COVID-19, Coronavirus 19 disease, is caused by the SARS-CoV-2 virus, which can be asymptomatic or symptomatic, progressing to systemic conditions of variable severity. The virus is highly transmissible. As of 2020, we are witnessing an unprecedented pandemic, with impressive mortality1.

The governments of several countries worldwide used initial lockdown strategies, physical distancing, and face masks while vaccines were under development and concepts about the disease were being established. Currently, vaccination is advancing around the world. As authorities rush to immunize the highest number of people, numerous variants have emerged1.

But what influence did this disease have on the prevalence of sexually transmitted infections? What has changed?

According to independent surveys carried out by researchers from the United States of America (USA)2,3, Spain4, and Italy5, the pandemic resulted in decreased demand for care services for people with sexually transmitted infections. In addition, many people were not screened for traceable sexually transmitted diseases such as Chlamydia trachomatis, Neisseriae gonorrhoea, syphilis, and HIV, so the number of reported cases decreased2,3. After the COVID-19 outbreak was declared in 2020, the notification of Chlamydia decreased on a weekly basis, for 40 weeks. The same happened with syphilis, but no significant pattern was observed in N. gonorrhea notification2. However, Pinto et al.3 observed, in a study in more than 9 million patients from all USA states, that there was a decrease in the number of tests for Chlamydia and Neisseriae by 59% for females and 63% for males. It seems to be more likely that the reduction on the number of reported cases is plausible due to the lower demand for tests. With a decrease in the number of cases of COVID-19, the demand for medical visits and tests is expected to increase again and, consequently, the notification of infections, mainly the traceable ones.

In fact, reduced notification does not reflect a reduction in the number of cases, but rather a reduction in diagnosis. The numbers in some countries, such as Brazil, are unknown, but they tend to worsen underreporting and underdiagnosis. Therefore, lack of treatment. Because there have been several behavioral changes during the pandemic, test self-collection and mailing should be an increasingly attractive option for screening for asymptomatic infections, especially by Chlamydia trachomatis and Neisseriae gonorrhea2.

In the Sexually Transmitted Diseases Service of the Universidade Federal Fluminense (STD/UFF), in Niterói, the only free public service, as far as we know, that serves patients by spontaneous demand or by referral from the public and private networks, without regulation by the Brazilian Unified Health System, in the Metropolitan Region of Rio de Janeiro, Brazil, the impact may be considered irreparable. Because the medical service, operating inside the Campus of Valonguinho, Center of Niterói, Brazil, completely stopped its activities for three consecutive months, March, April, and May 2020, the professionals responsible for seeing the cases left for retirement or postgraduate studies. As a result, only one doctor continues to see patients, and the volume of cases has dropped to less than half of the historical number in the sector. We suspended face-to-face consultations and began to provide guidance to patients through cell phone and/or WhatsApp communication.

During the period in which we stopped providing face-to-face care services from the STD/UFF we do not know where the new patients were seen or if they were seen at all. Additionally, almost all basic healthcare facilities were closed for non-COVID-19 cases. Only emergency services were operating, and most of these were for COVID-19 or suspected cases.

However, data received from the State Health Department of the State of Rio de Janeiro show that we have a lot to redress, analyze, and learn from the COVID-19 pandemic and its consequences in the field of sexually transmitted diseases. Table 16 reveals municipalities that reported many more cases of syphilis in pregnant women in 2020 compared to 2019. Other municipalities reported more cases of congenital syphilis in 2020 than in 2019.

Notably, in Rio de Janeiro city, acquired syphilis, syphilis in pregnant women, and congenital syphilis notifications were much higher in 2020 than in 2019.

On the other hand, in an important document7, the National HPV Vaccination Roundtable reported that in 2021 there was a 21% decrease in the rate of vaccination of adolescents against HPV, 22% against Tdap, and 18% against meningococcal disease. They concluded that vaccine doses destined to children in the public healthcare system were down 11.2 million and that vaccination rates among adolescents have dropped significantly.

Maranhão, from the Brazilian National Immunization Program (PNI), at a conference during the Seminar of the Brazilian Society of Immunization in October 20218, showed data on the request and release of doses of vaccines against HPV, per year, in Brazil, from 2015 to 2021.

Table 28 shows a significant 65% reduction in the number of doses requested by the state vaccination coordinators and doses released by the PNI. Does this mean, as mentioned above about the vaccination data in USA adolescents, a lower vaccination coverage in Brazilian adolescents?

With the evolution of vaccination, a reduction in the number of cases of COVID-19, and a gradual return to a routine that is similar to the pre-pandemic period, all health managers must now resume the care of sexually transmitted infections, predominantly those asymptomatic, which need to be screened and treated to avoid complications. Unfortunately, in Brazil, compulsory notification is only valid for acquired syphilis, syphilis in pregnant women, congenital syphilis, deaths from congenital syphilis, and HIV.

We have a lot of work to do, and a lot to improve, learn, and correct.