Arvesen, K B

Bjerring, P

Mikkelsen, C S

Penninga, L

English

    Aalborg UniversitetIs COVID-19 a sexually transmitted disease and how does the COVID-19 pandemicaffect sexually transmitted diseases?Penninga, L; Arvesen, K B; Bjerring, P; Mikkelsen, C SPublished in:Forum for Nordic Dermato-VenerologyCreative Commons LicenseCC BY-NC 4.0Publication date:2020Document VersionPublisher's PDF, also known as Version of recordLink to publication from Aalborg UniversityCitation for published version (APA):Penninga, L., Arvesen, K. B., Bjerring, P., & Mikkelsen, C. S. (2020). Is COVID-19 a sexually transmitteddisease and how does the COVID-19 pandemic affect sexually transmitted diseases? Forum for NordicDermato-Venerology, 25(2), 14-15. https://www.medicaljournals.se/forum/articles/25/2/14-15.pdfGeneral rightsCopyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright ownersand it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights.            ? Users may download and print one copy of any publication from the public portal for the purpose of private study or research.            ? You may not further distribute the material or use it for any profit-making activity or commercial gain            ? You may freely distribute the URL identifying the publication in the public portal ?Take down policyIf you believe that this document breaches copyright please contact us at vbn@aub.aau.dk providing details, and we will remove access tothe work immediately and investigate your claim.Forum for Nord Derm Ven 2020, Vol. 25, No. 214Covid-19 PandemicIs COVID-19 a Sexually Transmitted Disease and How Does the COVID-19 Pandemic Affect Sexually Transmitted Diseases?Luit Penninga1, Kristian BaKKe arvesen2, Peter Bjer-ring2 and Carsten sauer MiKKeLsen31Specialist in Surgery, Ilulissat Hospital, Avannaa Region, Ilulissat, Greenland, 2Specialist in Dermato-venereology, Department of Dermato-Venereology, Aalborg University Hospital, Denmark, and 3Specialist in Dermato-venereology, Private Practice in Dermato-Venereology, Brønderslev, Denmark, and Research Lab., Department of Dermato-venereology, Aalborg University Hospital, DenmarkAs the COVID-19 pandemic continues, we gain more insight into the nature of the disease. From the beginning COVID-19 was considered to be a respiratory disease, and patients with a severe or critical course of the disease developed acute respira-tory distress syndrome (ARDS) with a high risk of mortality. Currently, we know the disease can present in a variety of ways, affecting multiple organs and causing serious damage, including severe stroke, cardiac problems, and shock.COVID-19 was initially assumed to be transmitted by respirato-ry droplets and contact routes. Later COVID-19 was detected in various liquid fluids for prolonged periods after infection. For example, COVID-19 was present in the stool of 67% of infected patients from Wuhan, and the virus could still be detected in patients who already cleared the virus from the respiratory tract (1). As detection of the virus in stool occurred by PCR techniques it remains unclear whether actual transmission of the disease can occur through the stool of infected patients. Many have also asked whether COVID-19 can be transmitted through sexual activity.  Initially, this was assumed not to be possible and 2 small studies could not detect the virus in vaginal secretion or semen (2, 3). Though transmission of the disease through close physical contact and kissing could occur. A recent study has however detected the novel coronavirus in semen of 6 out of 38 tested patients (15.8%), and hence the initial assumption that COVID-19 could not be transmitted through sexual activity has been questioned (4). Interest-ingly, in 64% of the patients the virus was still present in semen, while tests of the oropharynx were already negative (4). Detection of the virus in semen was done by PCR-RNA techniques (4). Hence, we do not know whether transmission of the disease through semen can occur. Based on this study it is advised to use condoms to protect against COVID-19. It remains also to be elucidated how COVID-19 affects male fer-tility and the reproductive system (2,5). Currently, no studies have examined semen quality in recovered patients (3).During the COVID-19 pandemic many countries have in-troduced laws and regulations to reduce transmission of the disease. Social distancing has been applied and suggested in many countries, including abstinence from sexual activity with unknown partners (6). These policies may have affected the incidence of known sexually transmitted diseases (STDs) like chlamydia, gonorrhoea, human papillomavirus, herpes, syphilis, and HIV. General practitioners in Denmark have reported that during the lockdown, they did not have any patients with chlamydia. In Italy consultations for STDs were much fewer during the lockdown (7). In New York city the number of confirmed STDs fell 80% from about 5,000 during the first week of March to about 1,000 in April 2020 (8). A physician from New York reported that he had no patients with symptoms of STDs during the last month (8). Similarly, in the Canberra region in Australia, there was a 52% decrease in the number of people testing positive for gonorrhoea in April, compared to the mean number of cases the last 5 years (9). Furthermore, a 34% decrease in cases of chlamydia was recorded (9).Simultaneously with policies on social distancing many doc-tors have reduced face-to-face consultations to avoid COV-ID-19 infection of patients, health care workers and families. Only people with acute diseases were diagnosed and treated. Hence, the absence of patients with chlamydia in GP practices during the lockdown may partly be caused by reduced access to healthcare. Especially, reports from the US mention that health care workers dedicated to diagnosing and treating STDs have been relocated to other services to fight COVID-19 (10, 11). In some countries, changes due to COVID-19 regulations and policies also reduced availability of abort facilities. Patients normally taking pre-exposure prophylaxis (PrEP) against HIV, have reported that they dropped this during the COVID-19 lockdown, as they were not that sexually active. Hopefully, they resume PrEP when resuming sexual activity. Luit Penninga et al. – Is COVID-19 a STD and How Does the COVID-19 Pandemic Affect STD?Forum for Nord Derm Ven 2020, Vol. 25, No. 2 Covid-19 PandemiC     154. Li D, Jin M, Bao P, Zhao W, Zhang S. Clinical characteristics and results of semen tests among men with coronavirus disease 2019. JAMA Netw Open 2020; 3: e208292.5. Kashi AH. COVID-19 and semen: An unanswered area of re-search. Urol J 2020; 17: 328.6. Turban JL, Keuroghlian AS, Mayer KH. Sexual health in the SARS-CoV-2 Era. Ann Intern Med 2020; 173: 387–389. 7. Sacchelli L, Viviani F, Orioni G, Rucci P, Rosa S, Lanzoni A, et al. Sexually Transmitted Infections during the COVID-19 outbreak: comparison of patients referring to the service of sexually trans-mitted diseases during the sanitary emergency with those referring during the common practice. J Eur Acad Dermatol Venereol 2020 Jun 3. [Epub ahead of print].8. Klein M. Safer sex in the city: STD cases plummet amid coro-navirus pandemic. New York Post April 25, 2020. Available at: https://nypost.com/2020/04/25/std-cases-plummet-amid-coro-navirus-pandemic/.9. Tregenza H. Coronavirus shutdown could be responsible for decrease in sexually transmitted infection rates in the ACT. May 20, 2020. Available at: https://www.abc.net.au/news/2020-05-20/coronavirus-shutdown-leads-to-apparent-drop-in-stis-in-canber-ra/12264908.10. Brueck H. STD rates appear to be quietly skyrocketing across the US, as fewer people get tested and treated during the pandemic. May 18, 2020. Available at: https://www.businessinsider.com/std-infection-rates-may-be-on-rise-during-coronavirus-pandemic-2020-5?r=US&IR=T.11. Wetsman N. Health departments are concerned about spikes in STIs while attention is on COVID-19. Some places are already seeing case clusters. April 21, 2020. Available at: https://www.theverge.com/2020/4/21/21229776/sti-hiv-increase-coronavi-rus-response-contact-tracing.12. Dourado I, Magno L, Soares F, Massa P, Nunn A, Dalal S, et al. Adapting to the COVID-19 Pandemic: continuing HIV prevention services for adolescents through telemonitoring, Brazil. AIDS and Behavior 2020; 24: 1994–1999.13. Napoleon SC, Maynard MA, Almonte A, Cormier K, Bertrand T, Ard KL, et al. Considerations for STI Clinics during the COVID-19 pandemic. Sex Transm Dis 2020 47: 431–433.A study from Brazil report how they have applied telemedi-cine to continue preventive services for HIV for adolescents (12).  Special attention to continued efforts to reduce STDs is important also during the COVID-19 pandemic (13).Currently, no epidemiological data have presented the inci-dence of sexually transmitted diseases before, during and after the lockdown caused by the COVID-19 pandemic on sexually transmitted diseases. Such data would clarify whether the reduction in diagnosis of STDs is due to a reduced incidence of STDs or due to reduced detection of STDs.To conclude, currently it is unclear whether COVID-19 can be transmitted sexually, though this is potentially possible as the novel coronavirus RNA is present in semen of infected patients. People are advised to use proper prevention when sexually active with unknown partners or when sexually active with a partner who has recently had COVID-19. Furthermore, the exact influence of the COVID-19 pandemic on the incidence, diagnosis and treatment of other STDs is unclear, although it appears that social distancing has reduced the number of STDs.RefeRences:1. Gaspari V, Lanzoni A, Patrizi A, Orioni G, Viviani F, Bardazzi F. Can Covid-19 be a sexually transmitted disease? Posterity will judge. Dermatol Ther 2020 May 24:e13676 [Epub ahead of print].2. Song C, Wang Y, Li W, Hu B, Chen G, Xia P, et al. Absence of 2019 Novel Coronavirus in Semen and Testes of COVID-19 Patients. Biol Reprod 2020; 103: 4–6.3. Perry MJ, Arrington S, Neumann LM, Carrell D, Mores CN. It is currently unknown whether SARS-CoV-2 is viable in semen or whether COVID-19 damages spermatozoa. Andrology 2020 May 29. [Epub ahead of print].

Is COVID-19 a sexually transmitted disease and how does the COVID-19 pandemic affect sexually transmitted diseases?

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Is COVID-19 a sexually transmitted disease and how does the COVID-19 pandemic affect sexually transmitted diseases?

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