Number of people with syphilis and gonorrhoea went UP during lockdown in Italy, small study finds
Rates of syphilis and gonorrhoea may have actually increased during lockdown, a small study suggests.
Researchers in Italy compared the number of diagnoses at a single clinic in Milan in March and April this year to the same period in 2019.
They found there were 44 cases of syphilis – which leaves patients with sores around their genitals – during lockdown, up from 32 last year.
There were 39 people diagnosed with gonorrhoea during Italy’s first strict national shut down, compared to 32 in 2019. Diagnoses of urinary tract infections were also up year-on-year.
Scientists behind the study said the findings suggested younger people did not take the threat of Covid-19 seriously and continued to have unprotected sex despite social distancing rules.
Lead author Dr Marco Cusini, from the IRCCS Foundation National Cancer Institute in Milan, said: ‘It was assumed that the lockdown would reduce the opportunity for sexual encounters and STIs.
‘However, I was surprised by the number of new acute infections diagnosed in this short period of time.’
The study only looked at one clinic in Milan, however, and the small increase in the findings may not apply to the whole city.
Several other studies in the US, Ireland and Australia have found the opposite – that rates of STIs plummeted during lockdown.
Rates of syphilis and gonorrhoea may have actually increased during lockdown, a small study suggests (file)
Researchers analysed infections between March 15 and April 14 following social isolation measures adopted by many governments around the world to control the pandemic, with the same period last year.
The results – presented at the virtual 29th European Academy of Dermatology and Venereology (EADV) Congress today – revealed that despite a reduction of more than a third in the total number of patients visiting the two main STI centres in Milan that were studied, the number of acute bacterial infections still rose.
This rise included secondary syphilis and gonorrhoea, but cases did fall in the non-acute cases, such as genital warts and molluscum contagiosum – a skin infection that causes small white lumps to form.
Researchers concluded that the Covid-19 pandemic, despite lockdown and advice on social and physical distancing, did not stop risky sex and that acute STIs actually increased.
Dr Cusini added: ‘Gonorrhea and syphilis are typically more prevalent in people in their 30s, so infection may have increased because the concentration of Covid-19 morbidity and mortality in the elderly made the younger, more active, cohort feel protected and so less risk averse.
‘Whilst it is unrealistic to prevent people from having sex, even in this extraordinary pandemic, close contact during sexual intercourse inevitably involves an increased risk of SARS-CoV-2 contagion.
‘The findings show the importance of ongoing screening for STIs and the real benefit of having these types of services open and available during these unprecedented times.’
Dr Cusini’s findings appear to be the outlier, as most statistics point to STI rates plummeting during lockdown.
In Australia, for example, chlamydia is at an all-time low, with the latest Australian Government Department of Health data showing figures for January to June are the lowest in a decade.
There were 37,582 positive tests for the STI in this period – down from 54,485 in 2019, 53,965 in 2018 and 60,687 in 2017.
For gonorrhoea and syphilis, the department’s data shows January to June infections dropped across the country as well.
There were 15,970 gonorrhoea positive tests this year – down from 17,488 in 2019 and 2,296 cases of syphilis were recorded nationwide between January to June – down from 2,900 in 2019.
Similarly, in Ireland, chlamydia has plummeted by about a fifth. There were 1,764 cases of the STI reported to the Health Protection Surveillance Centre in the third quarter of 2020, a drop of 489 cases on 2019.
Gonorrhoea cases dropped by 129 to 527 and herpes infections fell from 419 to 305. Syphilis infections also decreased from 198 to 144.
While gonorrhoea is still highly susceptible to the most common antibiotic treatment option, ceftriaxone, the emergence of antimicrobial resistant gonorrhoea remains of concern to medics.
Recommended combinations with antibiotics such as azithromycin should be avoided in the light of antibiotic stewardship, necessitating new treatment guidelines, scientists said.
Gonorrhoea is caused by the bacterium neisseria gonorrhoeae and it often presents no symptoms in women and is mostly symptomatic in men.
Common symptoms in men include urethral discharge and pain upon urination – or dysuria – and women may present with odourless vaginal discharge, dysuria and pain during sexual intercourse. Symptoms usually appear between one to 10 days after infection.
Gonorrhoea is on the rise across Europe and in 2017 alone, there were more than 89,000 confirmed cases – 240 per day.
The UK reported 55 per cent of all cases with 75 per 100,000, followed by Ireland with 47 per 100k, Denmark at 33, Iceland 29, Norway 27 and Sweden 25.
The first symptoms of syphilis usually develop around two or three weeks after infection, although they can start later than this.
The main symptom is a small, painless sore or ulcer typically on the penis, vagina, or around the anus, although it can sometimes appear in the mouth or on the lips, fingers or buttocks.
Secondary syphilis is a progression of the disease and symptoms, but is curable with treatment.
In 2018, there were 33,927 confirmed cases in Europe, the highest rate being in Malta where there were 17.9 cases per 100 000 population, next was Luxembourg with 17.1, with the UK at 12.6 and Spain with 10.3.
