The Impact of the COVID-19 Pandemic on STI Testing in King County, WA

Background: It is unclear whether the observed decrease in STI cases during the COVID-19 pandemic is due to declines in STI testing and/or decreases in sexual activity. In this study, we sought to describe the impact of the COVID-19 pandemic on STI testing among sexually active young adults.

Methods: This cross-sectional internet survey, conducted in October-November 2020, ascertained individuals’ healthcare utilization, STI testing, and sexual behavior before and after the implementation of COVID-19 mitigation strategies. Participants were ages 16-39, residing in King County, Washington. We defined “need for STI testing” as having been sexually active within the last year and having a new sex partner and/or had multiple partners since March 2020 or since their most recent STI test.

Results: Among 1,368 respondents, 922 (67.4%) were categorized as needing STI testing. Of these, 11.7% of cisgender women and 5.9% of cisgender men who have sex with women (MSW) received testing since March 2020. Cis women and MSW primarily did not test due to being busy (48.4% and 41.7%, respectively), or not wanting to go to a facility (37.1% and 25.0%). Approximately 30% of cisgender women and MSW stated they preferred an at-home STI test over a clinic visit.

Discussion: STI testing during the pandemic was suboptimal, notably in cisgender women, who are at high risk for morbidity. This lack of STI testing despite ongoing sexual activity may lead to undetected transmission of STIs and development of adverse reproductive tract sequalae. Our study suggests potential for expansion of at-home STI testing.