A Worsening Epidemic Looming in the Midst of Covid-19
The pandemic is exacerbating STI disparities
By Mickey Emmanuel, MD, Joanna S. Cohen, MD, and Monika Goyal, MD, MSCE
I was greeted Monday morning by one of my teenage patients who revealed anxiously, “I’m worried I might have an STD.” She was 17 years old with a history of sexually transmitted infections (STI) and recently had a new sexual partner. I commended her on seeking care. Prior to the Covid-19 pandemic, I could easily order all available testing, but now, testing is less available.
The four most common STIs are chlamydia, gonorrhea, syphilis, and HIV. Rates of gonorrhea and chlamydia have been increasing over the past five years, disproportionately affecting communities of color and adolescents. This pandemic has the potential to exacerbate these disparities. The reasons for this are multifactorial and include limited access to primary care and STI clinics, shortage of STI testing supplies, and hesitancy from the public regarding routine screening and preventive care during the pandemic.
Chlamydia and gonorrhea are the two most common STIs in the U.S. with the highest number of reported cases in young women between 15 and 24 years old. These two bacterial infections are commonly known for causing uncomfortable vaginal or penile discharge, but often are asymptomatic, meaning that someone might not even know they are infected. If left untreated, these STIs can lead to devastating complications. Complications in women include pelvic inflammatory disease, an invasive infection of the uterus and fallopian tubes, which can cause infertility, ectopic pregnancies (pregnancies occurring outside the uterus), and chronic pelvic pain. In men, they can lead to infections of the testicles and in the worst cases affect fertility. Infection with chlamydia can also increase a person’s risk of acquiring HIV. Since 2014, there has been a 19% increase in the rates of chlamydia and a 63% increase in the rates of gonorrhea, and now with the Covid-19 pandemic, it is unclear at what rate this will continue to rise. Needless to say, these infections can be detrimental to a young person’s physical and emotional health and it is crucial that they are detected and treated early.
Sexually transmitted infections affect persons of color disproportionately, contributing to already existing health disparities that are being exacerbated by the pandemic. Studies show that people of color have the highest rates of STIs in the U.S. Notably, chlamydia cases among Black females is five times higher than in white females. There are many reasons why these disparities exist, including difficulty accessing preventive care and distrust of health care institutions.
Routine screening and treatment for STIs can help prevent pelvic inflammatory disease and its subsequent effects, highlighting that the key to addressing these disparities is prevention. During the Covid-19 pandemic, routine preventive testing is becoming even more difficult to access. Due to unprecedented testing needs for Covid-19, the U.S. Centers for Disease Control and Prevention (CDC) has acknowledged shortages of testing supplies for gonorrhea and chlamydia. Many hospitals, clinics, and public health services are already seeing the effects of this shortage and attempting to find ways to prioritize testing for their patients. In some clinics and hospitals, the shortage of testing supplies has led to a complete halt in STI testing. Fortunately, I was able to offer testing for my 17-year-old teen because she carried a particularly high risk of infection. I am fearful that in the near future, she might not have the opportunity to get tested and have to face the uncertainty of an asymptomatic infection or the consequences of an untreated infection.
Maintaining access to STI testing and preventive care is critical during this Covid-19 pandemic to prevent the downstream effects on reproductive health. The negligence of this administration to prepare for the Covid-19 pandemic has led to ubiquitous effects in every aspect of health care including sexual preventive health. It is imperative that we work toward solutions now to improve access to care and availability of testing to prevent the tremendous burden that these STIs can cause in the future.
