STI Testing and Rates of STI Diagnoses Before and During the COVID-19 Pandemic in a US HIV Cohort

Background: The COVID-19 pandemic affected sexually transmitted infection (STI) testing and diagnosis rates in the United States, but these patterns have not been well characterized among people with HIV. Methods: We analyzed medical records data of HIV Outpatient Study (HOPS) participants seen for HIV care from January 2019 to March 2021, with ≥1 CD4+ cell count and viral load test results recorded. We used Poisson regression models to estimate rate ratio (RR) and 95% confidence interval (CI) to compare STI testing and diagnoses rates on/after versus before March 1, 2020 (early COVID-19 pandemic [pandemic] vs. prepandemic). Results: Of 2311 eligible patients, STI tests (STI cases, primarily defined as test results that were positive) were as follows during the analysis time frame: 4991 gonorrhea (157), 4978 chlamydia (135), and 4216 syphilis (114). Comparing pandemic versus prepandemic periods, STI testing RRs were 0.78 for both gonorrhea (95% CI, 0.73–0.82) and chlamydia (95% CI, 0.73–0.83), and 0.93 for syphilis (95% CI, 0.88–0.99); diagnosis rates were not statistically different. Multivariable models showed reduced testing for gonorrhea (adjusted RR, 0.79; 95% CI, 0.72–0.87) and chlamydia (adjusted RR, 0.78; 95% CI, 0.71–0.86) for men who have sex with men, but not for other HIV transmission groups. Conclusions: The fallout of the COVID-19 pandemic on sexual health may not be seen for some time. Despite reduced STI testing, rates of STI diagnoses did not decrease. It will take a return to more routine screening and improved access to sexual health care to uncover the true impact of undetected or untreated STIs.