key: cord-0720055-ap3br49j
authors: Moriarty, D.; O'Connor, C.; Bourke, J.; Murphy, M.; Horgan, M.; Cremin, S.
title: An Irish Department of Genito‐Urinary Medicine in the COVID‐19 Era
date: 2021-03-03
journal: J Eur Acad Dermatol Venereol
DOI: 10.1111/jdv.17169
sha: 41e64f96357cc938470609d595eab3d8301b2f34
doc_id: 720055
cord_uid: ap3br49j

Genito-urinary medicine (GUM) is a high-volume, outpatient-based specialty, predominantly involving healthy young people. Our GUM clinic is the largest in south-west Ireland, with a broad catchment area. We outline the changes made to optimise safety and enhance efficiency during the COVID-19 pandemic.

assistance were required for medical staff. Initially, only patients symptomatic of STI were seen in person. Screening was streamlined by removing non-essential elements, such as same-day microscopy, and introducing self-swabbing. Personal protective equipment and social distancing became mandatory. Face shields were used during pharyngeal swabbing. Laboratory results were provided electronically instead of on paper to enhance efficiency. Results were communicated by text or phone, eliminating the need for return appointments. Prescriptions were phoned or emailed to pharmacies. Topical therapies were prescribed for genital warts instead of weekly cryotherapy.

From April to August 2018, 3300 patients were seen (50% male). In the same period in 2020, 848 patients were seen, with a higher proportion of male patients (63.5%).

For female patients, the mean age was 30 years (range: 17-65). Most (306) were heterosexual, and three were bisexual. The mean number of sexual partners in the previous three months was 1.2 (range: 0-15) . Most (162) were symptomatic, 129 were asymptomatic, 14 were contacts of someone with an STI, and four presented for other reasons. Bacterial vaginosis (63) and genital warts (46) were the most common diagnoses. 148 (48%) had a negative screen, of whom 89 were asymptomatic (Fig. 1 ). The mean number of sexual partners in the previous three months was 1.7 (range: 0-15). Most (254) were asymptomatic, 227 were symptomatic, 25 were contacts of someone with an STI, and 33 presented for other reasons. Genital warts (89) and Chlamydia trachomatis (34) were the most common diagnoses. Other reasons included urethritis, epididymo-orchitis, syphilis, hepatitis, antibody testing and PrEP/PEP. 257 (47.6%) had a negative screen, of whom 149 were asymptomatic (Fig. 1) .

Diagnoses in April-August 2018 and 2020 were compared ( Table 1 ). The proportion of negative screens decreased from 61.5% (2018) to 47.8% (2020). Most conditions decreased in number during lockdown, apart from anogenital warts, which increased from 121 (3.6%) to 135 (15.9%).

Compared with 2018, there were reduced diagnoses during the COVID-19 crisis. Although the absolute number of diagnoses decreased during lockdown, the proportion of patients having symptoms or a diagnosis increased. This is expected as patients were triaged by phone, and less asymptomatic patients were seen. There was a marked reduction in bacterial infections, e.g. Chlamydia trachomatis and Neisseria gonorrhoeae, consistent with other reports. 1 This may be due to reduced numbers of sexual partners during lockdown, or due to reduced testing of asymptomatic individuals. Presentations with genital warts increased, which may be explained by delayed development following human papillomavirus infection, contracted prior to COVID-19. 2 COVID-19 has profoundly reduced interpersonal exposure, with consequences for healthcare systems and sexual health. Some changes made in response to challenges have been positive and will become permanent features of our GUM service.

Reporting of sexually transmitted infections during the COVID-19 pandemic

Development and duration of human papillomavirus lesions, after initial infection

Percentage is the percentage of all patients in the time period

Negative screen 2030 (61.5%) 405 (47.8%) À1625 (À13.7%)

None declared.

This article has no funding sources.