Trends in STI testing, diagnoses, and use of online chlamydia self-sampling services among young people during the first year of the COVID-19 pandemic in England

Purpose Measures to control COVID-19 reduced face-to-face appointments and walk-ins at sexual health services (SHSs). Remote access to SHSs through online self-sampling for STIs was increased. This analysis assesses how these changes affected service use and STI testing among young people in England. Methods Data on all chlamydia, gonorrhoea and syphilis tests from 2019-2020 amongst English-resident 15-24 year olds (hereafter referred to as ‘young people’) were obtained from national STI surveillance datasets. We calculated proportional differences in tests and diagnoses for each STI, by demographic characteristics including age and socioeconomic deprivation, between 2019 and 2020. Among those tested for chlamydia, we used binary logistic regression to determine crude and adjusted odds ratios (OR) between demographic characteristics and being tested for chlamydia by an online service. Results Compared to 2019, there were declines in testing (30% for chlamydia, 26% for gonorrhoea, 36% for syphilis) and diagnoses (31% for chlamydia, 25% for gonorrhoea and 23% for syphilis) among young people in 2020. These reductions were greater amongst 15-19 year-olds ( vs . 20-24 year-olds). Among young people tested for chlamydia, those living in the least deprived areas were more likely to be tested using an online self-sampling kit compared to those living in the most deprived areas (males; OR=1.24[1.22-1.26], females; OR=1.28[1.27-1.30]). Conclusion The first year of the COVID-19 pandemic in England saw declines in STI testing and diagnoses in young people and disparities in the use of online chlamydia self-sampling which risk widening existing health inequalities. Implications and contributions There was a decrease in STI testing of young people during the first year of the COVID-19 pandemic in England with larger reductions among teenagers. There was an increase in use of online STI self-sampling services but with inequalities in provision which risk widening existing inequalities in sexual health.