As COVID-19 slows, STDs are spiking in Utah

A lull in new cases may be due to declines in testing, not transmission.

(Francisco Kjolseth | The Salt Lake Tribune) Blood samples await testing for coronavirus antibodies inside a Huntsman Cancer Institute screening bus, in Park City on May 6, 2020. The nationwide focus on COVID-19 testing and tracking and prevention measures meant reduced resources and staff for testing for sexually transmitted diseases, health experts say.

The coronavirus pandemic may have masked a spike in sexually transmitted infections in Utah, where they had already been on the rise for years, health experts say.

Statewide, the rates of positive tests for STIs dropped at the beginning of 2020, when COVID-19 began to spread and the state went into an initial lockdown.

But by December, when the escalating number of new coronavirus cases was setting and breaking records and COVID-19 patients were filling ICU beds, the rate of STIs also rose — to their highest levels in years.

“We’re already seeing in the first quarter of this year a very significant increase. It’s not like things slowed down,” said Lynn Beltran, epidemiology supervisor for the Salt Lake County Health Department.

During the year of relative social isolation, gonorrhea infected more people — about 3,100 Utahns in 2020, up from about 2,900 the previous two years. New gonorrhea cases rose especially sharply in the final months of 2020.

(Christopher Cherrington | The Salt Lake Tribune)

Chlamydia is far more common in Utah, with 11,073 cases reported in 2019. In 2020, the rate of positive chlamydia tests dropped, to 320 cases per 100,000 residents — which is down from 345 in 2019 and 335 in 2018.

The sharpest decline occurred during the second quarter of 2020, when pandemic lockdowns were at their most forceful and widespread.

But that may not mean actual transmission of chlamydia slowed down.

It’s unclear whether there were fewer positive chlamydia tests due to “a change in sexual behaviors during the pandemic, a change in testing behaviors during the pandemic, a combination of these behavior changes, or an unrelated set of circumstances,” wrote Megan Evans, STD prevention coordinator for the Utah Department of Health, in an email to The Tribune.

There was “a little bit of a lull right as things closed down,” Beltran acknowledged.

But, she noted, “People really weren’t seeing their doctors a lot. Testing shut down for a lot of nonemergent health issues. ... For example, agencies that normally provide HIV testing to at-risk populations had ceased their testing programs.”

Nationally, many STI clinics shut their doors or slashed their hours last spring, The Associated Press reported, and public health staffers and some testing supplies were reallocated to COVID-19 testing efforts.

During the final months of 2020 in Salt Lake County, rates of chlamydia and gonorrhea both rose to their highest levels in years, and they stayed high in the first three months of 2021.

“We are now seeing spikes with all three STD rates,” which includes syphilis, Beltran said. “This could be due to a lack of public health intervention during the pandemic, that would ensure timely diagnosis and treatment of patients and their partners.”

Left untreated, STIs can have serious long-term health complications, health officials warn, including infertility, pelvic inflammatory disease and chronic pelvic pain.

Statewide, syphilis and HIV infections, which are far more rare than gonorrhea and chlamydia, “did not drastically deviate from what we would have expected based on past trends,” Evans wrote.

In 2018, 170 Utahns were diagnosed with syphilis. That’s a rate of 5.4 in every 100,000 residents, a figure that dropped to 4.3 in 2019 and 4.1 in 2020. But early data in Salt Lake County showed cases rising again in 2021.

Meanwhile, 127 Utahns, or about four in every 100,000 residents, were diagnosed with HIV in 2020, the same rate as in 2019 and 2018.

“We really won’t know the true impact for a while because it’ll take time to collect the correct data,” said Blake Johnson, HIV and STI prevention coordinator for the Utah AIDS Foundation. “But experts do expect that there will be an increase in HIV and STI positivity rates due to the reallocation of research, money, and personnel from HIV to COVID-19.

“I am sure that once we are more back to normal and testing resumes at its pre-COVID pace,” Johnson said, “we will see an increase in HIV and other STIs.”