Impact of the COVID-19 Pandemic on Chlamydia and Gonorrhea Screening in the U.S

Am J Prev Med. 2021 Sep;61(3):386-393. doi: 10.1016/j.amepre.2021.03.009. Epub 2021 May 19.


Introduction: This study evaluates the impact of the COVID-19 pandemic on testing for common sexually transmitted infections. Specifically, changes are measured in chlamydia and gonorrhea testing and case detection among patients aged 14-49 years during the COVID-19 pandemic.

Methods: U.S. chlamydia and gonorrhea testing and positivity were analyzed on the basis of >18.6 million tests (13.6 million tests for female patients and 4.7 million tests for male patients) performed by a national reference clinical laboratory from January 2019 through June 2020.

Results: Chlamydia and gonorrhea testing reached a nadir in early April 2020, with decreases (relative to the baseline level) of 59% for female patients and 63% for male patients. Declines in testing were strongly associated with increases in weekly positivity rates for chlamydia (R2=0.96) and gonorrhea (R2=0.85). From March 2020 through June 2020, an expected 27,659 (26.4%) chlamydia and 5,577 (16.5%) gonorrhea cases were potentially missed.

Conclusions: The COVID-19 pandemic impacted routine sexually transmitted infection services, suggesting an increase in syndromic sexually transmitted infection testing and missed asymptomatic cases. Follow-up analyses will be needed to assess the long-term implications of missed screening opportunities. These findings should serve as a warning for the potential sexual and reproductive health implications that can be expected from the overall decline in testing and potential missed cases.

MeSH terms

  • COVID-19*
  • Chlamydia Infections* / diagnosis
  • Chlamydia Infections* / epidemiology
  • Chlamydia*
  • Female
  • Gonorrhea* / diagnosis
  • Gonorrhea* / epidemiology
  • Humans
  • Male
  • Mass Screening
  • Pandemics
  • SARS-CoV-2
  • Sexually Transmitted Diseases* / epidemiology