ABSTRACT
Objectives: We compared the number and profile of patients diagnosed with bacterial sexually transmitted infections (STI) before and during the global pandemic. Method(s): Our study used German claims data provided by AOK PLUS from 01/01/2017-30/06/2021. Continuously insured adults with one inpatient and/or outpatient diagnosis of chlamydia (ICD-10 A55/A56), gonorrhea (A54), or syphilis (A51/A53) were included. The number of new STI cases was assessed quarterly from 2018-2021. A window of 180 days was used to detect new infections, as re-infections are possible. Result(s): Overall, 10,222 individuals (11,685 cases) were included. Approximately 60.4% were female, with a mean/median age of 31.9/28.0 years. Only 3.1% received an STI code at baseline. Chlamydia was the most common STI (77.2%), followed by gonorrhea (13.2%) and syphilis (9.6%). Females recorded more chlamydia (67.4%), while males accounted for a higher share of syphilis (76.9%) and gonorrhea (61.3%) cases. Chlamydia patients were younger at diagnosis (mean/median: 29.9/26.0 years) than gonorrhea (38.4/35.0) and syphilis (41.9/40.0) patients. From 2018-2021, the number of new chlamydia and syphilis cases fluctuated. A decrease in new gonorrhea cases was observed beginning in Q2 2020 (median/range: 93/83-110 vs. 118/101-137 in the pre-COVID period). The share of women with gonorrhea diagnoses was disproportionately lower during COVID compared to pre-COVID (median/range: 33.7%/27.4-38.1% vs. 42.6%/37.1-47.1% during pre-COVID). While no difference in age profile was observed for gonorrhea or syphilis, the age of patients with chlamydia during COVID was slightly lower (29.2 vs. 31.0 during pre-COVID). Conclusion(s): Fewer women received gonorrhea diagnoses during the COVID period, and the average age of chlamydia patients dropped. Further research is needed to assess whether these trends are suggestive of under-diagnosis or systematic changes in risk-taking behavior during lockdown. Copyright © 2022
ABSTRACT
Objectives: This study compared the diagnostic setting and treatment of new cases of bacterial sexually transmitted infections (STIs) in Germany from 2018-2020. Method(s): This study utilized German claims data (AOK PLUS) from 01/01/2017-30/06/2021. We included continuously insured adult patients with an inpatient/outpatient chlamydia (ICD-10 A55/A56), gonorrhea (A54), or syphilis (A51/A53) diagnosis from 01/01/2018-31/12/2020. To account for potential re-infection, a 180-day window was used to detect new cases. Diagnostic setting was observed at index and a 6-month follow-up period was used to assess outpatient treatment with prescribed therapies. Result(s): Overall, 8,913 individuals (cases: 10,032, female: 60.3%, mean age: 32.1 years) were included. Most chlamydia (97.4%), gonorrhea (96.3%), and syphilis (96.9%) cases were diagnosed in the outpatient setting. Among STI cases recorded in the outpatient setting (96.9%), the most common diagnosing physicians were gynecologists (54.5%), general practitioners (20.8%), and urologists (11.5%). No changes in relation to diagnosing physician were observed between pre-COVID and COVID-periods. From 2018-2020, the share of syphilis and gonorrhea cases diagnosed in inpatient vs. outpatient settings varied;no difference between pre-COVID and COVID periods was detected. Despite the overall low number of inpatient chlamydia diagnoses, the proportion of new cases reported in hospitals decreased after the pandemic onset (median/range: 1.8%/1.3-2.0% vs. 2.6%/2.1-3.9% during pre-COVID). Syphilis had the lowest treatment rate at 42.2% (penicillin: 27.9%, doxycycline: 13.1%, tetracycline: 0.0%), followed by gonorrhea with 54.9% (ceftriaxone: 16.2%, azithromycin: 39.6%), and chlamydia with 60.5% (doxycycline: 41.0%, azithromycin: 22.8%, levofloxacin: 1.1%). No longitudinal changes in relation to treatment were observed. Conclusion(s): Generally, diagnosis of bacterial STIs is uncommon in the hospital. Nevertheless, the share of chlamydia cases diagnosed in the inpatient setting decreased during COVID, possibly in relation to healthcare resource capacity constraints. Further research is needed to explore potential reasons for this trend and the substantial proportion of patients without treatment. Copyright © 2022