Sexually Transmitted Infection Diagnoses and Access to a Sexual Health Service Before and After the National Lockdown for COVID-19 in Melbourne, Australia

Abstract

Background We aimed to examine the impact of lockdown on sexually transmitted infection (STI) diagnoses and access to a public sexual health service in the COVID-19 pandemic in Melbourne, Australia. Methods The operating hours of Melbourne Sexual Health Centre (MSHC) remained the same during the lockdown. We examined the number of consultations and STI at MSHC between January and June 2020 and stratified the data into pre-lockdown (3-February to 22-March), lockdown (23-March to 10-May) and post-lockdown (11-May to 28-June) with seven weeks in each period. Incidence rate ratio (IRR) and its 95% confidence intervals (CI) were estimated using Poisson regression models. Results The total number of consultations dropped from 7,818 in pre-lockdown to 4,652 during lockdown (IRR=0.60;95%CI:0.57-0.62) but increased to 5,347 in the post-lockdown period (IRR=1.15;95%CI:1.11-1.20). There was a 68% reduction in asymptomatic screening during lockdown (IRR=0.32; 95%CI:0.30-0.35) but it gradually increased in the post-lockdown period (IRR=1.59;95%CI:1.46-1.74). STI with milder symptoms showed a marked reduction, including non-gonococcal urethritis (IRR=0.60;95%CI:0.51-0.72), and candidiasis (IRR=0.61;95%CI:0.49-0.76) during lockdown compared with pre-lockdown. STI with more marked symptoms did not change significantly, including pelvic inflammatory disease (IRR=0.95;95%CI:0.61-1.47) and infectious syphilis (IRR=1.14;95%CI:0.73-1.77). There was no significant change in STI diagnoses in post-lockdown compared to lockdown. Conclusions The public appeared to be prioritising their attendance for sexual health services based on the urgency of their clinical conditions. This suggests that the effectiveness of clinical services in detecting, treating and preventing onward transmission of important symptomatic conditions is being mainly preserved despite large falls in absolute numbers of attendees.

Brief Report: Changes in PrEP Use, Sexual Practice, and Use of Face Mask During Sex Among MSM During the Second Wave of COVID-19 in Melbourne, Australia

“… 3 , 18 The reduction in sexual risk can potentially lead to temporal reductions in HIV and other sexually transmitted infections (STI). 5 , 19 , 20 However, the severity of COVID-19 pandemic in some settings may cause interruptions in delaying and accessing HIV/STI testing. 21 – 23 This is supported by a study conducted in 3 Kenyan counties showing that there was a significant reduction in the number of HIV tests at clinical sites during lockdown although there was an increase in HIV self-testing.…”

“…Under the previous restrictions during the national lockdown in March and April 2020, individuals had reduced their sexual activities, particularly sex with casual partners. 3 – 5 There have been a few Australian and international studies examining pre-exposure prophylaxis (PrEP) use during the COVID-19 pandemic. 6 – 8 Our previous Melbourne-based study reported that one in 4 men who have sex with men (MSM) taking daily HIV PrEP in January–February 2020 (ie, before first lockdown) had stopped taking PrEP in early May.…”

The silent epidemic of lymphogranuloma venereum inside the COVID-19 pandemic in Madrid, Spain, March 2020 to February 2021

“…This outcome was probably related to the Spanish government’s decision to minimise all healthcare activities that were not dedicated to COVID-19 in primary care centres, such as STI clinics. As other authors have reported, this led to a reduction in the number of consultations [ 6 ] and in testing volume [ 7 ], since only patients with LGV symptoms were able to access the centres. In fact, a similar drop has been reported for a wide range of communicable diseases [ 5 ].…”

“…These data could explain the significant increase in the number of LGV cases and the proportion with respect to the CT-positive samples following the first wave. Nonetheless, the resumption of social gatherings, including sexual activities, together with an increase in the asymptomatic screening in the re-opened STI centres [ 6 ] might also have led to the subsequent increase in LGV cases after the lockdown. However, the clinical activity in our centre increased progressively and, now in 2021, has reached the same levels as in the pre-pandemic period.…”

HIV Testing and Diagnoses During the COVID-19 Pandemic in Melbourne, Australia

“…These restrictions may reduce the opportunity for sex with casual partners and, hence, reduce an individual's sexual risk. 1 , 2 This proposition is supported by substantial declines in presentations for HIV postexposure prophylaxis prescriptions during the COVID-19 lockdowns in several countries such as Australia and the United Kingdom. 3 , 4 We described the impact these restrictions may have had on HIV testing and diagnoses.…”