Use of healthcare reimbursement data to monitor bacterial sexually transmitted infection testing in France, 2006 to 2020

Abstract

Background Diagnoses of bacterial sexually transmitted infections (STIs) have increased in France since the 2000s. The main strategy to control STI transmission is recommending/facilitating access to condom use, testing, and antibiotic treatments. Aim This study analyses the evolution of STI testing in the private sector in France from 2006 to 2020. Methods National health insurance reimbursement data were used to determine numbers and rates of individuals aged ≥ 15 years tested for diagnoses of chlamydia, gonorrhoea and syphilis in the private sector in France and to describe their evolution from 2006 to 2020. Results Upward tendencies in testing were observed from 2006 to 2019 for all three STIs. The highest testing rates were identified in people aged 25‒29-years old. The observed testing-increase from 2017 to 2019 was twice as high in young people (< 25 years old) as in older people. In 2019, chlamydia, gonorrhoea and syphilis testing rates were respectively 45.4 (+ 21% since 2017), 41.3 (+ 60%), and 47.2 (+ 22%) per 1,000 inhabitants. For all STIs combined, the number of tested individuals decreased by 37% between March and April 2020 during the first COVID-19 epidemic wave and lockdown in France. Conclusion Improvements found in STI testing rates may have resulted from better awareness, especially among young people and health professionals, of the importance of testing, following prevention campaigns. Nevertheless, testing levels remain insufficient considering increasing diagnoses. In 2020, the COVID-19 pandemic had a considerable impact on STI testing. Partner notification and offering diverse testing opportunities including self-sampling are essential to control STI epidemics particularly in exposed populations.

Effects of COVID-19 measures on access to HIV/STI testing and condoms among adults in Sweden: a cross-sectional online survey

“…While our results rely on self-reported data, they are substantiated by laboratory data from Sweden, indicating a decrease in STI tests in 2020 versus 2019 of up to 25% varying by region [20]. Similar reductions occurred in HIV/STI tests in Belgium [21], France [22] and the wider european region [6].…”

“…Possibly, cis-women in our study were also less affected if using alternative contraceptives in steady partnerships, reducing their need for condoms and opportunistic STI testing. French data also showed a greater reduction in STI testing for men than women during the pandemic [22]. Pre-pandemic evidence suggested that sexual and gender minorities faced barriers accessing HIV/STI testing and youth clinics in Sweden, indicating pre-existing inequities [24, 25].…”

A Neglected Narrative in the COVID-19 Pandemic: Epidemiological and Clinical Impacts of the COVID-19 Outbreak on Syphilis

“…51 Similarly, a study analyzing the STI screening data from the French national health database revealed a 37% decrease in the total number of STI screenings in April 2020 during the first wave of COVID-19 compared to March 2020, with a 32% decrease in syphilis testing. 52 Redeployment of essential staff was an important reason for the decreased supply of STI care in the COVID-19 era. Before COVID-19, contact tracing was an essential component in many STD monitoring and management strategies.…”

“… 51 Similarly, a study analyzing the STI screening data from the French national health database revealed a 37% decrease in the total number of STI screenings in April 2020 during the first wave of COVID-19 compared to March 2020, with a 32% decrease in syphilis testing. 52 …”

“…After the COVID-19 pandemic subsided and restrictive social measures softened, new syphilis diagnoses recovered quickly to approach pre-pandemic levels or even beyond. 1 , 69 Based on an assumption that clinical interruptions persist for 18 months, a predictive model estimated over 57,000 STI cases in addition in 5 years just among MSM in Atlanta, Georgia, the U.S. 52 Timely actions are desired for the control and prevention of syphilis in places where the resurgence has already taken place or where the resurgence of infections is predicted to unfold, such as the US. 5 , 38 , 83 , 84 …”