Dr. John McSorley
(British Association for Sexual Health and HIV)
2020 brought unprecedented challenges for all working within sexual and reproductive health; staff grappled with maintaining essential service delivery during periods of varying lockdown and restrictions, whilst also responding to the immediate predations and consequences of COVID-19 itself. The response to these challenges has been remarkable across the healthcare system.
Build back better
We now look beyond the worst of the pandemic, determined to “build back better”. Within the context of sexual health, this must include a focus on how we can drive down rates of sexually transmitted infections (STIs). We entered the COVID-19 pandemic reporting a surge of bacterial STIs. Data from Public Health England showed that gonorrhoea diagnoses in England in 2019 were the highest since records began, with syphilis cases at levels not seen since World War II.
It is vital that antimicrobial stewardship is placed at the heart of the government’s pandemic recovery efforts.
The pandemic adversely impacted our ability to measure trends in behaviour and detect infection as services pivoted to provide acute care to the most symptomatic, and testing of others reduced. The majority of STIs of interest are asymptomatic at least for some time. COVID-19 didn’t lessen the threat posed by antibiotic resistance. Populations may have sought and found access to treatments without supervision or assessment of appropriateness or susceptibility. The embrace of digital access to care has expanded access to care and helped address some prior inequalities and unmet need, but it is important that all the pathways to care are fully understood for optimal benefit to all.
Opportunity for sexual health improvements
With this in mind it is vital that antimicrobial stewardship is placed at the heart of the government’s pandemic recovery efforts. We can build upon the wider system knowledge hard won during COVID-19. Within sexual health, services should be supported and resourced to embrace the digital technology that can expand and expedite access to care and facilitate rapid testing and diagnosis. Support should also be in place for increased use of genomics enabling individualised treatments, therefore maximising the utility of currently available treatments and safeguarding future options. Advances in vaccination technology may yield options for STI prevention obviating any challenges for antibiotic control. Modernising online services, contact tracing and partner notification systems—the cornerstones of infection management—will create a sexual health system that empowers people and their service providers to respond swiftly with appropriate interventions that don’t exacerbate the global threat of antimicrobial resistance.
Now is the time to identify what works, embed solutions and capitalise on a generational opportunity for sexual health.