Could the pandemic affect sexually-transmitted disease incidence in high-risk groups? Considerations about the COVID-19 lockdown

Abstract

Dear Editors,We read with great interest the work by Sousa et al. 1 on factors associated with sex practice under the effect of drugs among men who have sex with men (MSM) during the period of social isolation in the context of the COVID-19 pandemic. In their multicentric online survey, the authors found that a significant portion (95%) of MSM that engaged in chemsex did so in sex with casual partners during the pandemic's upward epidemiological curve in both countries (April 2020). Moreover, chemsex practice in Brazil exceeded that in Portugal by more than twice.The outbreak of coronavirus disease 2019 (COVID-19) tremendously impacted healthcare and economic systems worldwide. COVID-19 is an acute respiratory illness caused by the SARS-CoV-2. The high susceptibility of the general population to this virus' contagion led to an overall negative impact on personal and social relationships, since transmission occurs via droplets or direct contact with contaminated objects (fomites).As such, the first-line preventive strategies are to increase social distancing, and rise up all the general prevention measures focusing on the infective respiratory diseases (i.e., droplet barriers and contact isolation) 2 . These important personal limitations, along with the huge negative impact caused by media and social networks, led to a growing fear of close relationships. The condition of personal isolation is more evident when facing the reduction of fortuitous sexual intercourse, as reported by recent surveys in general population 3,4 , in contrast with what Sousa et al. 1 found in the MSM group.It is noteworthy that some authors described the presence of SARS-CoV-2 in feces, as well as in the seminal fluids of male subjects, including those who did not present symptoms and signs of COVID-19. These findings could lead to a potential role of sexual transmission in this disease.Among the categories at higher risk of STIs, MSM might represent an important public health challenge during the COVID-19 pandemic 5 . MSM is a particular risk group of STIs, requiring specific health interventions. MSM is, in fact, the group with the highest prevelance of HIV contagions and subsequently AIDS. In particular, the limited access to the first-line preventive measures (i.e., condoms) in some countries, along with their high rate of substances of abuse seem to explain the high rates of unprotected anal intercourse (up to 84%) in MSM 5 . Moreover, the experience of community discrimination, with social stigma and subsequent isolation, determined the growing of unorthodox sexual behaviors, with an increased risk of STIs. In addition, the fear of social discrimi- CARTA LETTERCould the pandemic affect sexually-transmitted disease incidence in high-risk groups? Considerations about the COVID-19 lockdown A pandemia pode afetar a incidência de doenças sexualmente transmissíveis em grupos de alto risco? Considerações sobre o isolamento social na COVID-19 ¿Podría la pandemia afectar la incidencia de enfermedades de transmisión sexual en grupos de alto r...