A National, County-Level Evaluation of the Association Between COVID-19 and Sexually Transmitted Infections within the United States in 2020.

Abstract

Shifts in public health infrastructure to respond to one emerging health threat may have unanticipated consequences for pre-existing diseases. Also, previous research evaluating the impact of COVID-19 on sexually transmitted infections (STIs) has been conducted nationally, with little exploration of the impact on a granular geospatial level. This ecological study seeks to quantify the association between COVID-19 cases or deaths and chlamydia, gonorrhea, and syphilis cases for all United States (US) counties in 2020. Separate, adjusted multivariable quasi-Poisson models with robust standard errors modeled the county-level association between 2020 COVID-19 cases and deaths per 100,000 and 2020 chlamydia, gonorrhea, or syphilis cases per 100,000. Models were adjusted for sociodemographic characteristics. Every 1,000 additional COVID-19 cases per 100,000 was associated with a 1.80% increase in the average number of chlamydia cases (P < .001) and 5.00% increase in the average number of gonorrhea cases (P < .001). Every 1,000 additional COVID-19 deaths per 100,000 was associated with a 57.9% increase in the average number gonorrhea cases (P < .001) and 74.2% decrease in the average number of syphilis cases (P = .004). Higher rates of COVID-19 cases and deaths were associated with increased rates of some STIs at the US county-level. The underlying reasons for these associations could not be established by this study. The emergency response to an emerging threat may have unanticipated influence on pre-existing diseases that varies by level of governance.