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COVID-19 upended sexually transmitted infection (STI) prevention in the spring and stretched public health officials to their limits, so more innovative strategies are needed to maintain prevention efforts in the future, an expert panel said.

Even prior to COVID-19, rates of STIs, such as chlamydia, gonorrhea, and syphilis, were up nationally, and those increases are expected to continue, according to preliminary 2019 surveillance data, reported Gail Bolan, MD, director of the CDC Division of STD Prevention in a media roundtable at the virtual .

The CDC's 2019 preliminary data found cases of chlamydia increased to about 1.76 million reported cases, gonorrhea cases rose to 602,000 total, and cases of syphilis increased to about 123,000, with syphilis in newborns up more than 20% versus the prior year.

"In the beginning of the year, we reported STD [cases] above 2019 levels," said Hillard Weinstock, MD, of the CDC. But that changed during the pandemic, as there was a "clear drop" in reported cases in spring and summer 2020 compared with 2019.

Specifically, Weinstock noted a 53% drop in weekly reported cases of chlamydia, and a 33% decline each in weekly reported cases of gonorrhea and primary and secondary syphilis versus comparable periods in 2019.

But once the stay-at-home orders were lifted, researchers saw corresponding increases in reporting of STI cases, with both gonorrhea and syphilis cases at least returning to 2019 levels, though chlamydia cases have yet to return to prior year levels.

Weinstock said the decline in reported STI cases could be due in part to closures and reduced access to STI testing services. In addition, he noted 2019 surveillance data is not yet complete, meaning the discrepancy between the 2019 and 2020 numbers may be an underestimate.

David Harvey, MSW, executive director of the National Coalition of STD Directors, provided context for these numbers from the staffing side. He cited barriers to STI prevention efforts, such as clinic closures, reduced hours, and capacity, as well as staff redeployment within health departments to assist with COVID-19 response.

Indeed, the National Coalition of STD Directors surveyed health departments across the U.S. in 50 states, seven large cities, and eight U.S. territories in both March and June 2020.

Their initial survey provided evidence for declines in STI reporting, with 83% of STI programs deferring STI services or field visits and two-thirds reporting a decline in sexual health screening and testing. In addition, 60% of clinics reported "reduced capacity" to treat STIs, and only about a third said they had the capability to perform remote or virtual field visits.

The June survey revealed nearly 80% of STI/HIV health department workforce were deployed to COVID-19 emergency response "for any period of time," with 20% reporting their STI program operations were "completely disrupted" and they are unable to perform core functions.

Notably, about 30% of STI programs reported serving as the leader for a state or city's COVID-19 contact tracing efforts. In fact, Harvey said only 2% of programs said they were not involved in any way in COVID-19 contact tracing.

"Most programs within our field were contributing in some way to contact tracing efforts, which speaks to the expertise around contact tracing our field provided," he said.

Bolan stressed the importance of innovation in STI prevention, highlighting three additional components to incorporate into STI prevention services, namely STI "express visits," partnerships with pharmacies and retail health clinics, and expanding telemedicine.

For example, when a patient goes to pick up a prescription, they could receive STI testing, the pharmacist could then dispense any treatment for the patient or their partners and "the cost is lower than emergency department visits," Bolan said. She also discussed how telemedicine could help fill gaps when clinics are closed or services are reduced, including mailing patients without symptoms a self-collection testing kit or referring them to a nearby lab for testing services, as a way to expand access outside of the clinical setting.

"Innovation often comes in times of difficulty," Bolan said, adding that despite "worrying trends in STD transmission," researchers are "encouraged by ideas and creative solutions."

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