The coronavirus pandemic delivered isolation and a sharp decline in social activities. Contrary to expectations though, it did not result in an improvement of incidence rates of sexually transmitted diseases (STIs).
In fact, the available epidemiological figures – and the daily experience of professionals at clinics – suggest otherwise: there continues to be a marked increase in STIs and a decrease in the use of barrier contraceptives capable of preventing infection.
"There are two examples of cases that we are seeing with increasing frequency at the clinic: diagnoses of syphilis and herpes simplex are on the rise," said Dr Adriana Giaccaglia, a member of the Argentine Society of Gynaecology for Children and Adolescents (SAGIJ).
She adds that since at least 2005, Argentina has seen “increasing numbers of STIs."
At SAGIJ, they can provide concrete data: epidemiological records show that in 2016, the rate of syphilis was 24.14 cases per 100,000 inhabitants. In 2017, it rose to 34.8 cases; in 2018, it jumped to 51.8 cases. And by 2019 it was already hovering at around 56.8 cases per 100,000 inhabitants.
"Something similar happens with other diseases," explained Giaccaglia, who works in the gynaecology team at the University Hospital of Mendoza.
"According to the latest Epidemiological Bulletin from the Health Ministry, purulent secretions from the penis that characterise some of these sexual diseases are on the rise: in 2015, 7.1 cases per 100 thousand inhabitants were reported. But by 2018 there were 13 per 100,000 inhabitants."
Positive tests for syphilis also increased: in 2019 it stood at 5.9 percent and in 2020 it rose to 6.9 percent, which shows that few tests are being done to diagnose the problem properly and points to underreporting of the issue.
While all these figures fell during 2020, experts believe that the explanation is not that there are fewer cases but that the disruption caused by the Covid pandemic made consultations more difficult, thus leading to a drop in diagnoses and epidemiological records.
"There is a lot of talk about HIV and hepatitis C, about which there has been good news. But for the rest of STIs – mycoplasma, chlamydia, gonorrhoea, among others – many people don't even know they exist. And many, if not treated in time, can leave permanent sequelae or increase infertility in women," said Dr María Laura Martínez, a specialist in gynaecology at DIM Centros de Salud.
She clarified that these pathologies are now being seen on a daily basis at specialised clinics across people of all social and economic categories.
Cause for concern
The reasons that explain these trends are varied and range from cultural elements to paradoxical new medical technologies.
"Condoms or dental dams are not still used as they should be over the course of a relationship," Martinez said. "Although adolescents and young adults begin to have sex using condoms, when they perceive themselves as a ‘stable couple,’ which may be after a few months, they are ‘enabled’ to stop using condoms and seek to avoid pregnancy with other methods. Also, nowadays social practices enable a greater number of couples in a short period of time. However, the concept of a ‘stable’ couple is not synonymous with one partner not having an undiagnosed STI.”
Added to this is the popularity of new, safe, affordable and convenient long-term contraceptive options, such as implants.
"Pregnancy is no longer an issue of concern and many young people are therefore opting to stop using condoms," said SAGIJ’s Giaccaglia.
In addition, this lack of knowledge is also influenced by the fact that for almost two years there was no sexual education classes or workshops at schools, impacting incidence rates. Therefore, there is less dissemination of such issues among who are initiating their sexual lives.
On the other hand, Giaccaglia explained that "the use of barrier protection is also falling among those over 50 years of age,” with an additional impact.
“On the one hand, women assume that they no longer need protection, while men prefer to stop using it due to cultural reasons or because they are worried about losing their sexual potency. The fact is though that STI cases are also on the rise in these groups.”
Nevertheless, infections are on the rise on the most among young adults. In terms of syphilis, positive test rates grew sharply in the 15 to 19 age group in 2020, reaching nine percent. Among those aged 20 to 24, the positivity rate reached 10.4 percent. This is all the more reason to rethink and resume prevention policies.
To improve the state of play, both experts recommend the urgent resumption of public educational and preventive campaigns. They also propose the scheduling of a gynaecological and urological check-up for both members of a "stable" couple who decide to stop using protection within their relationship. And to this they add a final piece of advice: ensure vaccination against HPV (Human papillomavirus) continues.
Finally, they suggest that clinicians should be more aware of such issues when ordering routine tests, making sure STIs that may be present but asymptomatic are detected.