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Is COVID-19 Affecting the Epidemiology of Stis? Miscellaneous Sex Transm Infect: first published as 10.1136/sextrans-2020-054543 on 27 July 2020. Downloaded from RESEARCH LETTER among MSM, a finding consistent with Contributors AL designed the work, collected the epidemic trends highlighted in the the data, wrote the manuscript and revised it. MGD literature.1–3 analysed the data and wrote the article. MG collected Is COVID-19 affecting the the data and revised the work. FM collected the data The fear of infection by severe acute and wrote the article. MZ reviewed the letter. AC epidemiology of STIs? The respiratory syndrome coronavirus 2 approved the final version of the manuscript. experience of syphilis in Rome (SARS- CoV-2) may have reduced sexual Funding The authors have not declared a specific encounters and led to a genuine decline grant for this research from any funding agency in the in STIs. However, we cannot exclude public, commercial or not- for- profit sectors. that patients have been postponing their Dear Editor, Competing interests None declared. visits because of worries about attending In response to the COVID-19 pandemic, Patient consent for publication Not required. the clinic during the pandemic, as also on 9 March 2020, the Italian govern- Provenance and peer review Not commissioned; described for other medical specialities.4 It ment announced a nationwide lockdown externally peer reviewed. is also possible that even with the recent programme of social distancing, self- This article is made freely available for use in relaxation of lockdown measures, there isolation for contacts and prohibition of accordance with BMJ’s website terms and conditions may be lasting changes to many aspects for the duration of the covid-19 pandemic or until public events. People with other medical of people’s social life, including sexual otherwise determined by BMJ. You may use, download needs were still able to attend hospital lifestyle. and print the article for any lawful, non- commercial outpatient appointments provided they In conclusion, we highlight the strong purpose (including text and data mining) provided that all copyright notices and trade marks are retained. carried printed self- certification to explain effects of COVID-19 and consequent the reason for the journey to an inspection lockdown on syphilis diagnoses in Rome. © Author(s) (or their employer(s)) 2020. No commercial re-use . See rights and permissions. Published by BMJ. by the police. We emphasise the need to find ways of Throughout the lockdown period, encouraging patients to seek care in cases the STI/HIV Unit of the San Gallicano where they suspect an STI, which is part Dermatological Institute, the largest STI/ of the urgent care interventions for which HIV clinic in Rome, has remained open To cite Latini A, Magri F, Donà MG, et al. services remain open regardless of lock- Sex Transm Infect Epub ahead of print: [please include for emergencies, including STI testing for down. It remains to be determined whether Day Month Year]. doi:10.1136/sextrans-2020-054543 people with symptoms and for asympto- COVID-19 will have lasting effects on the matic people at risk. Virtual consultations epidemiology of syphilis and other STIs. Received 14 April 2020 have also been activated. Revised 15 June 2020 The spread of SARS-CoV -2 may change Accepted 27 June 2020 From the start of lockdown, we the epidemiology of STIs and may also observed a reduction in STI diagnoses, Sex Transm Infect 2020;0:1. raise concerns about sexual intimacy that doi:10.1136/sextrans-2020-054543 particularly of early syphilis. In the whole will have to be considered when counsel- of March 2020, we diagnosed 15 cases of ling patients. Research is also needed to ORCID iDs early syphilis, and all occurred in the first understand the magnitude and duration Alessandra Latini http:// orcid. org/ 0000- 0002- 9421- week, prior to the lockdown announce- 6560 of any genital shedding of SARS- CoV-2 Maria Gabriella Donà http:// orcid. org/ 0000- 0003- ment. This is in contrast with the increase during infection. 3250- 1726 in the number of syphilis cases we diag- Massimo Giuliani http:// orcid. org/ 0000- 0002- 9421- 1 2 http://sti.bmj.com/ nosed in the last 2 years, including the Alessandra Latini , Francesca Magri, 6560 1 1 period immediately prior to lockdown, Maria Gabriella Donà , Massimo Giuliani , Mauro Zaccarelli http:// orcid. org/ 0000- 0001- 5763- 1 3 0650 especially among men who have sex with Antonio Cristaudo, Mauro Zaccarelli men (MSM) and people living with HIV 1STI/HIV Unit, San Gallicano Dermatological Institute (PLWH). Between 1 January 2020 and IRCCS, Roma, Italy REFERENCES 2 1 Unemo M, Bradshaw CS, Hocking JS, et al. Sexually 9 March 2020, 68 new cases of syphilis Department of Dermatology, Sapienza University of Rome, Roma, Italy transmitted infections: challenges ahead. Lancet Infect were diagnosed in our centre, of which 3Clinical Department, National Institute for Infectious Dis 2017;17:e235–79. on September 23, 2021 by guest. Protected copyright. 60 (88%) were in MSM and more than Diseases, Lazzaro Spallanzani, IRCCS, Roma, Italy 2 Ghanem KG, Ram S, Rice PA. The modern epidemic of half (38, 56%) in PLWH. During the first syphilis. N Engl J Med 2020;382:845–54. Correspondence to Dr Alessandra Latini, STI/HIV 3 Forrestel AK, Kovarik CL, Katz KA. Sexually acquired quarter of 2019, the number of syphilis Unit, San Gallicano Dermatological Institute IRCCS, syphilis: historical aspects, microbiology, epidemiology, diagnoses totalled 25, of which 23 (92%) 00144 Roma, Italy; alessandra. latini@ ifo. gov. it and clinical manifestations. J Am Acad Dermatol were in MSM and 17 (68 %) in PLWH. Correction notice The article has been corrected 2020;82:1–14. Thus, compared with the first quarter of since it is published. The author names have been 4 Tam CF, Cheung KS, Lam S, et al. Impact of updated. coronavirus disease 2019 (COVID-19) outbreak on 2019, in the first quarter of 2020, the ST- segment- elevation myocardial infarction care in number of syphilis diagnoses doubled Handling editor Anna Maria Geretti Hong Kong, China. Circ Cardiovasc Qual Outcomes among PLWH and increased fourfold Twitter Massimo Giuliani @giumas3 2020;17:CIRCOUTCOMES120006631. Latini A, et al. Sex Transm Infect Month 2020 Vol 0 No 0 1.
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