The Impact of the COVID-19 Pandemic on Syphilis: A Retrospective Study among the Ege University HIV Cohort.

Introduction/objective: The SARS-CoV-2 pandemic has led to significant changes in the lives, habits, and frequency of hospital admissions of People Living with HIV (PLWH). However, information is limited on the changes in the sexual behavior of these individuals and the resulting Sexually Transmitted Infections (STIs). This study aimed to determine the trends in syphilis among the Ege University HIV cohort before and during the pandemic.

Methods: All PLWH who presented to the HIV outpatient clinic of Ege University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, for HIV care for the first time between January 1st, 2008 and October 1st, 2022, and whose laboratory results for syphilis were available, were reviewed. Those presenting between January 1st, 2008, and March 11th, 2020, were defined as the pre-pandemic (group A) cases, and those presenting between March 12th, 2020, and October 1st, 2022, were defined as the pandemic period (group B) cases. Clinical and laboratory information about the cases was obtained retrospectively from medical records.

Results: The number of PLWH who presented to the clinic for a first visit with a new HIV diagnosis or follow-up between the specified dates was 1283 (956 group A, 327 group B). Overall, 155 (%12.1) PLWH were diagnosed with syphilis. A total of 204 syphilis episodes occurred during 6,173 Person-years of Follow-up (PYFU). Of these episodes, 86 (42.1%) were diagnosed in the pre-pandemic period, and 118 (57.8%) during the pandemic. The number of episodes during the pandemic was significantly higher in group A than in the pre-pandemic period (3.47 per 100 PYFU and 2.57 per 100 PYFU, respectively; p=0.0434). When comparing the number of episodes during the pandemic period, compared to group A, group B members had a significantly higher number of syphilis episodes during the pandemic (3.47 and 7.81 per 100 PYFU, respectively; p<.001).

Conclusion: This study shows that syphilis rates remained high during the pandemic. Healthcare providers are recommended to prepare PLWH for potential emergencies to be encountered in the future and repeatedly remind them to use prevention in all high-risk circumstances.