Trends in STI testing and diagnosis rates during the COVID-19 pandemic at a large urban tertiary care center, and the role of the emergency department in STI care

Abstract

IntroductionThe COVID-19 pandemic has had profound effects on access to care, including outpatient sexually transmitted infection (STI) testing and treatment. Many vulnerable populations already relied on the emergency department (ED) for much of their care prior to the pandemic. This study examines trends in STI testing and positivity before and during the pandemic at a large urban medical center and evaluates the role of the ED in providing STI care.MethodsThis is a retrospective review of all gonorrhea, chlamydia, and trichomonas tests from November 1, 2018, through July 31, 2021. Demographic information and location and results of STI testing were extracted from the electronic medical record. Trends in STI testing and positivity were examined for 16 month periods before and after the COVID-19 pandemic started (March 15, 2020), with the latter divided into the early pandemic period (EPP: March 15 -July 31, 2020) and late pandemic period (LPP: August 1, 2020 - July 31, 2021).ResultsTests per month decreased by 42.4% during the EPP, but rebounded by July 2020. During the EPP, the proportion of all STI testing originating in the ED increased from 21.4% pre-pandemic to 29.3%, and among pregnant women from 45.2% to 51.5%. Overall STI positivity rate increased from 4.4% pre-pandemic to 6.2% in the EPP. Parallel trends were observed for gonorrhea and chlamydia individually. The ED represented 50.5% of overall positive tests, and as much as 63.1% of positive testing during the EPP. The ED was the source of 73.4% of positive tests among pregnant women, which increased to 82.1% during the EPP.ConclusionsSTI trends from this large urban medical center paralleled national trends, with an early decrease in positive cases followed by a rebound by the end of May 2020. The ED represented an important source of testing for all patients, and especially for pregnant patients, throughout the study period, but even more so early in the pandemic. This suggests that more resources should be directed towards STI testing, education, and prevention in the ED, as well as to support linkage to outpatient primary and obstetric care during the ED visit.

Risk factors for treatment non-completion among patients with syphilis

“…This is consistent with published data demonstrating a large proportion of urogenital STI diagnoses originate in the ED. 15 Expansion of rapid point-of-care testing 16 might also afford the opportunity to provide a diagnosis, counseling, and linkage to care while patients are still in the ED. Additional strategies that have since improved treatment rates in the study ED include the institution of a partner clinic within the hospital to provide outreach and linkage to care support 17 and the implementation of an EMR alert for patients unable to be reached who then re-present to the ED, allowing results to be addressed at the next ED visit.…”

Concurrent Sexually Transmitted Infection Testing Among Patients Tested for Mpox at a Tertiary Healthcare System

“…Contrary to our hypothesis, apart from HIV testing, we did not encounter a difference in rates of concurrent testing by healthcare setting. Although outpatient acute care settings may have been overrepresented in our study, recent studies have highlighted the importance of these healthcare settings in STI testing [ 20 , 21 ]. These locations serve as the front line for such testing, and a better understanding of why testing rates were relatively low will help inform where future interventions to mitigate shortcomings in screening can be implemented.…”