OS10.2 STI Epidemiology in The Time of COVID- 19 Pandemic in European Union/European Economic Area (EU/EEA) Countries-- Data Artifact or Real Impact of The Pandemic?

Background: Prior to the COVID-19 pandemic, bacterial STIs under surveillance in EU/EEA were increasing, with number of reported gonorrhoea and syphilis cases reaching an all-time-high in 2019. In contrast, data reported by EU/EEA countries for 2020 indicated a decrease for all STIs under surveillance at EU/EEA-level. We aimed to describe changes in STI epidemiology during the COVID-19 pandemic (2020-2021) and identify drivers of changes in STI notifications. Methods: Numbers of chlamydia, gonorrhoea and syphilis notified cases in EU/EEA countries during 2019-2021 were retrieved from The European Surveillance System. An online survey (June-July 2022) addressed to STI surveillance contact points in EU/EEA countries collected qualitative information to help interpretation of STI surveillance data. Results: In 2020, 161,954 chlamydia, 33,425 gonorrhoea and 21,604 syphilis confirmed cases were notified by 25 countries (totalling 313,484,379 population) that reported consistently during 2019- 2021. Compared to 2019, notifications decreased by 8% for chlamydia, 8% for gonorrhoea and 9% for syphilis. In 2021, as compared to 2020, chlamydia notifications increased by 6%, gonorrhoea by 19% and syphilis by 10%. 17/22 EU/EEA countries that responded to the survey indicated that the COVID-19 pandemic context impacted surveillance data quality, with most affected parameters: number of reported cases (17/17), timeliness of reporting (8/17); and completeness of variables (7/17). Decreases in 2020 were associated with the lockdown periods and were related to: reduced access to/availability of STI clinical services (17/17); changes in sexual/health-seeking behaviour (17/17); reduced STI prevention services (12/17); redistribution of resources to COVID-19 response (11/17); and reduced community testing (9/17). Countries indicated that surveillance data during COVID-19 pandemic most likely does not provide a true picture of STI epidemiology among heterosexuals (11/17), MSM (10/17) and young people (15-24-year-old) (9/17). Conclusion: Under-ascertainment due to reduction in access to/availability of STI prevention and clinical services, behaviour changes and under-reporting due to resources redirected to COVID-19 response are likely causes of STI notifications dropping in EU/EEA during 2020. Case notifications rebounded in 2021 at similar (chlamydia, syphilis) or higher levels (gonorrhoea) than in 2019 in most countries. Data indicate a continued unmet need for STI prevention in EU/EEA and a need for more resilient surveillance capacity. [ABSTRACT FROM AUTHOR]