STI TESTING AND RATES OF STI DIAGNOSES BEFORE AND DURING COVID-19 PANDEMIC IN A U.S. HIV COHORT.

Background: The COVID-19 pandemic affected sexually transmitted infection (STI) testing and diagnosis rates in the United States (U.S.), but these patterns have not been well characterized among people with HIV (PWH).

Methods: We analyzed medical records data of HIV Outpatient Study (HOPS) participants seen for HIV care from January 2019-March 2021, with ≥1 CD4+ cell count and viral load test results recorded. We used Poisson regression models to estimate rate ratio (RR) and 95% confidence interval (CI) to compare STI testing and diagnoses rates on/after vs before March 1, 2020 (early COVID-19 pandemic (pandemic) vs. pre-pandemic).

Results: Of 2,311 eligible patients, STI tests (STI cases, primarily defined as tests that were positive) were as follows during the analysis timeframe: 4,991 gonorrhea (157), 4,978 chlamydia (135), and 4,216 syphilis (114). Comparing pandemic vs. pre-pandemic periods, STI testing RRs were 0.78 for both gonorrhea (CI: 0.73-0.82) and chlamydia (CI: 0.73-0.83), and 0.93 for syphilis (CI: 0.88-0.99); diagnosis rates were not statistically different. Multivariable models showed reduced testing for gonorrhea (adjusted RR 0.79, CI: 0.72-0.87) and chlamydia (adjusted RR 0.78, CI: 0.71-0.86) for men who have sex with men, but not for other HIV transmission groups.

Conclusions: The fallout of the COVID-19 pandemic on sexual health may not be seen for some time. Despite reduced STI testing, rates of STI diagnoses did not decrease. It will take a return to more routine screening and improved access to sexual health care to uncover the true impact of undetected or untreated STIs.