Despite COVID-19 Pandemic, Risky Sexual Behavior and STIs Are Rising

Sexually Transmitted Infections

Despite COVID-19 lockdowns and advice on social/physical distancing, risky behaviors persisted, and there was an increase in acute sexually transmitted infections (STIs).

New research[1] launched at the 29th EADV Congress, EADV Virtual, has found that despite the COVID-19 (SARS-CoV-2) lockdown restrictions, diagnosis of sexually transmitted infections (STIs), including gonorrhea, secondary syphilis, and mycoplasma genitalium (MG), have increased.

The research, conducted in two main STI centers in Milan, Italy, compared the number of confirmed diagnoses of the most common STIs in patients with symptoms for the period March 15, 2020, to April 14, 2020, following social isolation measures (lockdown) adopted to control the epidemic, with the same period in 2019.

The results revealed that despite a reduction in the total number of attendances by over a third (37%, 233 in 2019 vs 147 in 2020), the number of acute bacterial infections, most associated with men who have sex with men (MSM), increased during the observational period, including secondary syphilis and gonorrhea. Cases fell, however, in the non-acute cases, such as genital warts and Molluscum Contagiosum.

It concludes that the COVID-19 pandemic, despite lockdown and advice on Social/Physical distancing, did not inhibit risky behaviors and that acute STIs actually increased.

Dr. Marco Cusini, La Fondazione IRCCS Ca’ Granda Ospedale Maggiore di Milano Policlinico, Milano, Italy, explains: “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. 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.”

While gonorrhea is still highly susceptible to the mainstay antibiotic treatment option ceftriaxone, the emergence of antimicrobial-resistant gonorrhea remains of concern. Recommended combinations with antibiotics such as azithromycin should be avoided in the light of antibiotic stewardship, necessitating new treatment guidelines. Dr. Henry J.C. de Vries of the STI outpatient clinic Health Service Amsterdam presented on The threat of antimicrobial-resistant gonorrhea at 12:00-12:15 CET on Thursday 29th October 2020.

Gonorrhea is caused by the bacterium Neisseria gonorrhea.[2] It often, but not always, presents no symptoms in females and is mostly symptomatic in males.[3] Common symptoms in men include urethral discharge and pain upon urination (dysuria), and women may present with odorless vaginal discharge, dysuria, and pain during sexual intercourse.[3] Symptoms usually appear between 1-10 days after infection.[4] Gonorrhea is on the rise across Europe, in 2017 alone, there were more than 89,000 confirmed cases (240 per day), of which MSM accounted for almost half of all the cases (47%).[5] The United Kingdom reported 55% of all cases (75 per 100,000) followed by Ireland (47), Denmark (33), Iceland (29), Norway (27), and Sweden (25).[4]

The first symptoms of syphilis usually develop around 2 or 3 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.[6] Secondary syphilis is a progression of the disease and symptoms, however is curable with treatment.[7] In 2018, there were 33,927 confirmed cases in Europe. The highest rate was observed in Malta (17.9 cases per 100 000 population), followed by Luxembourg (17.1), the United Kingdom (12.6) and Spain (10.3).[8]

About EADV:

Founded in 1987, EADV is the leading community to further the knowledge of health professionals and advocates in the field of dermatology and venereology. It is a non-profit organization with close to 8,000 members, across 113 different countries in the world, providing a valuable service for every type of dermato-venereologist professional. The EADV is committed to improving the quality of patient care, continuing medical education for all dermato-venereologists within Europe, and advocacy on behalf of the speciality and patients.

About EADV Virtual:

This year’s Congress is a first in EADV’s history. EADV Virtual – New Frontiers in Dermatology and Venereology provides an exceptional opportunity for colleagues from around the world to explore the latest developments in science and patient care that are at the heart of the academy’s mission. The user experience is immersive and simple to follow. To find out more visit


  1. Cusini, M, Benardon, S, Vidoni, G, et. al. COVID-19 and STIs. Abstract no 1790, EADV Virtual, 29-31 October 2020
  2. Pharmaceutical Journal. Gonorrhoea infection: diagnosis and treatment. Available at: Accessed October 2020
  3. NCBI. Gonorrhea. Available at: Accessed October 2020
  4. Web MD. Gonorrhoea. Available at: Accessed October 2020
  5. ECDC. Gonorrhoea. Available at: Accessed October 2020
  6. NHS Choices. Syphilis. Available at: Accessed October 2020
  7. CDC. Syphilis. Available at: Accessed October 2020
  8. ECDC. Syphilis. Available at: Accessed October 2020

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