Martí Vall-Mayans

Infectious Diseases Department, Hospital Germans Trias Pujol, Badalona, Catalonia (Spain)

The outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease (COVID-19) that emerged in December 2019 has been brought to global attention and declared a pandemic by WHO on March 2020. By August 2020 COVID-19 was still having a huge impact in the lives of people, causing at the same time a high social and economical impact worldwide. In many places the situation was having a disproportionate impact on vulnerable populations with a severe negative physical, mental, as well as sexual health and HIV outcomes amongst them. Health resources, including STI services have been significantly impacted by this outbreak, with new and challenging demands. More so in places with services under-resourced due to public health funding cuts applied before the the pandemic. Indeed, in Europe services entered into the pandemic against a background of the highest number of HIV positive individuals accessing care and of high incidence of STI: gonorrhoea diagnoses were at their highest in a generation and syphilis rates at levels not seen for decades, at a moment also when antimicrobial resistance was placing more complex demands on clinical services.

SARS-CoV-2 spreads mainly by droplets expelled by coughing, sneezing, or talking during close face-to-face contact or when a person touches a surface or object that has active virus particles on it and then touches their mouth, nose, or eyes. An estimated 55% of transmission may occur via presymptomatic carriers. Sexual encounters potentially might facilitate transmission of SARS-CoV-2 due to the impossibility to apply the only current available measures to reduce the spread of the virus. Hence, organizations, patients and staff should be fully mindful of the need to prioritise measures that can mitigate further spread of SARS-CoV-2. On the other side, in some places persons visiting sexual venues or chemsex parties, if exposed, might be subject to privacy controversies and stigma through the use of information technology–based contact tracing methods in response to COVID-19.

Health staff caring STI patients need to be aware of the clinical manifestations of COVID -19, especially those that affect the skin and the reproductive and digestive systems, as well as of its impact on people living with HIV (PLWH) to counsel patients. Main cutaneous lesions have been described as maculopapular eruptions, acral areas of erythema with vesicles or pustules (pseudo-chilblain) and urticarial lesions. SARS-CoV-2 can be present in the semen of patients with COVID-19, and it may still be detected in the semen of recovering patients but it has not been proven that the virus can be sexually transmissible. Around 10% of patients with COVID-19 will manifest gastrointestinal symptoms; however, SARS-CoV-2 shedding in stool could be observed in 40% of patients with confirmed infection. This highlights the need to better apply preventive measures during anogenital contact to prevent spread of this and other pathogens. PLWH generally appear to fare similarly to HIV-negative people, though they experience a range of immunologic and inflammatory abnormalities. Still inconclusive,  PLWH who are on ART could be less likely to contract SARS-CoV-2. In this line there are studies underway looking at whether ART, or the drugs currently approved for PrEP for HIV, have any benefit as prevention for COVID-19. But for now PLWH or on PrEP should continue to follow preventive measures for all people, including frequent handwashing, wearing masks, and practicing social distancing in public spaces. Perhaps the testing of large populations for SARS-CoV-2 could also provide an opportunity for blood-borne viruses such as HIV/HCV/HBV and syphilis, to be tested, treated and controlled.

34 IUSTI Congress - European Congres on Sexually transmitted Infections and HIV/AIDS
Bucharest, September 3-5,