(P52) Quantifying the impact of COVID-19 operational changes on syphilis, gonorrhea, and chlamydia testing and treatment at Baltimore City Health Department Sexual Health Clinics

Tuesday, July 25, 2023

16:00 – 18:00 CST

Primary Presenter(s)

EG

Elizabeth Gilliams, MD, MSc

Medical Director for STI services
Baltimore City Health Department Sexual Health Clinics, United States

Co-author(s)

SW

Sarah Williford

Division of Infectious Diseases, Johns Hopkins School of Medicine, United States
NS

Norberth Stracker

Baltimore City Health Department, United States
Christina M. Schumacher, PhD, MHS (she/her/hers)

Assistant Professor
Johns Hopkins University School of Medicine
Baltimore, Maryland, United States

BACKGROUND

In March 2020, Baltimore City Sexual Health Clinics implemented procedures to triage patients to in-person visits versus remote care to mitigate spread of COVID-19. Patients reporting syphilis and HIV symptoms/exposure were prioritized and offered in-person visits. Patients with other symptoms were referred for laboratory testing and remote management by telemedicine. Visits were available walk-in pre-COVID-19, but switched to appointment-based during-COVID-19. We sought to quantify the impact of service changes on testing and treatment for syphilis, gonorrhea (NG), and chlamydia (CT).

METHODS

We analyzed patient data during-COVID-19 (April 1, 2020 - October 31, 2021) and pre-COVID-19 (January 1, 2018- December 31, 2019). Visits were grouped into episodes, defined as groups of visits < 14 days apart. We described setting (in-person vs telemedicine), reason for encounter, STI testing ordered, testing outcomes, and treatment offered during episodes. We used chi-squared tests to compare characteristics and testing/treatment outcomes during- vs. pre-COVID-19, stratified by pathogen (syphilis, NG/CT) and anatomic site (NG/CT only). Asymptomatic STI testing request data were excluded as these were completed via a mail-in testing service. Extragenital testing was possible only in-person or via mail-in testing.

RESULTS

There were 10,680 visits and 7,734 episodes during-COVID-19, and 23,541 visits and 19,994 episodes pre-COVID-19. The majority of during-COVID-19 care-episodes was telemedicine-only (53.8%). Syphilis testing decreased (49.7% during-COVID-19 vs. 73.9% pre-COVID-19 p< 0.0001); treatment completion among patients diagnosed with early or late syphilis was similar across periods (p >0.05). During-COVID-19, among 799 episodes with self-reported genital lesions and contact to syphilis, 69.5% and 94.5%, respectively, had testing ordered, with little drop-off at testing completion. During-COVID-19, among 3,633 episodes with symptoms indicative of urethritis or cervicitis/vaginitis, about half (44.2%) received urogenital NG/CT testing, vs. 89.1% pre-COVID-19 (p< 0.0001). During-COVID-19, a majority of patients with rectal and oropharyngeal exposure (both 54.9%) received NG/CT testing at these sites. NG/CT treatment completion was higher during-COVID (p< 0.01, all anatomic sites).

CONCLUSIONS

A dramatic reduction in STI testing for symptomatic patients was observed during-COVID-19, in line with visit prioritization protocols. Protocols favoring remote management, empiric treatment, and multiple visits per episode may have contributed to reduced testing. Greater in-person availability was prioritized during service restoration.