63% for men.1 Both reductions in STI testing had a strong association with weekly positivity rates (chlamydia R2=0.96 and gonorrhea R2=0.85).1 Researchers said that an expected 26.4% (27,659) of chlamydia cases and 16.5% (5,577) of gonorrhea cases were possibly missed between March 2020 and June 2020.1
Researchers said the COVID-19 pandemic’s effect on testing and infection rates warrants follow-up study to determine the long-term effects of missed chlamydia and gonorrhea screenings. “These findings should serve as a warning for the potential sexual and reproductive health implications that can be expected from the overall decline in testing and potential missed cases,” researchers concluded.1
In an interview with Contemporary OB/GYN®, Kaufman said this study is significant because it is thought to be the first nationally representative analysis of the pandemic’s effect on STI and cases. He said it comes after a CDC report issued last month that found STIs were at an all-time high in 2019, with 1 in 5 American young adults likely infected. “At a high level, the study finds that STI testing dramatically declined and never fully returned to pre-pandemic levels – between late February and late July 2020, likely resulting in higher positivity rates and a strong likelihood of missed cases, particularly in asymptomatic but potentially infectious individuals,” Kaufman said. He noted that while STIs are often asymptomatic, over time they can lead to adverse outcomes, including chronic pelvic inflammatory disease and infertility.
Kaufman said the study found STI testing decreased between late February 2020 to early April 2020 by 40% before returning to 85% of baseline by late June 2020. “Positivity rates for chlamydia increased from 4.7% in late February to as high as 5.9% in mid-April to 5.1% by late June,” he explained. He said similar patterns were observed in gonorrhea, “with increases from 1.4% to 2.4% in February to mid-April and back down to 1.9% by late June.” He added that for both chlamydia and gonorrhea, positivity rates remained higher than baseline 2019 levels by the end of the study.
Kaufman said that the most important aspect of the Health Trends® study is to remind providers to reinstate guideline-based STI screening. “Screening should not be performed based on symptoms alone,” he emphasized. He said that STI screening is important because many patients harbor infection without manifesting symptoms. “If left untreated, they may pass an STI unknowingly to others or experience adverse health outcomes, such as loss of fertility,” he said.
Kaufman noted that despite these risks, discussing this topic can be uncomfortable for the patient and the physician. “It is important for providers to start with the facts to lessen the discomfort of the conversation including the high prevalence of chlamydia and gonorrhea in the United States and that many STIs are asymptomatic. Messages that are judgement-free can help kick off the conversation,” Kaufman said.
He said that providers should stress medical testing guidelines to avoid stigma. “Instruct clinical staff to follow your lead because many patients will also see nurse practitioners or physician assistants as part of routine exams and it’s important that your practice is all on the same page. Direct discussions about STIs may be uncomfortable, but they are vital to protecting patient and public health,” he said.