IntroductionAustralia recorded its first case of COVID-19 in late January 2020. On 22P March 2020, amid increasing daily case numbers, the Australian Government implemented lockdown restrictions to help ‘flatten the curve’. Our study aimed to understand the impact of lockdown restrictions on sexual and reproductive health. Here we focus on sexual practices.MethodsAn online survey was open from the 23PP April 2020 to 11P May 2020. Participants were recruited online via social media and other networks and were asked to report on their sexual practices in 2019 and during lockdown. Logistic regression was used to calculate the difference (diff) (including 95% CIs) in the proportion of sex practices between time periods.ResultsOf the 1187 who commenced the survey, 965 (81.3%) completed it. Overall, 70% were female and 66.3% were aged 18–29 years. Most (53.5%) reported less sex during lockdown than in 2019. Compared with 2019, participants were more likely to report sex with a spouse (35.3% vs 41.7%; diff=6.4%; 95% CI 3.6 to 9.2) and less likely to report sex with a girl/boyfriend (45.1% vs 41.8%; diff=−3.3%; 95% CI −7.0 to -0.4) or with casual hook-up (31.4% vs 7.8%; 95% CI −26.9 to -19.8). Solo sex activities increased; 14.6% (123/840) reported using sex toys more often and 26.0% (218/838) reported masturbating more often. Dating app use decreased during lockdown compared with 2019 (42.1% vs 27.3%; diff= −14.8%; 95% CI −17.6 to -11.9). Using dating apps for chatting/texting (89.8% vs 94.5%; diff=4.7%; 95% CI 1.0 to 8.5) and for setting up virtual dates (2.6% vs 17.2%; diff=14.6%; 95% CI 10.1 to 19.2) increased during lockdown.ConclusionAlthough significant declines in sexual activity during lockdown were reported, people did not completely stop engaging in sexual activities, highlighting the importance of ensuring availability of normal sexual and reproductive health services during global emergencies.

Research in context Evidence before this study A systematic review of chlamydia screening interventions identified six RCTs published up to the 14 th February 2016, four of which investigated the effect on the incidence of PID of a single offer of a chlamydia screening test and two which investigated the effect of multiple rounds of chlamydia screening on chlamydia prevalence. In a meta-analysis, the incidence of PID was lower in intervention than control groups (risk ratio, RR 0•68; 95%CI 0•49 to 0•94; I 2 =8%). However, methodological limitations of the trials could have resulted in an overestimation of the protective effects of a single chlamydia screening test. A cluster-RCT in women and men in the general population in the Netherlands found no change in chlamydia positivity among those tested after three rounds of screening (RR 0•96, 95% CI 0•84 to 1•09). However, screening uptake was low, with only 16% screened in the first round, falling to 10% in the third round. A cluster RCT of a multifaceted intervention that included syndromic management for sexually transmitted infections (STIs) among young adults in the community and STI screening in female sex workers in Peru found no difference in chlamydia prevalence after four years among young adults but in secondary analyses, found a reduction among female sex workers (adjusted RR 0•72; 95% CI 0•54 to 0•98). None of the trials investigated the impact of multiple rounds of testing on both chlamydia prevalence and the incidence of PID. We searched PubMed from January 1 2016 to February 28 2018 with the terms "chlamydia" and ("randomised controlled trial" or "randomised clinical trial" or "trial" or "randomly") and restricted the search to clinical trials in English only. No further completed trials were identified.

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Articles requiring a descriptive 15-word introductory line are: Editorials, and Perspectives.Articles requiring short (50-word) unstructured abstracts are: Notable cases (abstract should state the general area of relevance, describe the specific nature of the case, and point out the relevance/implications for clinical practice or health policy).Articles requiring 4-6 bullet-point) summaries are: Clinical focus article including narrative review. Methods: Consecutive patients were recruited and completed a questionnaire and tested for chlamydia.Outcome: Chlamydia prevalence in general practice. Results Conclusions:Chlamydia prevalence is similar in women and men attending general practice.Testing only those with genital symptoms or partner with chlamydia would have missed over 73% of cases. Most men and women are amenable to being tested and treated in general practice, even in rural areas.