105 Sexually Transmitted Infection Testing at an Urban Hospital Pre- and Post-SARS-CoV-19 Pandemic

Abstract

Study Objectives: To determine whether behavior changes made during the SARS-CoV-19 pandemic impacted the number of patients being tested and the positivity rate of sexually transmitted infections (STI) at a large, urban ED in the Bronx to identify how to improve the sexual health services available to our patients. Methods: A retrospective, cross-sectional study using data from the EMR at a public hospital in the Bronx, New York. Included patients were aged 13 and over that had STI testing from Aug. 1, 2019 to Feb. 1, 2020 (Period 1) and Aug. 1, 2020 to Feb. 1, 2021 (Period 2) in the adult or pediatric ED. Periods 1 and 2 are 6 month periods before and after the SARS-CoV-19 pandemic in NYC, respectively. Counts and percents were used to quantify STI tests (HIV point of care, HIV 4th generation serum, Gonorrhea Amplification, Chlamydia Amplification, and Treponema Pallidum Ab screen) and positive results during Period 1 vs. Period 2. A chi-squared test of independence determined significance of positivity rates in Period 1 vs Period 2 with a p-value of.05. Results: In Period 1, there were 2386 distinct patients accounting for 5445 STI tests with 54% female, 30% male and 18% unknown or other self-identified sex. The average age of all patients was 37 years (S.D. ± 15). In Period 2, 2218 distinct ED patients accounting for 5816 STI tests with 52% female, 24% male, 24% unknown or other self-identified sex. The average age for Period 2 was 37 years (S.D. ± 15). Our data (Table 1) show that more STI diagnostic tests were performed in Period 2 than Period 1 for chlamydia, gonorrhea, and syphilis in our ED. There were fewer HIV tests performed in Period 2. There were no significant differences in positivity rates between Periods 1 and 2 for HIV, chlamydia, gonorrhea, or syphilis, although there was a trend towards significance for gonorrhea and syphilis. Conclusion: A higher absolute number of chlamydia, gonorrhea, and syphilis tests were performed in our ED in the post-SARS-CoV-19 time period. This overall increase in testing may be due to an increased utilization of emergency services given oversubscribed outpatient resources. The decrease in HIV testing could be due to patients opting out of testing, or providers having a lower suspicion of HIV infection in the context of the pandemic. A stable positivity rate could imply that despite newly imposed SARS-CoV-19 guidelines on social behavior, patients in our population continued to engage in condomless sexual encounters. STI testing panels incorporated into the electronic medical record may facilitate complete STI testing that includes HIV as an opt-out reminder for providers. [Formula presented]