Session: STIs: a global health crisis, but not a lost cause
O10.2 - STI epidemiology in the time of COVID-19 pandemic in European Union/European Economic Area (EU/EEA) countries– data artifact or real impact of the pandemic?
Prior to the COVID-19 pandemic, bacterial STIs under surveillance in EU/EEA were increasing, with number of reported gonorrhoea and syphilis cases reaching an all-time-high in 2019. In contrast, data reported by EU/EEA countries for 2020 indicated a decrease for all STIs under surveillance at EU/EEA-level. We aimed to describe changes in STI epidemiology during the COVID-19 pandemic (2020-2021) and identify drivers of changes in STI notifications.
Methods
Numbers of chlamydia, gonorrhoea and syphilis notified cases in EU/EEA countries during 2019-2021 were retrieved from The European Surveillance System. An online survey (June-July 2022) addressed to STI surveillance contact points in EU/EEA countries collected qualitative information to help interpretation of STI surveillance data.
Results
In 2020, 161,954 chlamydia, 33,425 gonorrhoea and 21,604 syphilis confirmed cases were notified by 25 countries (totalling 313,484,379 population) that reported consistently during 2019-2021. Compared to 2019, notifications decreased by 8% for chlamydia, 8% for gonorrhoea and 9% for syphilis. In 2021, as compared to 2020, chlamydia notifications increased by 6%, gonorrhoea by 19% and syphilis by 10% (Figure).
17/22 EU/EEA countries that responded to the survey indicated that the COVID-19 pandemic context impacted surveillance data quality, with most affected parameters: number of reported cases (17/17), timeliness of reporting (8/17); and completeness of variables (7/17). Decreases in 2020 were associated with the lockdown periods and were related to: reduced access to/availability of STI clinical services (17/17); changes in sexual/health-seeking behaviour (17/17); reduced STI prevention services (12/17); redistribution of resources to COVID-19 response (11/17); and reduced community testing (9/17). Countries indicated that surveillance data during COVID-19 pandemic most likely does not provide a true picture of STI epidemiology among heterosexuals (11/17), MSM (10/17) and young people (15-24-year-old) (9/17).
Conclusion
Under-ascertainment due to reduction in access to/availability of STI prevention and clinical services, behaviour changes and under-reporting due to resources redirected to COVID-19 response are likely causes of STI notifications dropping in EU/EEA during 2020. Case notifications rebounded in 2021 at similar (chlamydia, syphilis) or higher levels (gonorrhoea) than in 2019 in most countries. Data indicate a continued unmet need for STI prevention in EU/EEA and a need for more resilient surveillance capacity.
