Sexually transmitted infections, or STIs, have been on the rise for years. But the COVID-19 pandemic has disrupted public health efforts to address the problem, and this has some worried about a surge in cases.
The Primary Health Care Clinic in Des Moines, Iowa, offers a safe haven for people with STIs like gonorrhea, chlamydia and HIV. In a nondescript testing room, there’s a basket filled with condoms and pamphlets.
"We just tell everybody, it's confidential, judgment free, we want to make sure everybody's as comfortable as possible," says Noah Beacom, the prevention specialist at the clinic.
Last year, the clinic performed nearly 4,000 STI tests, but Prevention Services Manager John Shaw says this year looks much different. "We're down to about a quarter of the amount of tests that we would normally be doing on like a month per month basis."
Blame COVID-19. Due to new screening and cleaning procedures, the clinic has limited the number of appointments.
And Beacom said they‘ve drastically cut back on community outreach events, which account for about a quarter of their tests. "Like Pride, like Iowa Leather weekend — or before we went to colleges a lot more and stuff like that."
The clinic is hardly alone. Under COVID-19, many public health organizations had to suspend or cut back vital STI services like outreach programs.
"A lot of what we do for STI prevention is trying to get out to the venues, trying to get out to the community. And obviously, all that ended very, very quickly," says Stefan Baral, an epidemiologist at Johns Hopkins University.
In an April survey Baral conducted, gay men reported having a much tougher time getting access to STI testing. It was especially a problem for those in the 15-to-24 age group.
"So these are folks that know they're symptomatic, and know that they have an STI and just can't access the sort of confirmatory test or the treatment," he says.
That’s at a time when STIs rates have been skyrocketing nationally. From 2014 to 2018, rates of gonorrhea went up 63 percent while syphilis increased 71 percent.
George Walton, the sexually transmitted disease program manager at Iowa’s public health department, can already see how the pandemic may be distorting this year’s numbers.
The rate of chlamydia appears to be down, but he says that might be misleading. "I have a strong suspicion that it's not just a true decrease in transmission. I suspect that there's just more asymptomatic people who aren't getting tested and getting diagnosed."
Walton says the pandemic also has caused shortages of STI testing supplies, medication and public health workers.
That’s forced public health organizations to provide services in new ways.
Erin Davison-Rippey, executive director for Planned Parenthood in Iowa, says they’ve started using telehealth. That's allowed them to expand testing and treatment options.
"That allows patients from across the state to easily access care that might not otherwise be available, where they live," she says.
The Primary Health Care Clinic is adapting too, by offering an at-home HIV test.
"We advertised on some of the gay, bi dating apps, and a lot of the folks that we're getting responses from live in like rural areas," Beacom says.
Baral says these pandemic-inspired shifts are important to better reach the community. "In the context of COVID, it's taught us that like, we have to do better with thinking about how to serve people, you know, via the internet, via the places where they're engaging."
Baral adds that these new approaches can better reach rural and suburban populations — where STI cases are growing the fastest.
This story was produced by Side Effects Public Media, a news collaborative covering public health.