Increase in sexually transmitted infection during the COVID‐19 pandemic in Taiwan

We read with great interest Balestri et al.'s report,1 which showed that the incidence of sexually transmitted infection (STI) in the lockdown period between 9 March and 4 May 2020 during the COVID-19 pandemic was comparable to that during the same period in 2019. This observation suggested that infection control and policy, such as quarantine, social distancing and the closure of leisure venues, did not provide additional benefit regarding STI prevention. In Taiwan, several studies have shown that strict performance of infection control and policies, such as mask wearing and hand hygiene, for mitigation of the COVID-19 outbreak could not only effectively prevent the spread of SARS-CoV-2 infection but also help reduce respiratory infectious diseases, including influenza, invasive pneumococcal disease and tuberculosis.2-4 However, the impact of COVID-19 infection control measures for the COVID-19 on the incidence of STIs in Taiwan remains unknown. Gonorrhoea was caused by Neisseria gonorrhea an STI and a notifiable disease in Taiwan. Therefore, this study was conducted to determine whether the incidence of gonorrhoea in Taiwan was affected during the COVID-19 pandemic. As a notifiable disease in Taiwan, gonorrhoea reporting is mandatory for all clinicians. Using the open data website of Taiwan's CDC, we could obtain the case number of patients with gonorrhoea over time.5 To compare the case number during the same period each year, we extracted the monthly cases of gonorrhoea between January and August from 2015 to 2020. First, a total of 4332 patients with gonorrhoea were reported during the first 8 months in 2020, which was much higher than the accumulative case number within the same period between 2015 and 2019 (ranging from 2212 to 3172; Fig. 1a). Second, the monthly case number in 2020 seemed to gradually increase with time (Fig. 1b). The case number between May and August was 2547, which was much higher than that between January and April (n = 1785). Therefore, our findings indicated that the incidence of gonorrhoea increased during the COVID-19 pandemic. Moreover, our finding could be underestimated due to the possible underreporting of gonorrhoea due to the fear of visiting hospitals for help during the COVID-19 pandemic. Overall, this finding echoes Balestri et al.'s report1 that the STI incidence was not reduced by infection control measures for COVID-19. The possible explanation could be that the quarantine at home, social distance outdoors and avoidance of visiting crowded areas may result in an increasing duration of stay at home or indoors and further increase the risk of unsafe sexual behaviour. In conclusion, regardless of some confounding factors, such as underreporting of gonorrhoea due to the fear of visiting hospitals for help during the COVID-19 pandemic, our findings indicate that safe sexual practices to prevent STIs, such as gonorrhoea, remain important in the COVID-19 pandemic period. All authors declare that there are no conflicts of interest. None.